ACP Recommends CBT Treatment for Chronic Insomnia Disorder

HealthDay News — Cognitive behavioral therapy is recommended as the initial treatment for all adults with chronic insomnia disorder, according to a clinical practice guideline published online May 3 in the Annals of Internal Medicine.

Amir Qaseem, MD, PhD, from the American College of Physicians (ACP) in Philadelphia, and colleagues conducted a systematic review of randomized controlled trials to develop recommendations on the management of chronic insomnia disorder in adults. Evaluated outcomes included questionnaire-assessed global outcomes, patient-reported sleep outcomes, and harms.

The researchers developed 2 recommendations for chronic insomnia disorder. All adult patients should receive cognitive behavioral therapy for insomnia (CBT-I) as the initial treatment (Grade: strong recommendation; moderate-quality evidence). In addition, clinicians should employ a shared decision-making approach, including discussion of the benefits, harms, and costs of short-term medication use, in order to decide whether to add pharmacologic therapy for adults in whom CBT-I alone was unsuccessful (Grade: weak recommendation; low-quality evidence).

“Cognitive behavioral therapy for insomnia is an effective treatment and can be initiated in a primary care setting,” ACP President Wayne J. Riley, MD, MPH, said in a statement. “Although we have insufficient evidence to directly compare CBT-I and drug treatment, CBT-I is likely to have fewer harms. Sleep medications can be associated with serious adverse effects.”

References

1. Qaseem A, Kansagara D, Forceia MA, et al. Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2016; doi: 10.7326/M15-2175. 
2. Brasure M, Fuchs E, MacDonald R, et al. Psychological and Behavioral Interventions for Managing Insomnia Disorder: An Evidence Report for a Clinical Practice Guideline by the American College of Physicians. Ann Intern Med. 2016; doi: 10.7326/M15-1782
3. Wilt TJ, MacDonald R, Brasure M, et al. Pharmacologic Treatment of Insomnia Disorder: An Evidence Report for a Clinical Practice Guideline by the American College of Physicians. Ann Intern Med. 2016; doi: 10.7326/M15-1781
4. Kathol RG, Arnedt JT. Cognitive Behavioral Therapy for Chronic Insomnia: Confronting the Challenges to Implementation. Ann Intern Med. 2016; doi: 10.7326/M16-0359