Systematic review and meta-analysis of 9 RCTs (n=760, adults ≥60 years) evaluating digital CBT-I (dCBT-I) vs. control conditions for insomnia severity, with subgroup analyses by therapist guidance and control type.
dCBT-I significantly reduced ISI-measured insomnia severity post-intervention (MD = −3.96, 95% CI −5.35 to −2.56; I² = 56.3%) and at follow-up (MD = −3.66, 95% CI −5.37 to −1.94; I² = 10.3%). Unguided dCBT-I alone also showed significant benefit (MD = −4.36, 95% CI −6.06 to −2.66; I² = 37.7%).
- Only 9 RCTs with 760 participants; follow-up data were sparse, limiting conclusions about long-term durability. - Findings apply mainly to relatively younger older adults (≥60 years), so generalizability to the oldest-old is unclear. - Moderate heterogeneity at post-intervention (I² = 56.3%) and uncertain incremental value of therapist guidance vs. unguided delivery.
dCBT-I is an effective, scalable option for older adults with insomnia, with unguided formats showing meaningful benefit — making it practical for settings where therapists are scarce. Clinicians should consider it a first-line digital tool, while noting that long-term follow-up evidence remains limited.
