Treating insomnia with cognitive behavioural therapy may do more than improve sleep. A small clinical trial suggests that cognitive behavioural therapy for insomnia, commonly known as CBT-I, could also be linked to a slower pace of biological ageing in older adults.

“CBT-I was associated with a significant slowing in the pace of biological ageing according to DunedinPACE”

The findings, published in The Lancet Healthy Longevity, add to growing evidence that persistent sleep problems may affect far more than energy levels and daytime alertness. Insomnia has been associated with changes in stress regulation, inflammation, metabolism and cardiovascular health. These systems are closely connected to the ageing process.

The study does not prove that CBT-I extends life or prevents age-related illness. It also does not show that the treatment makes people biologically younger. Instead, it found a measurable difference in one blood-based marker used to estimate how quickly biological ageing is occurring.

That distinction matters.

Chronological age is simply the number of years a person has lived. Biological ageing refers to changes taking place in cells, tissues and body systems. People of the same chronological age can have very different biological profiles. Lifestyle, long-term illness, stress, sleep, physical activity and genetic factors may all influence this process.

Researchers increasingly use “epigenetic clocks” to estimate biological ageing. These tools analyse chemical changes attached to DNA. Such changes can reflect patterns linked to ageing, although they are not a direct measure of life expectancy.

“Participants who received CBT-I were nearly three times as likely to experience remission of insomnia compared with those who received sleep education”

The new trial involved nearly 100 adults aged 60 or older who met established criteria for insomnia disorder. Participants were recruited and were randomly assigned to receive either CBT-I or sleep education.

The control group received general advice about sleep and healthy sleep habits. The CBT-I group took part in an eight-week programme designed specifically to treat persistent insomnia.

CBT-I is not simply a collection of bedtime tips. It is a structured psychological treatment that addresses the thoughts, emotions and behaviours that can maintain insomnia. Sessions may include techniques to reduce anxiety about sleep, change unhelpful beliefs, regulate time spent in bed and rebuild the association between bed and sleep.

Patients may also learn strategies for managing stress, improving sleep routines and responding differently to wakefulness during the night. The aim is to address the causes and patterns that keep insomnia going, rather than relying only on sleeping medication.

The results showed a clear benefit for sleep. Participants who received CBT-I were nearly three times as likely to experience remission of insomnia compared with those who received sleep education.

The study also examined blood samples taken before treatment and during follow-up over the following two years. Scientists assessed biological ageing using three epigenetic measures: DunedinPACE, GrimAge and PC-PhenoAge.

CBT-I was associated with a significant slowing in the pace of biological ageing according to DunedinPACE. The other measures, which estimate biological age in different ways, did not show the same result.

DunedinPACE is designed to estimate the speed at which biological ageing is occurring at a particular point in time. Researchers have compared it with a car’s speedometer. It indicates how fast the process is moving, rather than how far it has progressed overall.

The difference between the treatment groups was approximately -0.02. In broad terms, this suggested that people in the CBT-I group were ageing about 2 per cent more slowly for each year of chronological ageing during the period measured.

That figure cannot be translated directly into extra years of life, a lower chance of cancer or protection against heart disease. It is a population-level result based on a biomarker. It should not be interpreted as a guarantee for any individual receiving CBT-I.

Still, the finding is notable because it points towards a possible biological pathway connecting sleep and health. Sleep is a period when the body shifts towards repair and recovery. The parasympathetic nervous system becomes more active, helping to reduce the physiological effects of daytime stress.

Persistent insomnia may interfere with this process. Repeated nights of poor sleep can increase activation of the body’s stress-response systems. That may affect inflammation, metabolism and cardiovascular function. Over time, these disruptions could contribute to cellular damage and declining physical function.

Improving sleep may help reduce some of this strain. CBT-I could be relevant not only because it increases the amount or quality of sleep, but because it helps people respond differently to stress and nighttime wakefulness.

