Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline

Abstract

Introduction: This guideline establishes clinical practice recommendations for the use of behavioral and psychological treatments for chronic insomnia disorder in adults. Methods: The American Academy of Sleep Medicine (AASM) commissioned a task force of experts in sleep medicine and sleep psychology to develop recommendations and assign strengths based on a systematic review of the literature and an assessment of the evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The task force evaluated a summary of the relevant literature and the quality of evidence, the balance of clinically relevant benefits and harms, patient values and preferences, and resource use considerations that underpin the recommendations. The AASM Board of Directors approved the final recommendations. Recommendations: The following recommendations are intended as a guide for clinicians in choosing a specific behavioral and psychological therapy for the treatment of chronic insomnia disorder in adult patients. Each recommendation statement is assigned a strength ("strong" or "conditional"). A "strong" recommendation (ie, "We recommend…") is one that clinicians should follow under most circumstances. A "conditional" recommendation is one that requires that the clinician use clinical knowledge and experience, and to strongly consider the patient's values and preferences to determine the best course of action.1. We recommend that clinicians use multicomponent cognitive behavioral therapy for insomnia for the treatment of chronic insomnia disorder in adults. (STRONG) 2. We suggest that clinicians use multicomponent brief therapies for insomnia for the treatment of chronic insomnia disorder in adults. (CONDITIONAL) 3. We suggest that clinicians use stimulus control as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL) 4. We suggest that clinicians use sleep restriction therapy as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL) 5. We suggest that clinicians use relaxation therapy as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL) 6. We suggest that clinicians not use sleep hygiene as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL)

Advances in the Treatment of Chronic Insomnia: A Narrative Review of New Nonpharmacologic and Pharmacologic Therapies

“… 7 , 8 Other than the different treatments required for distinctive comorbidities, effective treatments for insomnia generally are the same across “primary” or “secondary” insomnia. 1 , 2 , 9 , 10 It is important to note, however, that for some of the more recent insomnia treatments (eg, dual orexin receptor antagonists [DORAs]), less is known about their effectiveness in patients with insomnia and comorbidities as these newer agents are relatively new and studies of those that have become commercially available have not yet been conducted to evaluate their efficacy specifically in insomnia patients with co-occurring disorders.…”

“…As regards behavioral and psychological treatments for chronic insomnia, clinical practice guidelines from the AASM and the American College of Physicians (ACP) both indicate that standard-of-care should be to at least provide cognitive behavioral therapies for insomnia (CBT-I) as first-line nonpharmacologic treatment. 9 , 67 Indeed, CBT-I is the only nonpharmacologic treatment for chronic insomnia that has received a strong recommendation for use by the AASM. 9 This is likely due in part by the numerous meta-analyses demonstrating robust clinical improvements across numerous sleep-related outcomes using individual, group, internet-based, and self-help CBT-I.…”

“…Brief therapies for insomnia, stimulus control, sleep restriction therapy, and relaxation therapy, and sleep hygiene ( Table 1 ) are all included as potential treatment options. 9 However, guidelines acknowledge that usefulness as a treatment for chronic insomnia is often based on a small body of low-quality evidence. 9 Further, their uses (except for sleep hygiene) are mostly indicated as single-component therapy.…”

“… 9 However, guidelines acknowledge that usefulness as a treatment for chronic insomnia is often based on a small body of low-quality evidence. 9 Further, their uses (except for sleep hygiene) are mostly indicated as single-component therapy.…”

Chronic Insomnia: Treatment with Transcranial Alternating Current Stimulation

“…At present non-drug therapy and drug therapy are usually used to treat chronic insomnia. Many patients with chronic insomnia have to take sedative hypnotic drugs for a long time to maintain sleep, and long-term use of drugs will bring a series of side effects and adverse reactions [4]. Therefore, it is necessary to find new effective non-drug treatments to improve the quality of sleep of chronic patients.…”