Leaving intensive care is meant to mark the start of recovery, yet many survivors find they cannot sleep. Broken nights can slow healing, lower mood and make a return to normal life harder. A new trial from China suggests that an online form of cognitive behavioural therapy can help, when it is added to the sleeping pills these patients are usually given.
Researchers at the Affiliated Hospital of North Sichuan Medical College and a partner hospital randomly assigned 120 patients with sleep problems to one of two groups. The findings appear in BMC Psychology. Both groups of 60 had been moved from the intensive care unit to a general ward between June and September 2025.
Everyone received the sleep medicine eszopiclone and routine advice on good sleep habits. The intervention group also followed a three-month online programme of cognitive behavioural therapy, which teaches people to change the thoughts and routines that keep them awake. Sleep, mood and quality of life were measured at the start, at the end of the three months, and again one month later.
Cognitive behavioural therapy is a structured talking treatment that links thoughts, feelings and behaviour. Insomnia severity describes how much poor sleep disrupts daily life, while sleep quality reflects how rested a person feels. Sleep efficiency is the share of time in bed that a person actually spends asleep.
At both follow-up points, the therapy group showed significantly greater improvements than the medication-only group in sleep quality, insomnia severity, depressive symptoms and overall quality of life. Anxiety told a slightly different story. The difference between groups was not significant straight after the programme, but it became significant at the one-month check.
The therapy group also cut back on medication at a significantly higher rate. Completion of the online modules and sleep diaries was described as good, and the control group accepted the advice and took their medication as directed. Sleep diaries kept by the therapy group showed that sleep efficiency rose, patients fell asleep more quickly, and they spent less time awake in the night.
Sleep problems are common after critical illness, and sleeping pills carry side effects and risks of dependence. An internet programme is cheap to deliver and can reach patients who are still weak, or who live far from a clinic. The trial was registered with the Chinese Clinical Trial Registry before it began.
The study has clear limits. It took place in one hospital, enrolled 120 patients and followed them for only one month after treatment ended, so it cannot show whether the gains last. The diary data came only from the therapy group, so those improvements have no comparison and should be treated as exploratory.
Cognitive behavioural therapy for insomnia is already widely recommended as a first treatment for chronic sleep problems, and online versions have worked in other groups of patients. This trial extends that evidence to people recovering from intensive care, and it suggests that therapy alongside medication may do more than medication alone.
