Digital Cognitive Behavioral Therapy for Insomnia in Older Adults: A Systematic Review and Meta-analysis

To evaluate the efficacy of digital cognitive behavioral therapy for insomnia (dCBT-I) as a behavioral intervention in older adults, with focus on insomnia severity and the sustainability of treatment effects.

Systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating dCBT-I in adults aged ≥ 60 years. Databases searched included PubMed, Web of Science, Cochrane Library, and EBSCOhost. Mean differences (MDs) in insomnia severity were pooled using random-effects models. Subgroup analyses examined therapist guidance and control type.

Nine RCTs involving 760 participants were included. Compared with control conditions, dCBT-I significantly reduced insomnia severity at post-intervention (MD =  - 3.96, 95% CI - 5.35 to - 2.56; I² = 56.3%). A significant reduction was also observed at follow-up (MD =  - 3.66, 95% CI - 5.37 to - 1.94; I² = 10.3%), although follow-up evidence was limited. Unguided interventions were also associated with significant improvements (MD =  - 4.36, 95% CI - 6.06 to - 2.66; I² = 37.7%).

dCBT-I may reduce ISI-measured insomnia severity in relatively younger older adults, with limited evidence regarding the durability of effects at follow-up. Unguided interventions may offer practical advantages in scalability and accessibility, although the incremental value of therapist guidance remains uncertain. Further well-powered randomized controlled trials with longer follow-up are needed to confirm long-term efficacy and determine the optimal delivery format.