Comparative efficacy of different digital technologies in adults with insomnia: a systematic review and network meta-analysis of randomized controlled trials

Objective To evaluate the efficacy of eight digital interventions for adults with insomnia and compare their relative effects using Bayesian network meta-analysis, so as to provide evidence-based references for digital insomnia management. Methods Randomized controlled trials (RCTs) were retrieved from six electronic databases up to February 7, 2026. Eligible studies enrolled adult participants with insomnia, with primary outcomes including the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Sleep Onset Latency (SOL), and Wake After Sleep Onset (WASO). Risk of bias was assessed using the RoB 2.0 tool. Intervention hierarchies were obtained using the surface under the cumulative ranking curve (SUCRA). The GRADE framework for network meta-analysis was applied to rate evidence certainty. Results Twenty-six RCTs involving 6 353 participants covering eight digital interventions were included. Conventional meta-analysis showed that digital interventions significantly reduced ISI (MD = 3.31, 95%CI 2.48-4.15, P < 0.001, I² = 67%), improved PSQI (MD = 1.52, 95%CI 1.07-1.97, P < 0.001, I² = 0%), and shortened SOL (MD = 12.60, 95%CI 7.66-17.55, P < 0.001, I² = 0%) and WASO (MD = 16.93, 95%CI 8.90-24.96, P < 0.001, I² = 0%). Network meta-analysis suggested that combined digital cognitive behavioral therapy for insomnia with wearable devices (DCBT-I+WD) and biofeedback (BF) obtained favourable SUCRA ranks for ISI reduction; BF and digital cognitive behavioral therapy for insomnia (DCBT-I) ranked highly for PSQI improvement; DCBT-I had the highest SUCRA for SOL reduction; DCBT-I and digital sleep education (DSE) showed relatively good performance for WASO reduction. Conclusion Different digital technologies can significantly improve various sleep outcomes among adults with insomnia. DCBT-I showed favourable effect estimates. However, data on some digital interventions in some outcomes were mainly based on limited primary studies with sparse direct comparative evidence and thus were highly uncertain and do not allow firm conclusions. Large-sample, multicentre, longitudinal RCTs remain necessary to verify their long-term therapeutic effects.