Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians.
Level 1 - systematic review of randomized trials
Clinical practice guideline based on a systematic review of randomized controlled trials
PubMed 27136449 · doi:10.7326/M15-2175
What was done
The American College of Physicians (ACP) developed clinical recommendations for managing chronic insomnia disorder in adults based on a systematic review of randomized controlled trials published in English between 2004 and September 2015. Evaluated endpoints included questionnaire-assessed global outcomes, patient-reported sleep measures, and adverse effects. Recommendations and underlying evidence were evaluated using the GRADE-based ACP grading framework.
What was found
The abstract reports no numerical effect sizes or quantitative outcome data. It details two clinical recommendations: - Cognitive behavioral therapy for insomnia (CBT-I) is recommended as the initial treatment for all adult patients with chronic insomnia disorder (Grade: strong recommendation, moderate-quality evidence). - A shared decision-making approach discussing the benefits, harms, and costs of short-term medications is recommended to decide whether to add pharmacotherapy when CBT-I alone is unsuccessful (Grade: weak recommendation, low-quality evidence).
Why it matters
This guideline establishes CBT-I as the primary standard of care for adult chronic insomnia, restricting medication use to an adjunctive, second-line role guided by shared decision-making.
Limits
The abstract reports no numerical trial counts, participant sample sizes, or quantitative outcome measures. The underlying literature search was restricted to English-language randomized trials published between 2004 and September 2015. Evidence supporting the pharmacological recommendation was graded as low-quality.
Cited by
- supports The American College of Physicians established that Cognitive Behavioral Therapy for Insomnia (CBT-I) should be the first-line treatment for insomnia before sleep medications are prescribed.