American Academy of Sleep Medicine

View all recommendations from this society

Released December 2, 2014; Updated December 21, 2021

Don’t offer hypnotics as the only initial therapy for chronic insomnia in adults. Use cognitive-behavioral therapy for insomnia (CBT-I), whenever possible, and use medications only when necessary.

Cognitive-behavioral therapy for insomnia (CBT-I) involves a combination of behavioral modification, such as stimulus control and sleep restriction, and cognitive strategies, such as replacement of fears about sleep with more positive expectations. Clinical trials show that CBT-I can be equally or more effective than hypnotics over an extended period of time without associated side effects. Medication alone or in combination with CBT-I may be necessary for some patients, after considering prior treatment responses, availability of CBT-I resources, and patient preferences.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The Executive Committee of the American Academy of Sleep Medicine developed 21 candidate recommendations for ways in which medical waste could be minimized while care for patients with sleep disorders is improved. Members of the Executive Committee then voted to assign priorities to each, and the top five were selected. Final wording of the five statements were approved by the full Board of Directors of the American Academy of Sleep Medicine in 2014. The American Academy of Sleep Medicine developed rationale and references for each recommendation. The final statements, explanations and citations were approved by a final vote of the Board of Directors. The list was reviewed and updated by the Guidelines Advisory Panel with final revisions approved by the Executive Committee in 2021.

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Sivertsen B, Omvik S, Pallesen S, et al. Cognitive behavioral therapy vs zopiclone for treatment of chronic primary insomnia in older adults: a randomized controlled trial. JAMA. 2006 Jun 28;295(14):2851-8.

Morin CM, Valliéres A, Guay B, et al. Cognitive behavioral therapy, singly and combined with medication, for persistent insomnia: a randomized controlled trial. JAMA 2009 May 29;301(19):2005-15.