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.”
- 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.
- 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
- 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
- Kathol RG, Arnedt JT. Cognitive Behavioral Therapy for Chronic Insomnia: Confronting the Challenges to Implementation. Ann Intern Med. 2016; doi: 10.7326/M16-0359