ConexiantNew Guidance on Chronic Insomnia Treatment

✅ Guideline Update

The American Academy of Sleep Medicine issued two new conditional recommendations for chronic insomnia disorder in adults. CBT-I remains preferred first-line; combination therapy is favored over pharmacotherapy alone but not over CBT-I alone.

Clinical Considerations

• Combination CBT-I plus medication produced small, clinically meaningful improvements over pharmacotherapy alone in global insomnia severity and sleep continuity.
• Adding medication to CBT-I did not yield clinically meaningful improvements in severity, continuity, or daytime functioning, despite short-term total sleep time gains.
• Combination treatment carried slightly higher adverse effects, particularly morning sleepiness, compared with CBT-I alone.
• Newer dual orexin receptor antagonists were not studied in combination with CBT-I; most trial data come from older hypnotics.

Practice Applications

• Recommend CBT-I as first-line for chronic insomnia disorder when access permits.
• Consider combination therapy for patients prioritizing rapid symptom relief or short-term sleep time gains.
• Reserve pharmacotherapy alone for patients unable to access or engage with CBT-I.
• Integrate shared decision-making given conditional recommendations and patient-specific access barriers.

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