Insomnia Treatment Guidelines

Recommended First-Line Treatments

The American Academy of Sleep Medicine recommends Cognitive Behavioral Therapy for Insomnia (CBT-I) as the first-line treatment for chronic insomnia, which has been shown to be more effective than pharmacotherapy in the long term 1, 2
Brief Behavioral Treatment for Insomnia (BBT-I) focusing on behavioral components can also be effective for treating insomnia 3

The American Academy of Sleep Medicine recommends short-intermediate acting benzodiazepine receptor agonists or ramelteon as the first pharmacological option for patients unable or unwilling to receive CBT-I, which have demonstrated positive effects on sleep latency, total sleep time, and/or wake after sleep onset 1, 4
Low-dose doxepin (3 or 6 mg) is recommended as a second pharmacological option, which has been shown to improve insomnia severity, sleep latency, and sleep quality 2
Sedating antidepressants, such as trazodone, amitriptyline, doxepin, and mirtazapine, are recommended as a third pharmacological option, particularly for patients with comorbid depression or anxiety 1, 5

The American Academy of Sleep Medicine recommends that sleep hygiene education be used in combination with other therapies, as it is not effective for treating chronic insomnia on its own 1
Over-the-counter antihistamines or herbal supplements, such as valerian and melatonin, are not recommended for chronic insomnia due to lack of efficacy and safety data 1, 6
Older medications, including barbiturates, barbiturate-type drugs, and chloral hydrate, are not recommended due to significant adverse effects 1, 5
Pharmacotherapy should be supplemented with behavioral and cognitive therapies when possible, and long-term medication use should be accompanied by consistent follow-up and monitoring for adverse effects 1