Summary of the best evidence that cognitive behavioral therapy for insomnia improves sleep quality in patients with chronic insomnia

Aim: To evaluate and summarize the best available evidence regarding the efficacy of cognitive behavioral therapy for insomnia (CBT-I) in improving sleep quality in patients with chronic insomnia and to provide structured, evidence-based recommendations for clinical nursing practice. Design: This evidence summary was conducted using the PIPOST model from the Center for Evidence-Based Nursing at Fudan University, which guided the development of structured evidence-based questions. Methods: A systematic search was performed across multiple databases and guideline repositories for literature published from inception to December 10, 2024. Literature types included clinical guidelines, best practice information sheets, expert consensuses, systematic reviews, evidence summaries, and meta-analyses. Databases searched included UpToDate, BMJ Best Practice, Joanna Briggs Institute, Guidelines International Network, National Institute for Health and Care Excellence, Embase, PubMed, Web of Science, MEDLINE, CNKI, and WanFang. Data sources: The following sources were utilized: UpToDate, BMJ Best Practice, Joanna Briggs Institute, Guidelines International Network, National Institute for Health and Care Excellence, Registered Nurses' Association of Ontario, Scottish Intercollegiate Guidelines Network, Embase, PubMed, Sinomed, Web of Science, DynaMed, MEDLINE, CNKI, WanFang database, and Chinese Medical Journal Full-text Database. The search period was from database inception to December 10, 2024. Results: A total of 28 papers were included, comprising five guidelines, three expert consensus papers, 12 systematic reviews, and eight meta-analyses. The overall quality of the included literature was high. Forty-one pieces of best evidence were summarized across nine domains: diagnostic criteria for chronic insomnia, assessment conditions, the timing of CBT-I initiation, treatment formats, components of CBT-I, assessment metrics and tools, symptom improvement indicators, comparisons of implementers, and adverse effects. Conclusion: This study synthesized the best available evidence supporting CBT-I as an effective intervention for improving sleep quality in patients with chronic insomnia. Clinical staff should conduct comprehensive assessments before implementing CBT-I and should develop personalized treatment plans based on individual patient characteristics. The evidence supports CBT-I as a first-line treatment with minimal adverse effects compared to pharmacological interventions.