New Guideline Clarifies the Role of CBT-I in Chronic Insomnia

A new clinical practice guideline from the American Academy of Sleep Medicine indicates that cognitive behavioral therapy for insomnia (CBT-I) alone remains the most effective first-line treatment for chronic insomnia, while adding medication may offer modest benefits for select outcomes such as total sleep time. The guideline is supported by a systematic review and meta-analysis evaluating the efficacy and harms of combining behavioral-psychological and pharmacological therapies. Earlier guidelines recommended CBT-I and medications as separate options but did not assess their combined use, despite its common adoption in clinical practice. The updated analysis found that combination therapy may improve certain sleep parameters compared with medication alone, but does not outperform CBT-I alone, which provides durable benefits without medication-related risks. Accordingly, the guideline issues two conditional recommendations with low certainty: it suggests combination therapy over medication alone, but recommends against it when compared to CBT-I alone. Given that chronic insomnia affects 10%–15% of adults, the guideline emphasizes shared decision-making, encouraging clinicians and patients to tailor treatment strategies based on individual preferences, goals, and risk considerations. Source: https://link.springer.com/