­ACP: New Clinical Practice Guideline for Treating Insomnia

The American College of Physicians (ACP) has published clinical practice guidelines for the management of chronic insomnia disorder in adults.

To create the guidelines, the ACP Clinical Guidelines Committee performed a systematic review of 3 randomized, controlled trials that included adults aged 18 years and older with chronic insomnia disorder and were published in English from 2004 through September 2015.
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The Committee evaluated global outcomes assessed by questionnaires, patient-reported sleep outcomes, and harms, and then graded the evidence based on the ACP grading system, which uses the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

As a result, the Committee made 2 recommendations:

1. Adult patients with chronic insomnia disorder should receive cognitive behavioral therapy (CBT-I) as the initial treatment.

The researchers found that in-person CBT-I was among the most effective treatment, and CBT-I generally improved global outcomes—including increased remission, increased treatment response, and improved sleep outcomes—in the general population.

2. If CBT-I is unsuccessful, clinicians should discuss the benefits, harms, and costs of short-term use of pharmacologic therapy to decide whether to add it to CBT-I.

The researchers found that added pharmacologic treatment improved sleep outcomes and, in some cases, improved global outcomes in the general population and in adults older than 55 years.

“Cognitive behavioral therapy for insomnia is an effective therapy for chronic insomnia disorder and can be performed and prescribed in the primary care setting,” they concluded.

“There is insufficient evidence to directly compare CBT-I and pharmacologic treatment. However, because CBT-I is noninvasive, it is likely to have fewer harms, whereas pharmacologic therapy can be associated with serious adverse events. Thus, CBT-I provides better overall value than pharmacologic treatment.”

—Amanda Balbi

Reference:

Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians [published online May 3, 2016].  Ann Intern Med. doi:10.7326/M15-2175.