Analyze the efficacy of internet-based cognitive-behavioral therapy (ICBT) to improve sleep in patients with insomnia.

An estimated 33% to 50% of adults experience sleep disturbances, with 7% to 18% meeting the criteria for insomnia. These disturbances are linked to cognitive decline, weakened immune function, and deteriorating mental health. While sleep medications provide temporary relief, they are often associated with side effects like cognitive impairment, memory deficits, and brain-fog. Non-pharmacological approaches remain unexplored, highlighting the need for alternative, sustainable interventions

A systematic review and meta-analysis of PubMed, Cochrane, and Web of Science for randomized control trials until July 2024 was conducted. Eligible studies had at least one of the following primary outcomes: Sleep Onset Latency (SOL), Total Sleep Time (TST), Sleep Efficiency (SE) and Wake after Sleep Onset (WASO). Statistical Analysis was performed using the Revman 5.2. Pooled standardized mean differences (MDs) were calculated using a random effects model.

A total 36 studies, encompassing 3771 ICBT participants and 3068 controls were included. We found significant changes in insomnia patients receiving ICBT, with MDs of 18.26 min (95% CI, 12.11-24.41) for TST, 9.90% (95% CI, 8.09-11.71) for SE, 19.26 min (95% CI, 13.27-25.26) for WASO, and 17.95 min (95% CI, 12.98-22.92) for SOL. We also found substantial enhancements at short-term and long-term follow-ups when compared to pre-treatment levels.

The meta-analysis indicates the efficacy of ICBT in improving key sleep parameters (TST, SOL, WASO and SE). Additionally, these improvements were sustained at follow-up, highlighting its lasting impact beyond the treatment period, underscoring ICBT as a viable first-line treatment option, particularly in patients who may not have access to traditional in-person therapy.