Does cognitive behavioural therapy for insomnia work better than sleeping pills?

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1. 1

   Interventions for managing clinically relevant sleep disturbances or insomnia in cancer patients and survivors: an up-to-date systematic review and meta-analysis of self-reported sleep disturbance.

   Frontiers in psychology (Chan et al.)Published Jun 3, 2026Checked Oct 4, 2026

   “This systematic review and meta-analysis aimed to appraise the effectiveness of up-to-date interventions managing clinical sleep disturbances in cancer patients or survivors.MethodsData from randomized controlled trials were analysed following PRISMA guidelines. Five English databases were searched from January 2012 to June 2025. Outcomes were measured using Hedge's g with random-effects models. The methodological quality of the trials was assessed by Cochrane Risk of Bias Tool 2.0 and the certainty of evidence was determined using GRADE.Results42 trials with 3,844 participants were identified, with sample sizes ranging from 22 to 255. A moderate and large effect was found for cognitive behavioural therapy for insomnia (CBT-I) on improving sleep quality (g = 0.57; 95% CI = 0.20 - 0.93, p g = 0.91; 95% CI = 0.49 - 1.34, p g = 1.11; 95% CI = 0.43 - 1.78, p ConclusionThe existing evidence base needs to be expanded to adequately evaluate the effectiveness of other interventions for clinical sleep disturbances. CBT-I is currently the most empirically supported treatment for cancer patients and survivors with clinically relevant sleep disturbances.”

2. 2

   Risks Associated With Benzodiazepine Long-Term Use in Chronic Insomnia: A Systematic Review and (Network) Meta-Analysis.

   Journal of sleep research (Riemann et al.)Published Jun 11, 2026Checked Oct 4, 2026

   “This review included 27 studies published between 1987 and 2023, focusing on adults with insomnia symptoms lasting at least 3 months. The main outcomes examined were sleep quality, safety issues such as risk of falls, mental health concerns including depression and anxiety, and overall quality of life. Five outcomes were deemed suitable for meta-analysis: severity of insomnia, sleep quality, incidence of falls, depression, and anxiety. The results showed that people taking benzodiazepine medications had more severe insomnia than healthy sleepers, but less severe than those who were not taking any medication. The risk of falls was similar between those using benzodiazepine medications and those who were not. However, people using these medications experienced significantly higher levels of depression and anxiety compared to healthy sleepers. This review highlights a lack of studies on the long-term use of benzodiazepine medications, but suggests that extended use may worsen sleep quality, mental health, and quality of life. The findings support guidelines recommending limited use and prioritizing behavioural therapy and alternative safer pharmacotherapies for insomnia.”

3. 3

   Recommendations on Switching or Deprescribing Hypnotic Medications for Insomnia.

   Deutsches Arzteblatt international (Hajak et al.)Published Sep 18, 2026Checked Oct 4, 2026

   “Benzodiazepine receptor agonists, antidepressants, antipsychotics, and gabapentinoids should be tapered off gradually after medium- or long-term use (> 2 weeks), with a weekly dose reduction of 10-25%. Various gradual tapering methods can be used, depending on the drug, dose, duration of use, treatment regimen, and intended subsequent treatment. A longer taper is advisable after use at high doses (≥ 2/3 of the maximum dose) or over the long term (≥ 1 year). Withdrawal symptoms from benzodiazepine receptor agonists can be alleviated with the overlapping administration of daridorexant or eszopiclone. Cognitive behavioral therapy is recommended as an accompanying nonpharmacological treatment (relative risk [RR]: 1.68; 95% confidence interval: [1.19; 2.39]).ConclusionA drug-specific approach with evidence-based and practice-oriented protocols should be used when hypnotic medications are switched or discontinued.”

4. 4

   Cognitive behavioral therapy for insomnia (Wikipedia)

   WikipediaPublished Oct 4, 2026Checked Oct 4, 2026

   “Cognitive behavioral therapy for insomnia (CBT-I) is a therapy technique for treating insomnia without (or alongside) medications. CBT-I is the first-line treatment for insomnia and probably more efficacious and acceptable than pharmacotherapy. CBT-I aims to improve sleep habits and behaviors by identifying and changing thoughts and behaviors that prevent a person from sleeping well. The first step in treating insomnia with CBT-I is to identify the underlying causes. People with insomnia should evaluate or have their sleep patterns evaluated and take into account all possible factors that may be affecting the person's ability to sleep. This may involve keeping a sleep diary/journal for a couple of weeks, which can help identify patterns of thoughts or behaviors, stressors, etc. that could be contributing to the person's insomnia. After identifying the possible underlying causes and the factors contributing to insomnia, the person can begin taking steps toward getting better sleep. In CBT-I these steps include stimulus control, sleep hygiene, sleep restriction, relaxation training, and cognitive therapy. Some sleep specialists recommend biofeedback as well.”