CBT-I is an evidence-based treatment that helps patients improve sleep without medication, even when managing complex medical conditions. A 2025 systematic review and meta-analysis published in JAMA Internal Medicine evaluated the efficacy and acceptability of Cognitive Behavior Therapy for insomnia (CBT-I) among adults with chronic medical conditions. The study found that CBT-I produces significant improvements in sleep outcomes, supporting its use as a first-line intervention across diverse chronic disease populations.  

Key Findings on CBT-I Efficacy and Acceptability  

The meta-analysis included 67 randomized clinical trials with 5,232 participants with conditions including cancer, chronic pain, cardiovascular disease, and stroke. CBT-I was associated with large improvements in insomnia severity and moderate improvements in sleep efficiency and sleep onset latency.

54.0% of participants receiving CBT-I achieved remission, compared to 18.0% in control groups. These effects were consistent across chronic disease types, suggesting broad applicability.

The review also found that treatment delivery format did not significantly influence outcomes. Both digital and face-to-face CBT-I produced comparable results; however, longer treatments were associated with better outcomes for sleep efficiency and sleep onset latency than briefer interventions.  

Woman lying in bed with insomnia

CBT-I was also well tolerated. The mean dropout rate was approximately 13%, and patient satisfaction was generally high. Adverse effects were rare and typically minor, with only isolated reports of treatment-related issues.  

About half of the studies implemented standard CBT-I protocols without modification, while others incorporated minor adaptations such as disease-specific psychoeducation or fatigue management strategies. 

Commentary and Clinical Takeaways from Dr. Judith Beck 

“These findings reinforce that CBT-I is a critical evidence-based intervention that remains effective even in medically complex populations,” said Dr. Judith Beck, Beck Institute President. 

Dr. Beck emphasized the clinical implications: “For practitioners, this research provides reassurance that CBT-I can and should be implemented with patients who have chronic illnesses. While thoughtful adaptations may enhance engagement, the data suggest that clinicians can confidently apply standard protocols.” 

She also noted the importance of access: “The comparable outcomes for digital and in-person formats are especially encouraging. Expanding access to CBT-I through digital platforms could significantly improve care for patients who might otherwise go untreated.” 

This large-scale meta-analysis demonstrates that CBT-I is an effective, acceptable, and scalable treatment for insomnia in chronic disease populations. The findings support broader implementation in medical and behavioral health settings, with future research needed to refine adaptations and expand access. 

Reference: 

Scott, A. J., Correa, A. B., Bisby, M. A., Chandra, S. S., Rahimi, M., Christina, S., … & Dear, B. F. (2025). Cognitive behavioral therapy for insomnia in people with chronic disease: a systematic review and meta-analysis. JAMA Internal Medicine, 185(11), 1350-1361. 

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