Digital cognitive behavioral therapy shows largest benefit for insomnia in cancer survivors

The primary outcome was insomnia severity index (ISI) score; secondary measures included sleep onset latency, wake after sleep onset, total sleep time, and sleep efficiency. Digital CBTi produced the largest reduction in ISI scores (9.70 points lower than usual care, 95% CI −10.80 to −8.61), followed by telephone-based CBTi (8.74 points). Digital CBTi also showed improvements across all secondary sleep measures: sleep onset latency improved by 30.95 minutes, wake after sleep onset by 25.62 minutes, total sleep time increased by 31.67 minutes, and sleep efficiency improved by 14.63%. Group CBTi significantly improved sleep onset latency and wake after sleep onset but produced smaller gains overall. Notably, breast cancer patients showed different response patterns to digital CBTi, with larger improvements in sleep latency but smaller gains in sleep efficiency. The authors acknowledged that certainty of evidence was low to very low, primarily because of statistical imprecision and inconsistencies across the network, underscoring the need for high-quality head-to-head comparison trials.

The network meta-analysis identified digital CBTi as superior not only for insomnia severity but also for specific sleep architecture metrics. The 30-minute reduction in sleep onset latency is particularly meaningful clinically—this reflects the time patients spend awake trying to fall asleep, a core feature of insomnia. Telephone-based CBTi approached digital effectiveness, suggesting synchronous human contact may matter less than originally assumed. Interestingly, the subgroup analysis revealed that breast cancer survivors experienced larger improvements in latency but smaller improvements in sleep efficiency (the proportion of time in bed actually asleep), hinting that delivery mode effects may differ by cancer type and warrant further investigation. The low certainty rating reflects small sample sizes in individual trials and some contradictory findings across the network; these results guide clinical practice but should prompt confirmatory studies. Cost and accessibility remain compelling arguments for digital formats even if direct superiority over therapist-delivered formats emerges in future rigorous trials.