Practice Guidelines

Treatment of Chronic Insomnia in Adults: ACP Guideline


Am Fam Physician. 2017 May 15;95(10):669-670.

Author disclosure: No relevant financial affiliations.

Key Points for Practice

• Cognitive behavior therapy should be the initial treatment option in persons with chronic insomnia.

• Data were insufficient to establish the comparative safety of one pharmacologic treatment over another.

• The choice to use medications should be based on shared decision making, and prescriptions should be limited to five weeks or less.

From the AFP Editors

A diagnosis of chronic insomnia, also called chronic insomnia disorder, is based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th ed., and the International Classification of Sleep Disorders. These indicate that symptoms occur three or more nights per week for three or more months and cause significant functional distress or impairment. The symptoms are not associated with other disorders, such as sleep or mental conditions. Only 6% to 10% of persons have insomnia with these criteria.

Treatment, which can include psychological or pharmacologic therapy, alone or combined, as well as complementary and alternative methods, is aimed at improving sleep, distress, and dysfunction. The American College of Physicians (ACP) has provided recommendations for treatment of chronic insomnia in adults.


Cognitive behavior therapy (CBT) should be the initial treatment option in persons with chronic insomnia. Although data were limited overall regarding psychological therapies, moderate-quality evidence indicated that CBT (e.g., in-person therapy, telephone and web-based therapy, self-help books) improved remission, response to treatment, wake after sleep onset, sleep onset latency, and sleep efficiency and quality. However, data were insufficient to establish whether one psychological treatment method was superior. In persons older than 55 years, who more commonly present with wake after sleep onset than sleep onset latency, moderate-quality evidence indicated that sleep index scores improved in those receiving CBT vs. those not receiving CBT. The harms of

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Associate Deputy Editor.

A collection of Practice Guidelines published in AFP is available at



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May 15, 2018

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