USA: The American Academy of Sleep Medicine (AASM) has released an updated guideline on the treatment of chronic insomnia disorder in adults. The guideline updates the AASM's 2006 practice parameters. It was developed by an expert task force and approved by the AASM board of directors. The process included a systematic literature review, meta-analyses, and assessment of the evidence using the GRADE methodology.
The guideline, published in the Journal of Clinical Sleep Medicine, stresses on the use of multi component cognitive behavioral therapy for insomnia (CBT-I). CBT-I combines cognitive therapies with education about sleep regulation plus behavioral strategies such as stimulus control instructions and sleep restriction therapy. Treatment typically involves four to eight sessions.
Other key recommendations include:
Clinicians are suggested to use multi-component cognitive behavioral therapy for insomnia for the treatment of chronic insomnia disorder in adults.
Clinicians are suggested to use multi-component brief therapies for insomnia for the treatment of chronic insomnia disorder in adults.
Clinicians are suggested to use stimulus control as a single-component therapy for the treatment of chronic insomnia disorder in adults.
Clinicians are suggested to use sleep restriction therapy as a single-component therapy for the treatment of chronic insomnia disorder in adults.
Clinicians are suggested to use relaxation therapy as a single-component therapy for the treatment of chronic insomnia disorder in adults.
Clinicians are not suggested to use sleep hygiene as a single-component therapy for the treatment of chronic insomnia disorder in adults.
"This is the first systematic review to use the GRADE system to evaluate behavioral insomnia therapies," said lead author Jack Edinger, who has a doctorate in clinical psychology and is a professor in the section of sleep medicine at National Jewish Health in Denver. "The multicomponent treatment, cognitive behavioral therapy for insomnia, is the most supported therapy."
"There have been significant advancements in behavioral and psychological treatments for chronic insomnia, which affects millions of American adults," said AASM President Dr. Kannan Ramar. "The AASM guideline will help optimize patient-centered care by providing actionable recommendations for clinicians and patients."
The guideline includes several conditional recommendations — which require the clinician to use clinical knowledge and experience while considering the patient's values and preferences — suggesting that clinicians use multi-component brief therapies and three single-component therapies: stimulus control, sleep restriction therapy, and relaxation therapy. The guideline also suggests that sleep hygiene should not be used as a single-component treatment for chronic insomnia disorder in adults.
"Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline," is published in the Journal of Clinical Sleep Medicine.
DOI: https://jcsm.aasm.org/doi/10.5664/jcsm.8986