Effects of cognitive behavioral therapy on sleep quality and insomnia severity index in women with menopausal insomnia: a systematic review and meta-analysis

PURPOSE: This study aimed to evaluate the effects of cognitive behavioral therapy for insomnia (CBT-I) on sleep quality and insomnia severity in menopausal women through a systematic review and meta-analysis. METHODS: A comprehensive literature search was conducted up to October 2024 using PubMed, EMBASE, Cochrane, and CINAHL, with additional searches of Chinese and Korean databases to include East Asian studies. Randomized controlled trials (RCTs) assessing the effects of CBT-I on sleep outcomes in menopausal women were included. Eleven RCTs (n=973) met the inclusion criteria. The interventions comprised face-to-face, telephone, and internet-based CBT-I programs, with session counts ranging from 4 to 12 and follow-up durations extending from post-intervention to 52 weeks. Data were analyzed using Review Manager 5.4, and effect sizes were expressed as standardized mean differences (SMDs) and mean differences (MDs) with 95% confidence intervals (CIs). RESULTS: CBT-I significantly improved sleep quality (n=795, SMD=-1.01; 95% CI, -1.27 to -0.75) and reduced insomnia severity (n=504, MD=-4.49; 95% CI, -6.12 to -2.87). Subgroup analyses indicated that CBT-I was effective regardless of delivery mode (face-to-face or remote), follow-up duration, or baseline insomnia severity. CONCLUSION: CBT-I is an effective non-pharmacological intervention for improving sleep quality and reducing insomnia severity in menopausal women. These findings support the integration of CBT-I into clinical practice, particularly as a nurse-led intervention that can be delivered in both face-to-face and remote formats. To enable broader implementation, standardized CBT-I training programs and clinical protocols should be developed. Future studies should investigate long-term effectiveness and cultural applicability in diverse populations, including Korean women.