Practice Guidelines

Behavioral and Psychological Treatments for Chronic Insomnia Disorder: Updated Guidelines From the American Academy of Sleep Medicine

 

Am Fam Physician. 2022 Jan ;105(1):97-98.

Author disclosure: No relevant financial relationships.

Key Points for Practice

• CBT for insomnia and brief therapies for insomnia improve sleep quality and increase remission in chronic insomnia disorder.

• Stimulus control, relaxation therapy, and sleep restriction therapy are components of CBT for insomnia that appear effective on their own.

• Sleep restriction can transiently increase fatigue and impair concentration and should be avoided in patients with high-risk occupations or with increased risk of mania or seizures.

• Typical sleep hygiene education is minimally effective in chronic insomnia disorder.

From the AFP Editors

Chronic insomnia is a common sleep disorder that causes impairment, and treatment historically has been limited to sleep hygiene recommendations. The American Academy of Sleep Medicine has updated its clinical practice guidelines on behavioral treatments for chronic insomnia disorder.

CBT for Insomnia

Cognitive behavior therapy (CBT) for insomnia has the best evidence for clinical treatment of chronic insomnia disorder. In CBT for insomnia, qualified therapists combine cognitive therapy strategies with stimulus control instructions and sleep restriction therapy. Often, CBT for insomnia also includes sleep hygiene education and relaxation therapy. It usually takes between four and eight sessions and requires the patient to keep sleep diaries to track adjustments and progress.

CBT for insomnia increases remission in chronic insomnia disorder compared with control while reducing sleep latency and increasing sleep time. Benefits appear to be durable over time and include a reduced need for medications. Harms of CBT for insomnia include transient increases in fatigue with irritability and cognitive disturbances. The sleep restriction element of therapy may be contraindicated for high-risk occupations and in patients predisposed to mania or seizures.

Shorter Therapies Based on CBT

BRIEF THERAPIES FOR INSOMNIA

Brief therapies for insomnia are abbreviated versions of CBT for insomnia that typically include

Author disclosure: No relevant financial relationships.

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

This series is coordinated by Michael J. Arnold, MD, contributing editor.

A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide.

 

 

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