Effectiveness of Cognitive Behavioral Therapy for Insomnia on Sleep Quality in Patients with Insomnia: A Meta-Analysis


  • Cynthia Octaviani Masters Program in Public Health, Universitas Sebelas Maret
  • Hanung Prasetya Study Program of Acupuncture, Health Polytechnics, Ministry of Health, Surakarta
  • Bhisma Murti Masters Program in Public Health, Universitas Sebelas Maret




Background: The relationship between sleep quality and sleep quantity is very close and has a significant impact on a person's sleep needs. If someone does not get enough sleep, then this will have an impact on the quality of their sleep, and vice versa. Therefore, maintaining a good quality of sleep is very important to maintain a healthy body and improve quality of life. The aim of the study was to analyze the effect of cognitive behavior therapy for insomnia (CBT-I) on sleep quality in insomnia patients.

Subjects and Method: This study is a meta-analysis with PICO. Population: insomnia patients. Intervention: given cognitive behavior therapy for insomnia (CBT-I). Comparison: not given cognitive behavior therapy for insomnia (CBT-I). Outcome: sleep quality. The articles used in this study were obtained from five databases, namely PubMed, Embase, Web of Science, ScienceDirect, and Google Scholar. The keywords used to search for articles use the medical subject heading (MeSH) term and the emtree of the keywords "Insomnia" AND "Cognitive Behavior Therapy for Insomnia" AND "Sleep Quality". The articles used were full text in English from 2013 to 2023. Articles were selected using the 2021 PRISMA flowchart and analyzed using the RevMan 5.3 application.

Results: A total of 10 randomized controlled trial study articles came from Iran, Canada, Spain, Texas, Korea, Kansas and the United States. The total sample size is 473 research subjects. Based on the analysis, insomnia patients who were given CBT-I therapy showed an average PSQI score of 1.88 units lower than those not given CBT-I (placebo), and the difference was statistically significant (SMD = -1.88; 95% CI = -2.55 to -1.22; p<0.001). Then insomnia patients who were given CBT-I showed an average PSQI score of 0.52 units lower than those given other insomnia therapies, and the difference was statistically significant (SMD= -0.52; 95% CI= -0.77 to -0.28; p <0.001) . Then when viewed as a whole, it shows that insomnia patients who are given CBT-I therapy on average have or show a PSQI score of 0.78 units lower than other therapies and without CBT-I therapy (placebo), and this difference is statistically significant (SMD= -0.78; 95% CI= -1.13 to -0.42; p < 0.001).

Conclusion:  Cognitive behavior therapy for insomnia (CBT-I) can improve sleep quality in insomnia patients (decrease the PSQI score).

Keywords:  insomnia, cognitive behavior therapy for insomnia, sleep quality.

Correspondence:  Cynthia Octaviani. Master's Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Jawa Tengah, Indonesia. Email: Cynthia.octaviani14@gmail.com. Mobile: +6287812315855.



Bramoweth AD, Lederer LG, Youk AO, Germain A, Chinman MJ. (2020). Brief behavioral treatment for insomnia vs. cognitive behavioral therapy for insomnia: results of a randomized noninferiority clinical trial among veterans. Behav Ther. 51(4), 535–547. Doi: 10.1016/j.beth.2020.02.002.

Cunnington D, Junge MF, Fernando AT. (2013). Insomnia: prevalence, consequences and effective treatment. Med J Aust. 199; S36–S40. Doi: 10.5694/mja13.10718.

Danirmala D, Ariani P (2019). The incidence of insomnia in the elderly at Tresna Werdha Wana, Denpasar, Bali in 2015). EJ Medika Udayana. 8(1): 27.

Forma F, Pratiwadi R, ElMoustaid F, Smith N, Thorndike F, Velez F. (2022). Network meta-analysis comparing the effectiveness of a prescription digital therapeutic for chronic insomnia to medications and face-to-face cognitive behavioral therapy in adults. Curr Med Res and Opin. 38(10): 1727–1738. Doi: 10.1080/03007995.2022.2108616.

Hapsari A, Kurniawan A (2019). Effectiveness of cognitive behavior therapy (CBT) to improve sleep quality of insomniacs in early adulthood). J. Ilmu Kel. & Konsum. 12(3): 223–235. Doi: 10.24156/jikk.2019.12.3.223.

Hidaayah N, Alif H (2016). The relationship between anxiety levels and the occurrence of insomnia in premenopausal women in Ngablak Hamlet, Kedungrukem Village, Benjeng District, Gresik Regency). J Health Sci. 9(1). Doi: 10.33086/jhs.v9i1.187.

Kalmbach DA, Cheng P, O’Brien LM, Swanson LM, Sangha R, Sen S, Guille C (2020). A randomized controlled trial of digital cognitive behavioral therapy for insomnia in pregnant women. Sleep Med. 72: 82–92. Doi: 10.1016/j.sleep.2020.03.016.

Kline CE (2014). The bidirectional relationship between exercise and sleep: implications for exercise adherence and sleep improvement. Am. J. Lifestyle med. 8(6): 375–379. Doi: 10.1177/155987614544437.

