Insomnia therapy through a screen works, and keeps working a year on

Cognitive behavioural therapy for insomnia, known as CBT-I, is the recommended first-line treatment for insomnia, ahead of sleeping pills. The problem is access: there are simply not enough trained therapists to deliver it to everyone who needs it. Digital versions, delivered through apps and websites, could remove that bottleneck entirely, but only if they genuinely work and keep working. This meta-analysis set out to test both the short-term and long-term efficacy of digital CBT-I in adults with insomnia.

The researchers systematically searched PubMed, EMBASE, PsycINFO and CENTRAL from inception until 5 March 2020 for randomised controlled trials comparing digital CBT-I against controls such as wait-lists, treatment as usual or online education. Thirty-three studies made the cut, with 4719 participants randomised to digital CBT-I and 4645 to control. The primary outcome was the insomnia severity index, measured at post-intervention, at short-term follow-up ranging from 4 weeks to 6 months, and at 1-year follow-up.

Digital CBT-I reduced insomnia severity scores by 5.00 points more than control at post-intervention, a clear and statistically strong effect. The benefit was durable rather than a flash in the pan: the advantage was 3.99 points at short-term follow-up and 3.48 points at 1-year follow-up. Face-to-face CBT-I did outperform the digital version by 3.07 points, but this gap sat within the 4-point margin used to judge the two formats as comparable. Results did vary considerably between studies.

This analysis provides strong pooled support for what individual trials had been suggesting: the digital format preserves most of what makes CBT-I effective. The comparison with face-to-face therapy is the most useful part, confirming a real but small gap that falls within the non-inferiority margin. Open questions include how the therapy performs against more active control conditions, since most comparisons were against wait-lists or usual care, and how the varied study designs affected the pooled figures.

For anyone struggling with insomnia who has been unable to access a therapist, this evidence suggests the digital route is a genuinely effective alternative rather than a second-rate substitute. The durability finding matters most: improvements were not just an initial novelty effect but held for a full year. Face-to-face therapy retains a slight edge, so this is a reason to view digital CBT-I as a strong and accessible option, not necessarily the ceiling of what treatment can achieve.