Online insomnia therapy works about as well as the in-person kind

Cognitive behavioural therapy for insomnia is the treatment with the strongest evidence base for chronic sleeplessness, yet most people who could benefit never receive it. Trained therapists are scarce, sessions can be costly and demand far outstrips supply, so the challenge has shifted from proving the therapy works to making it available at the scale the problem demands. Delivering the programme over the internet is one obvious answer, but it raises a fair question: does a website or app version keep the potency of the face-to-face original? This meta-analysis set out to measure exactly that.

Two researchers independently searched key electronic databases covering 1991 to June 2015, selected eligible publications, extracted the data and rated methodological quality. Eleven randomised controlled trials met the criteria, together enrolling 1460 participants who received internet-delivered CBT-I. The analysis pooled effects on insomnia severity, sleep efficiency, subjective sleep quality, wake after sleep onset, sleep onset latency, total sleep time and the number of nocturnal awakenings. The authors also tested whether features of the studies, such as treatment length and the amount of clinical support, changed the size of the effects.

Internet-delivered CBT-I improved every sleep outcome measured at the end of treatment, with effect sizes ranging from 0.21 to 1.09. The gains were comparable to those found for face-to-face CBT-I and were generally maintained at follow-up between 4 and 48 weeks later. Not every version performed equally, however: longer treatment duration and a higher degree of personal clinical support were associated with larger effects, while trials that lost more participants from the intervention group showed smaller ones.

The result strengthens the case that CBT-I survives the move online rather than being diluted by it, which matters because access, not efficacy, has been the therapy's limiting factor. It also adds useful nuance: digital delivery is not one thing, and the human support wrapped around a programme appears to influence how much people gain from it. Open questions remain about which people do best with a fully automated programme versus a supported one, and how far these findings generalise beyond the volunteers who enrol in trials.

If poor sleep is a persistent problem and in-person therapy is out of reach, this is a reason to regard a structured online CBT-I programme as a genuine treatment rather than a gimmick. The evidence here suggests programmes with more built-in human support and a longer duration tended to deliver more, which is worth weighing when comparing options. It also suggests that sticking with a programme matters, since trials with heavier dropout saw weaker results.