Effectiveness of homeopathic interventions for insomnia and sleep disorders: A systematic review and meta-analysis

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BACKGROUND: Insomnia is a common sleep disorder, and many individuals seek alternative treatments like homeopathy. However, evidence for its effectiveness remains controversial. This systematic review and meta-analysis evaluated the effectiveness of homeopathic interventions for insomnia and sleep-wake disorders. METHODS: A comprehensive search of PubMed, MEDLINE, CINAHL, and the Cochrane Library was conducted for studies published between 2010 and 2025. We included randomized controlled trials (RCTs) and non-randomized studies involving adults (≥18 years) with primary insomnia receiving any homeopathic intervention compared to placebo, no treatment, or active care. Primary outcomes included validated sleep quality measures (e.g., Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI). Four reviewers independently performed study selection, data extraction, and risk of bias assessment using RoB 2.0 and ROBINS-I. A random-effects meta-analysis was conducted for controlled trials, and a narrative synthesis for non-randomized studies. Certainty of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). RESULTS: The search yielded 1304 records; 9 studies (six RCTs and three non-randomized) met inclusion criteria. Meta-analysis showed a moderate positive effect of homeopathy on sleep outcomes (SMD (Hedges' g) = 0.63 95% CI [-0.13, 1.39], p = 0.1051) but it is not statistically significant with substantial heterogeneity (I² = 88.26%) and publication bias (Egger's test, t = 2.8471, df = 4, p = 0.0465). Most studies had high or critical risk of bias, and overall certainty was low. CONCLUSION: There was no statistically significant difference between homeopathic interventions and control conditions for improving insomnia. This finding is based on low certainty evidence, with the primary limitations being a high risk of bias in the included studies and substantial unexplained heterogeneity. Therefore, current evidence is insufficient to support the effectiveness of homeopathic interventions for insomnia, and high-quality, rigorously designed trials are needed to provide a definitive answer. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42025649926.