AASM Guidelines on Combination Therapy for Chronic Insomnia Presented at SLEEP 2026

Cognitive behavioral therapy for insomnia (CBT-I) has traditionally been the first-line treatment, while medications are generally considered a second-line option. Despite existing clinical practice guidelines for both CBT-I and pharmacological treatments, clinicians often utilize combination therapies that include both behavior-focused and medication-based strategies. However, formal guidance on effectively implementing these combinations has been limited until recently.

During her presentation titled “Implementing The AASM Guideline for Combination Treatment of Chronic Insomnia: Evidence, Challenges, and Gaps,” Patel highlighted that the new AASM guideline offers structured, evidence-based recommendations for combining CBT-I with pharmacological interventions. This guideline was developed using systematic reviews and GRADE methodology to address critical gaps in previous recommendations.

In an interview with NeurologyLive®, Patel outlined the guideline’s two conditional recommendations. The task force advises that using a combination of CBT-I and medication is more beneficial than pharmacological treatment alone in adults with chronic insomnia. However, they do not endorse routinely recommending combination therapy over CBT-I used independently.

Patel also pointed out several evidence gaps, including the presence of small and less generalizable randomized controlled trials, insufficient data on sequential treatment approaches, and the exclusion of newer pharmacological agents. She emphasized that, while guidelines are valuable, individualized care remains paramount for treating patients effectively.

For more insights from SLEEP 2026, further coverage is available.