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SLEEP 2026 | VA/DOD clinical practice guidelines for the management of chronic insomnia disorder and OSA
Michael Mak, MD, FRCPC, DRCPSC, FCPA, FAASM, University of Toronto, Toronto, Canada, discusses the key takeaways from VA/DOD clinical practice guidelines for the management of chronic insomnia disorder and obstructive sleep apnea (OSA). Dr Mak highlights cognitive behavioral therapy (CBTI) as the first-line treatment for insomnia, and the consideration of pharmacotherapy for patients who cannot access or have not responded to CBTI. This interview took place at the 40th annual meeting of the Associated Professional Sleep Societies (APSS) in Baltimore, MD.
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Transcript
The key takeaway for the recently released VA and DOD, insomnia and sleep apnea guidelines, they remind us to use cognitive behavioral therapy for insomnia as a first-line treatment. Barring that, if you’re not able to access CBTI, brief behavioral therapy, which is the distilled version of that kind of therapy, can also be used. The guidelines specifically state not to use sleep hygiene education by itself as a treatment for chronic insomnia disorder, meaning that these are people that meet the criteria for having problems falling asleep or staying asleep, waking up too early three times a week for three months straight, causing daytime distress...
The key takeaway for the recently released VA and DOD, insomnia and sleep apnea guidelines, they remind us to use cognitive behavioral therapy for insomnia as a first-line treatment. Barring that, if you’re not able to access CBTI, brief behavioral therapy, which is the distilled version of that kind of therapy, can also be used. The guidelines specifically state not to use sleep hygiene education by itself as a treatment for chronic insomnia disorder, meaning that these are people that meet the criteria for having problems falling asleep or staying asleep, waking up too early three times a week for three months straight, causing daytime distress. If you have that kind of insomnia, sleep hygiene by itself is not going to help. So outside of the first-line treatments, which include the psychological therapies, the guidelines do suggest some pharmacotherapy. So there they discuss, you know, consider trialing the three DORA medications, i.e. suvorexant, lemborexant, and daridorexant. And then for people’s sleep maintenance issues, doxepin, which is a sedating antidepressant medication. And then there’s the three Z drugs, eszopiclone, zaleplon, and zolpidem. So those are the types of medications that you can choose to try if you have a patient that needs short-term treatments that are maybe unable to engage in psychological treatments or where they’ve tried the psychological treatments and didn’t work out.
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