Experts say the therapy may improve nervous-system regulation through several routes. Patients can learn to identify anxiety triggers, challenge unhelpful thoughts about sleep and develop more effective responses to difficult nights. Behavioural techniques can also help the brain reconnect the bed and bedtime with sleeping, rather than with frustration, worry or prolonged wakefulness.

Insomnia is common. About one-third of adults in the United States report symptoms of insomnia. As many as one in five may have symptoms severe enough to meet the criteria for insomnia disorder. Among adults over 65, the prevalence may rise to around 40 per cent.

In Malaysia, 30% to 35% of Malaysian adults experience distinct insomnia symptoms, with around 12% suffering from chronic insomnia, according to an epidemiological study in Malaysia.

The effects can extend into the daytime. People with insomnia may experience tiredness, reduced concentration, memory problems, irritability and low mood. They may also find it harder to manage work, relationships and ordinary daily activities.

For older adults, the consequences can be particularly serious. Poor sleep may worsen existing health problems. It may contribute to falls, reduced independence and difficulties with memory or mood. Treating insomnia could therefore offer benefits that reach beyond the bedroom.

CBT-I is widely regarded as the first-line treatment for chronic insomnia. It is generally preferred before long-term reliance on sleeping pills, which can cause side effects, tolerance or dependence in some people. Medication may have a role in selected cases, but it does not always address the behavioural and psychological patterns that sustain insomnia.

Despite the encouraging findings, several limitations must be considered.

The trial was small. Fewer than 100 participants took part, and all were recruited from one location. The participants may not represent the wider population of older adults. Results could differ among people from other ethnic, social or economic backgrounds, or among those with different medical conditions.

The study also cannot establish cause and effect. Although CBT-I was associated with slower biological ageing, the researchers cannot conclude that the therapy itself directly caused the change. Improvements in sleep, reduced stress, increased confidence or other differences between the groups may have contributed.

The follow-up period was relatively limited for a study about ageing. Two years may not be long enough to identify meaningful changes in some biological-age measures. A treatment might influence the pace of ageing before it produces detectable changes in broader estimates of biological age.

Epigenetic clocks also have important limitations. They are valuable research tools, but they are not the same as a clinical test for health or longevity. A favourable change in an epigenetic marker does not necessarily mean that a person will live longer or avoid a particular disease.

More research is needed to determine whether the findings can be reproduced in larger, more diverse trials. Future studies could follow participants for five to ten years, measure health outcomes directly and examine whether better sleep is linked to lower rates of cardiovascular disease, cognitive decline, frailty or other age-related conditions.

Researchers will also need to explore whether CBT-I has similar effects in men and women, people from different populations and adults with other sleep disorders. It would be useful to compare CBT-I with medication, digital therapy, mindfulness-based programmes and other behavioural treatments.

The study raises another important question: does the benefit depend on achieving lasting remission from insomnia? A short-term improvement may not be enough to alter long-term health. If sleep quality deteriorates again, any biological benefit could also weaken.

For now, the most reliable message is straightforward. Insomnia deserves proper assessment and treatment. It should not be dismissed as an unavoidable part of ageing. CBT-I remains an evidence-based option that can improve sleep without the risks associated with long-term use of some sleeping medicines.

People with persistent insomnia should discuss their symptoms with a healthcare professional. Other conditions can cause or worsen poor sleep, including sleep apnoea, restless legs syndrome, depression, anxiety, chronic pain and medication side effects. Identifying these problems is essential.

Good sleep habits may support treatment, but they are not always enough to resolve chronic insomnia. Keeping a regular wake time, limiting late-day caffeine, reducing alcohol, managing evening light exposure and creating a calm bedroom can help. However, persistent symptoms often require a structured approach.

The new findings make CBT-I more interesting from a public-health perspective. If treating insomnia improves sleep and also reduces biological stress, the therapy could become an even more important part of healthy ageing programmes.

That possibility remains unconfirmed. The study offers a promising signal, not a final answer. CBT-I has not yet been shown to reverse ageing, add years to life or prevent age-related disease.

Its established benefit is better sleep. The potential biological effect is an important area for future research.