Digital CBT-I

If you can get at least four sessions with a trained CBT-I therapist, in person or over video, do that. If you can't, use a well-tested program such as Sleepio, Somryst or SHUTi rather than waiting.

What it is

Cognitive behavioural therapy for insomnia (CBT-I) is the recommended first treatment for chronic insomnia, ahead of any sleeping pill. It is a package of behaviour changes and thinking techniques — keeping the bed for sleep, temporarily cutting time in bed, and challenging anxious thoughts about sleep; see Treating chronic insomnia for how it works.

The bottleneck has long been access: there are too few trained clinicians. Self-guided digital programs make it available at scale. Sleepio (endorsed for use in the UK's National Health Service), Somryst (cleared by the US Food and Drug Administration) and SHUTi are the ones with the most published data.

The evidence that it works

Across 11 randomised trials, internet-delivered CBT-I improved insomnia severity, sleep efficiency, sleep quality, time awake at night, time taken to fall asleep and total sleep time. The effects ranged from small to large and were sustained at 4 to 48 weeks — a range the authors judged comparable to face-to-face CBT-I.^[1]

The largest single trial randomised 1,711 adults with self-reported insomnia symptoms to a digital program or to sleep-hygiene education. Sleep itself improved a lot; daytime well-being and functioning improved much less.^[2] It was funded by the maker of the program tested, whose cofounder and chief medical officer was the trial's first author.

Is it as good as a therapist? Not proven

The one head-to-head trial set out to show that digital was no worse than face-to-face therapy, and did not. Among 101 patients referred to a sleep clinic, the digital group did significantly worse at both time points, by about 4.6 points on the Insomnia Severity Index at nine weeks and 2.8 at thirty-three. At nine weeks digital was formally inferior. At thirty-three weeks the authors called the result inconclusive, because the uncertainty range still overlapped the 2-point margin they had set in advance for "no worse".^[3]

One small trial is not a settled literature either. Pooling 52 randomised trials across every delivery format, no format was statistically better than another, but formats with a live therapist — in person or over video — ranked highest and unguided self-help lowest.^{[4] [5]} That analysis was corrected in 2025 after a data error; the corrected version is the one to trust.

A wider pooling of 87 trials of CBT-I in all its forms also found that face-to-face courses of at least four sessions beat self-help and shorter courses.^[6]

What to do

1. Prefer a therapist — at least four sessions, in person or over video — if you can get one.
2. If you can't, start a digital program now rather than waiting; pick one with published randomised trials behind it.
3. Expect better-consolidated sleep more than longer sleep, and smaller gains in how you feel during the day.

Further reading

• Zachariae R et al. Efficacy of internet-delivered cognitive-behavioral therapy for insomnia: a systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev 2016.^[7]
• Espie CA et al. Effect of Digital Cognitive Behavioral Therapy for Insomnia on Health, Psychological Well-being, and Sleep-Related Quality of Life: A Randomized Clinical Trial. JAMA Psychiatry 2019 — n = 1,711.^[8]
• Kallestad H et al. Mode of delivery of Cognitive Behavioral Therapy for Insomnia: a randomized controlled non-inferiority trial of digital and face-to-face therapy. Sleep 2021.^[9]
• Simon L et al. Comparative efficacy of onsite, digital, and other settings for cognitive behavioural therapy for insomnia: a systematic review and network meta-analysis. Sci Rep 2023, with author correction 2025.^{[10] [11]}