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SLEEP 2026 | AASM guideline on combination treatment for chronic insomnia disorder in adults
Emerson Wickwire, PhD, University of Maryland, Baltimore, MD, discusses the recommendations in the new American Academy of Sleep Medicine (AASM) guideline on combination treatment for chronic insomnia disorder in adults. Prof. Wickwire notes two key recommendations but highlights the need for further research to determine which patients benefit from combination treatment. This interview took place at the 40th annual meeting of the Associated Professional Sleep Societies (APSS) in Baltimore, MD.
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Transcript
Combination treatment for chronic insomnia disorder includes both behavioral treatments as well as medication treatments, oftentimes administered concurrently, although at times sequentially. The task force reviewed the literature, and 15 studies were included in a meta-analysis, which resulted in a clinical practice guideline. There are two key recommendations. The first is that, generally speaking, it’s a conditional recommendation that combination treatment should be used over medication treatment alone...
Combination treatment for chronic insomnia disorder includes both behavioral treatments as well as medication treatments, oftentimes administered concurrently, although at times sequentially. The task force reviewed the literature, and 15 studies were included in a meta-analysis, which resulted in a clinical practice guideline. There are two key recommendations. The first is that, generally speaking, it’s a conditional recommendation that combination treatment should be used over medication treatment alone. And the second recommendation is that combination treatment should not be used over CBT-I alone. Now, what the key to keep in mind is, is that there are very few adequately powered clinical trials to answer these questions. And so the task force identified far more future research questions than there were clinical recommendations. Some of those key research questions to be asked and answered in the future are adequately powered clinical trials, comparative effectiveness research to look at the long-term outcomes. So who are the patients, if any, who benefit from combination treatment relative to either insomnia medication alone or CBT alone, looking at issues like durability of effects, and of course, looking at cost-benefit, broadly defined.
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