AASM Issues New Guidelines for Treating Chronic Insomnia

Prior AASM guidelines from 2017 and 2021 supported pharmacological therapy and behavioral treatments such as cognitive behavioral therapy for insomnia (CBT-I) as standalone options, without exploring the benefits of combined approaches. Despite the lack of comparative studies, the combination of medications and CBT-I is frequently employed in clinical settings.

Dr. Daniel J. Buysse, the lead author and a professor at the University of Pittsburgh, noted, "Combination therapy for insomnia is widely used in clinical practice, yet the evidence guiding how and when to combine treatments has been surprisingly limited. Our analysis suggests that CBT-I is the most effective first-line treatment for insomnia, but using medication alongside CBT-I may yield modest benefits for certain outcomes like total sleep time." He emphasized that these recommendations are intended to promote patient-centered decision-making.

Chronic insomnia disorder affects about 10% to 15% of adults and is often encountered in both primary care and sleep medicine practices.

The guideline makes two conditional recommendations based on limited evidence. It suggests using a combination of CBT-I and medication instead of medication alone, which may lead to better sleep outcomes for some patients. However, the guideline advises against using combination therapy in lieu of CBT-I alone, given that the latter can provide significant and lasting improvements without the risks associated with medication. Shared decision-making that considers patient values and preferences is underscored in the recommendations.

AASM developed the guideline through a task force of sleep medicine experts who reviewed the relevant literature, assessing both benefits and harms of combination therapy alongside patient preferences. The draft was open for public feedback before receiving final approval from the AASM board.

Support for the guideline has been affirmed by various organizations, including the American Academy of Family Physicians and the American Geriatrics Society, alongside endorsements from several medical associations involved in sleep health.

The guideline's co-authors include experts in the field such as J. Todd Arnedt, Luis Buenaver, and Dr. Judy L. Chang. It was published on April 13, 2026.

For interview arrangements with Dr. Buysse or AASM representatives, inquiries can be directed to the AASM at [email protected]. Established in 1975, the AASM is dedicated to enhancing sleep care and health, with over 9,500 members and accreditation of 2,300 sleep centers nationwide.