Background <p>Patients undergoing total knee arthroplasty (TKA) may suffer from perioperative sleep disorders (PSD), and their management is challenging. The aim of this study was to assess the efficiency of digital cognitive behavioral therapy (dCBT) in the management of PSD after TKA.</p> Methods <p>From December 2022 to August 2023, a total of 114 patients undergoing primary, unilateral TKA under general anaesthesia were included. The primary outcome was the Athens Insomnia Scale (AIS) score. Other outcome parameters included sleep quality, pain scores (NRS scores), mental disorders (hospital anxiety and depression scale scores and MMSE scores) and recovery quality (quality of recovery-40 questionnaire).</p> Results <p>There was no significant difference in AIS score, sleep quality, pain score or mental status between the two groups immediately after admission. The AIS scores of the dCBT group and control group were 3 (2) andvs. 3 (2.25) (<i>P</i> &lt; 0.05) on the first postoperative day, 3 (1) vs. 3 (3) (<i>P</i> &lt; 0.05) on the third postoperative day, and 1 (1) vs. 2 (2) (<i>P</i> &lt; 0.05) on the 15th postoperative day, respectively. Compared with those in the control group, the sleep quality, anxiety scores and recovery quality in the early stage significantly improved in the dCBT group. However, the pain scores and cognitive function of the two groups were not significantly different.</p> Conclusion <p>dCBT can decrease the severity of PSD and improve recovery quality in the early stage after TKA surgery. Furthermore, dCBT can relieve anxiety and thereby promote postoperative recovery.</p>