eng Oriental Scientific Publishing Company Biomedical and Pharmacology Journal 0974-6242 2026-06-03 19 2 72113 article Siti Wahyuni 1 Indria Hafizah 2 Hilmi Amirul Haq 3 Bryan Naufal Abdullah 3 Ahmad Fikri Albab 3 Elizabeth 3 Department of Psychiatry, DR. Moewardi General Hospital, Surakarta, Indonesia Faculty of Medicine, Halu Oleo University, Kendari, Indonesia Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia Department of Research, Sulianti Saroso Infectious Disease Hospital, Jakarta, Indonesia Insomnia is among the most prevalent sleep disorders worldwide, affecting approximately one-tenth to one-third of adults and disproportionately impacting aging populations because of circadian and neurophysiological changes. Cognitive Behavioral Therapy for Insomnia (CBT-I) remains the recommended first-line non-pharmacological intervention. However, complete symptom remission is not consistently achieved. 25–40% of patients experience suboptimal remission, highlighting the need for effective adjunctive interventions. This network meta-analysis evaluated the comparative efficacy of non-pharmacological adjuncts to CBT-I on subjective and objective sleep outcomes among middle-aged and older adults diagnosed with insomnia according to DSM-5 or ICD criteria. A systematic search of PubMed, ScienceDirect, Scopus, and Cochrane Library databases identified randomized controlled trials (RCTs), with risk of bias assessed using the Cochrane RoB 2.0 tool. Continuous outcomes were synthesized as mean differences (MDs) using a frequentist random-effects network meta-analysis model in RStudio—the evidence synthesis incorporated 9 randomized controlled trials involving 874 participants diagnosed with insomnia. For subjective sleep outcomes, CBT-I (MD −6.30) and Meditative Movement Therapy (MMT) (MD −5.50) demonstrated the greatest reductions in Pittsburgh Sleep Quality Index (PSQI) scores, while MMT showed the highest efficacy in reducing Insomnia Severity Index (ISI) scores (MD −13.42). Regarding objective measures, conventional acupuncture significantly increased actigraphy-measured total sleep time (MD 91.30 minutes), whereas combined electro- and conventional acupuncture produced the greatest improvement in sleep efficiency (MD 12.96%). These interventions may alleviate physiological and cognitive hyperarousal associated with insomnia. Despite limitations in sample size and follow-up duration, the findings suggest that MMT is particularly effective in improving subjective sleep outcomes. In contrast, acupuncture-based interventions may provide superior benefits for objective sleep duration and efficiency, supporting their role as adjunctive therapies in comprehensive insomnia management. https://biomedpharmajournal.org/vol19no2/comparative-efficacy-of-non-pharmacological-adjuncts-to-cognitive-behavioral-therapy-for-insomnia-in-middle-aged-and-older-adults-a-network-meta-analysis/ Acupuncture Cognitive Behavioral Therapy for Insomnia (CBT-I) Insomnia Meditative Movement Therapy Older adults Pittsburgh Sleep Quality Index (PSQI)