The American Academy of Sleep Medicine (AASM) is inviting public comment on drafts of a clinical practice guideline on the Behavioral and Psychological Treatments for Chronic Insomnia Disorder in Adults and accompanying systematic review. Learn more here: https://aasm.org/aasm-invites-public-comment-on-the-draft-guideline-for-behavioral-and-psychological-treatments-for-chronic-insomnia-disorder-in-adults
The draft guidelines from AASM note: “We recommend that clinicians use multicomponent cognitive-behavioral therapy for insomnia for the treatment of chronic insomnia disorder in adults.“
They concluded that “Cognitive Behavioral Therapy for Insomnia (CBT-I) is generally regarded as the treatment of choice, has the most evidence available in the literature and is the only approach to receive a Strong recommendation.”
“CBT-I combines one or more of the cognitive therapy strategies with education about sleep regulation plus stimulus control instructions and sleep restriction therapy. CBT-I also often includes sleep hygiene education, relaxation training and other counter-arousal methods. Treatment progresses using information typically gathered with sleep diaries completed by the patient throughout the course of treatment (typically 4-8 sessions).”
They go on to note that “while cost of treatment varies by delivery method, the cost-effectiveness of CBT-I is favorable, as CBT-I is a time-limited treatment, and the limited available data suggests significant costs of untreated chronic insomnia disorder. The clinical consensus of the task force was that CBT-I is preferred because it has superior long-term effectiveness and improvement in symptoms with minimal side effects as compared to control conditions. Based on their clinical experience, the TF determined that the vast majority of well-informed patients would choose CBT-I for the treatment of chronic insomnia disorder.”
The draft guidelines also note “some of the challenges patients face when undergoing any of these psychological treatments include the ability to
attend sessions and adhere to treatment recommendations. In most cases, a noticeable improvement in insomnia symptoms is not immediate (as is the case with pharmacological interventions), and CBT-I treatment typically
ranges from 4-8 visits on a near-weekly basis, both of which may serve as barriers to treatment completion. Patients may also get discouraged if immediate results are not observed. It is important for the treating provider to recognize these challenges and help set realistic expectations before starting treatment. When discussing treatment options for chronic insomnia disorder, patients should be reminded that psychological and behavioral insomnia therapies produce more gradual improvements in insomnia symptoms compared to pharmacotherapy, yet unlike pharmacotherapy, the benefits are durable beyond the end of treatment and initial undesirable effects are typically mild and resolve quickly for most patients.”
You can learn more about CBT-I treatment with Dr. Finnerty at http://www.toddfinnerty.com/CBT-I.html