Sleep Healthy Using the Internet: A Meta-Analysis of Twenty Years of Research on a Digital Cognitive Behavioral Therapy for Insomnia Program.

STUDY

Objectives

To summarize two decades of research on Sleep Healthy Using the Internet (SHUTi), among the most-studied digital Cognitive Behavioral Therapy for Insomnia programs.

Methods

PubMed, CINAHL, Web of Science, and PsycINFO were comprehensively searched through October 7, 2025, for English-language primary, empirical reports of the effects of SHUTi on the Insomnia Severity Index (ISI) or sleep diary-assessed sleep onset latency (SOL) or wake after sleep onset (WASO, including early morning awakening [EMA] or not). Meta-analyses evaluated differences in effects on each sleep outcome between participants assigned to SHUTi versus online education control conditions and whether participant and study characteristics moderated effects.

Results

Twenty-nine publications reported unique data from 25 studies testing SHUTi among diverse populations from around the world (total N=14,166). Participants who were provided SHUTi reported clinically significant improvements on all sleep metrics (average declines from baseline to follow-up timepoints were ≥8 points on ISI, ≥21 minutes SOL, ≥27 minutes WASO without EMA, and ≥35 minutes WASO including EMA), with 64% completing a full therapeutic dose of SHUTi. Of the 10 RCTs comparing SHUTi with online education, SHUTi participants reported greater improvements from baseline through post-assessment and 6- and 12-month follow-ups (ISI Standardized Mean Differences [SMD]= -1.03 - -0.85, ps<.001; SOL SMD= -0.41 - -0.32, ps<.024; and WASO SMD= -0.48 - -0.45, ps<.001).

Conclusions

Individuals receiving SHUTi report clinically and statistically significant improvements in sleep, which are greater than those receiving online education. SHUTi demonstrates robust efficacy for treating insomnia across medically, psychiatrically, and demographically diverse samples.