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

High heterogeneity (I²=89%) in the insomnia severity analysis suggests considerable variation in study designs and populations. Three studies were rated as having a high risk of bias due to missing outcome data. Approximately half of the studies were conducted in the United States, which may limit the generalizability of findings to other cultural contexts regarding menopause and sleep perceptions. The review excluded studies where pharmacological interventions were added to the treatment, so it does not address CBT-I efficacy in combination with new sleep medications.

The authors declared no conflicts of interest and received no funding.

Do not assume CBT-I works for all menopausal insomnia cases. The review excluded studies where participants received additional pharmacological interventions beyond their usual medications, so the effect size reported here applies to CBT-I used alone or with routine care, not necessarily in complex cases requiring concurrent new drug therapy.