Cognitive Behavioral Therapy for Insomnia

Diagnosis and Treatment

The American Academy of Sleep Medicine recommends Cognitive Behavioral Therapy for Insomnia (CBT-I) as the first-line treatment for chronic insomnia disorder, characterized by sleep maintenance difficulties and early morning awakening, due to its superior long-term efficacy compared to medications 1, 2
The diagnosis of chronic insomnia disorder is based on features such as sleep maintenance difficulties, early morning awakening, duration of symptoms (≥3 nights per week for ≥3 months), and daytime consequences like fatigue and poor concentration, as outlined by the American Academy of Sleep Medicine 3, 4, 5
The American Academy of Sleep Medicine suggests that a detailed sleep history, including pre-sleep behaviors, bedroom environment, and mental state at bedtime, is essential for diagnosing and treating insomnia 4, 5

The American Academy of Sleep Medicine recommends obtaining 7-14 days of sleep diary data to document sleep patterns, including bedtime, sleep latency, number and duration of awakenings, and sleep efficiency, to provide objective baseline data and engage the patient in treatment 5, 3
A medication and substance review, including screening for stimulants, cardiovascular medications, antidepressants, and alcohol use, is necessary to identify potential contributors to insomnia, as suggested by the American Academy of Sleep Medicine 4, 5, 6

The American Academy of Sleep Medicine and the American College of Physicians recommend CBT-I as the first-line treatment for insomnia, which includes components such as stimulus control therapy, sleep restriction therapy, cognitive restructuring, and sleep hygiene education, with a strong recommendation based on high-quality evidence 1, 2, 5, 7
The American Academy of Sleep Medicine suggests that CBT-I can be delivered through individual therapy, group therapy, telephone-based delivery, web-based/digital programs, or self-help books, making it accessible even in resource-limited settings 1, 2, 7

The American Academy of Sleep Medicine recommends that pharmacotherapy should only supplement, never replace, CBT-I, and should be considered if CBT-I is insufficient after 4-6 weeks or if severe symptoms require immediate relief, with a weak recommendation based on low-quality evidence 7, 2
The American Academy of Sleep Medicine suggests that first-line pharmacotherapy options for combined sleep onset and maintenance insomnia include eszopiclone, zolpidem, and temazepam, with a weak recommendation based on low-quality evidence 7