Kurniawan A, Kasumayanti E, Putri ADED (2020). The effect of elderly exercise on reducing the insomnia scale in the elderly in Batu Belah Village, the working area of the Kampar Health Center in 2020). Jurnal Ners. 4(2): 102–106. Doi: 10.31004/jn.v4i2.1120.

Kwan Y, Yoon S, Suh S, Choi S (2022). A randomized controlled trial comparing neurofeedback and cognitive-behavioral therapy for insomnia patients: pilot study. Appl Psychophysiol Biofeedback. 47(2): 95–106. Doi: 10.1007/s10484022095346.

Lami MJ, Martínez MP, Miró E, Sánchez AI, Prados G, Cáliz R, Vlaeyen JWS. (2018). Efficacy of combined cognitive-behavioral therapy for insomnia and pain in patients with fibromyalgia: A randomized controlled trial. Cognit Ther Res. 42(1): 63–79. Doi: 10.1007/s1060801798754.

Martínez MP, Miró E, Sánchez AI, DiazPiedra C, Cáliz R, Vlaeyen JWS, Buelacasal G (2014). Cognitive behavioral therapy for insomnia and sleep hygiene in fibromyalgia: a randomized controlled trial. J. Behav. Med. 37: 683–697. Doi: 10.1007/s108650139520y.

Mawo PR, Rante SDT, Sasputra IN. (2019). The relationship between sleep quality and hemoglobin levels in UNDANA medical faculty students. CMJ. 7(2): 158–163. Doi: 10.35508/cmj.v7i2.1780.

McMain S, Newman MG, Segal ZV, DeRubeis RJ (2015). Cognitive behavioral therapy: Current status and future research directions. Psychother Res. 25(3): 321–329. Doi: 10.1080/10503307.2014.1002440.

Moon SY, Jerng UM, Kwon OJ, Jung SY, Lee JY, Yoon SW, Shin WC, et al. (2020). Comparative effectiveness of cheonwangbosimdan (tian wang bu xin dan) versus cognitive-behavioral therapy for insomnia in cancer patients: a randomized, controlled, open-label, parallel-group, pilot trial. Integr. Cancer Ther. 19. Doi: 10.1177/1534735420935643.a

Morin CM, Drake CL, Harvey AG, Krystal AD, Manber R, Riemann D, Speigelhalder K (2015). Insomnia disorder. Nat Rev Dis Primers. 1(1): 1–18. Doi: 10.1038/nrdp.2015.26.

National Sleep Foundation (2021). Sleep statistic. Available at: https://www.sleepfoundation.org/howsleepworks/sleepfactsstatistics (Accessed: 31 January 2023).

Putri KE, Murti B, Prasetya H (2021). The effectiveness of acupuncture in insomnia patients: Meta-analysis. IJM. 6(1): 42–51. Doi: 10.26911/theijmed.2021.06.01.05.

Siengsukon CF, Alshehri M, Williams C, Drerup M, Lynch S (2020). Feasibility and treatment effect of cognitive behavioral therapy for insomnia in individuals with multiple sclerosis: A pilot randomized controlled trial. Mult. Scler. Relat. Disord. 40: 101958. Doi: 10.1016/j.msard.2020.101958.

Taylor DJ, Zimmerman MR, Gardner CE, Williams JM, Grieser EA, Tatum JI, Bramoweth AD, et al. (2014). A pilot randomized controlled trial of the effects of cognitive-behavioral therapy for insomnia on sleep and daytime functioning in college students. Behav. Ther. 45(3): 376–389. Doi: 10.1016/j.beth.2013.12.010.

Teha ZDC, Budihastuti UR, Prasetya H. (2022). The effectiveness of lavender aroma therapy for better quality of sleep in pregnant women: Meta-analysis. Matern Child Health J. 7(4): 454–464. Doi: 10.26911/ thejmch. 2022.07.04.09.

TomfohrMadsen L, Madsen JW, Bonneville D, Virani S, Plourde V, Barlow KM, Yeates KO, Brooks BL (2020). A pilot randomized controlled trial of cognitive-behavioral therapy for insomnia in adolescents with persistent postconcussion symptoms. J Head Trauma Rehabil. 35(2): E103–E112. Doi: 10.1097/HTR.0000000000000504.

van der Zweerde T, Bisdounis L, Kyle SD, Lancee J, Van Straten A. (2019). Cognitive behavioral therapy for insomnia: a meta-analysis of long-term effects in controlled studies. Sleep Med Rev. 48: 101208. Doi: 10.1016/j.smrv.2019.08.002.

Walia HK, Mehra R. (2016). Overview of common sleep disorders and intersection with dermatologic conditions. Int. J. Mol Sci. 17(5): 654. Doi: 10.3390/ijms17050654.

Williams J, Roth A, Vatthauer K, McCrae CS (2013). Cognitive behavioral treatment of insomnia. Chest. 143(2): 554–565. Doi: 10.1378/chest.120731.

Yarahmadi M, Hafezi F, Makvandi B. (2021). Effectiveness of cognitive-behavioral therapy for improving sleep quality and reducing insomnia severity in afflicted patients. J. Iran. Med. Council. 4(4): 266–273. Doi: 10.18502/jimc.v4i4.8487.