CBT recommended as initial treatment; drugs should be considered if CBT unsuccessful
TUESDAY, May 3, 2016 (HealthDay News) — Cognitive behavioral therapy is recommended as the initial treatment for all adults with chronic insomnia disorder, according to a clinical practice guideline published online May 3 in the Annals of Internal Medicine.
Amir Qaseem, M.D., Ph.D., from the American College of Physicians (ACP) in Philadelphia, and colleagues conducted a systematic review of randomized controlled trials to develop recommendations on the management of chronic insomnia disorder in adults. Evaluated outcomes included questionnaire-assessed global outcomes, patient-reported sleep outcomes, and harms.
The researchers developed two recommendations for chronic insomnia disorder. All adult patients should receive cognitive behavioral therapy for insomnia (CBT-I) as the initial treatment (Grade: strong recommendation; moderate-quality evidence). In addition, clinicians should employ a shared decision-making approach, including discussion of the benefits, harms, and costs of short-term medication use, in order to decide whether to add pharmacologic therapy for adults in whom CBT-I alone was unsuccessful (Grade: weak recommendation; low-quality evidence).
“Cognitive behavioral therapy for insomnia is an effective treatment and can be initiated in a primary care setting,” ACP President Wayne J. Riley, M.D., M.P.H., said in a statement. “Although we have insufficient evidence to directly compare CBT-I and drug treatment, CBT-I is likely to have fewer harms. Sleep medications can be associated with serious adverse effects.”
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