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Patient Evidence Summary

Doctor, I have trouble sleeping because of my chronic disease, including chronic pain. Could CBT-I help me sleep better?

Difficulty sleeping is common among individuals with chronic disease (e.g., chronic pain, cardiovascular disease, and cancer) and can impact quality of life. This review found that Cognitive Behavioural Therapy for Insomnia (CBT-I) improved sleep for adults with chronic diseases, including those living with chronic pain. It helped people fall asleep faster, stay asleep longer, and reduced the severity of insomnia.

What is the evidence?

SUMMARY OF FINDINGS

Comparison of Cognitive Behavioural Therapy for Insomnia (CBT-I) vs sleep education, usual care, attention control, or wait-list

OutcomeOutcomesQuality of Studies
Improved insomnia severityCBT-I led to an improvement; people reported much less severe insomnia across studiesModerate – results favoured CBT-I, but study quality varied and one-third of studies had a high risk of bias*
Improved sleep efficiencyCBT-I led to a moderate improvement, with people spending a greater percentage of time asleep while in bedModerate – difference between the study groups varied across the studies and by treatment duration#
Faster sleep onsetCBT-I helped people fall asleep faster, with a moderate benefit across trialsModerate – larger and more rigorous studies reported slightly smaller effects
Treatment satisfactionMost participants completed treatment, reported concerns were uncommon, and adverse effects were rareHigh


NOTE: Pain relief was not directly measured, and only 25% of study participants were living with chronic pain.
*bias means the study results may be misleading
#longer treatment duration showed better outcomes for sleep efficiency and sleep onset.


What kind of study was this?

This was a systematic review and meta-analysis. A systematic review summarises all available studies on a health care intervention to provide high quality evidence on the effectiveness of that health care intervention. A meta-analysis uses statistical methods to combine results from multiple studies to produce an overall estimate of the treatment’s effects.

Who? This review included 67 randomized controlled trials involving 5,232 adults (aged 18 and older) with chronic diseases and insomnia. Age and gender varied across studies. Chronic diseases included chronic pain, cancer, irritable bowel syndrome, depression, cardiovascular disease, kidney disease, traumatic brain injury, COPD, and others. Studies using CBT-I with measured sleep outcomes were included.

What? The reviewers included studies that compared cognitive behavioural therapy for insomnia (CBT-I) with usual care such as educational interventions, attention control, or wait-list groups.

Treatment

vs

Usual care

CBT-I is a structured, non-drug program that helps people change unhelpful thoughts and behaviours that interfere with sleep.
Treatment typically includes:

  • Sleep restriction
  • Stimulus control
  • Cognitive therapy
  • Sleep hygiene education
  • Relaxation techniques

Most programs lasted several weeks and were delivered in-person, online, or in group sessions.



Usual care or education: Typically included basic advice about sleep or general health information.

Attention control: Involved structured interaction with providers without delivering CBT-I components.

Wait-list: Participants received no immediate treatment.




Why was this research done?

Difficulty sleeping (insomnia) is common among people living with chronic diseases such as chronic pain, cardiovascular disease, or cancer. Sleep problems are often long-lasting and can make day-to-day life harder.

CBT-I is usually the first treatment recommended for insomnia, but it is unclear if it works for people with other long-term health conditions. Chronic diseases can cause complex symptoms, require multiple medications, and lead to daily challenges that might affect how well behavioural sleep therapy works. This review looked at whether CBT-I works well and is acceptable for people living with chronic diseases. It is worth noting that only 25% of participants had chronic pain, so the results may not fully reflect the experiences of people living with pain. Pain relief was not directly measured, but poor sleep is known to worsen pain symptoms, so improving sleep is likely to be beneficial.

The quality of the studies included was mixed, and the amount of benefit people experienced from CBT-I varied from study to study. Even so, the overall evidence suggests CBT-I is helpful for improving sleep for people with chronic conditions. Future research could explore whether it also reduces chronic pain.


This Evidence Summary is based on the following article:

Scott AJ, Correa AB, Bisby MA, et al. Cognitive Behavioral Therapy for Insomnia in People With Chronic Disease: A Systematic Review and Meta-Analysis. JAMA Intern Med. 2025 Sep 22:e254610. doi: 10.1001/jamainternmed.2025.4610. PubMed

Published: Wednesday, December 24, 2025
Last Updated: Monday, January 12, 2026

Please note that the information contained herein is not to be interpreted as an alternative to medical advice from a professional healthcare provider. If you have any questions about any medical matter, you should consult your professional healthcare providers, and should never delay seeking medical advice, disregard medical advice or discontinue medication based on information provided here.

This Evidence Summary was printed from the PAIN+ CPN website on 2026/02/14.

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