Insomnia Treatment Guidelines

First-Line Treatment: Non-Pharmacological Approaches

The American Academy of Sleep Medicine recommends cognitive behavioral therapy for insomnia (CBT-I) as the initial intervention for treating insomnia, which includes components such as stimulus control therapy, sleep restriction therapy, cognitive therapy, and relaxation techniques 1
Sleep hygiene alone is insufficient for treating chronic insomnia but should be used in combination with other therapies, according to the American Academy of Sleep Medicine 1
Other effective behavioral interventions include paradoxical intention and biofeedback therapy, as suggested by the American Academy of Sleep Medicine 1

The American Academy of Sleep Medicine recommends selecting medications based on symptom pattern, treatment goals, past responses, patient preference, cost, comorbidities, contraindications, and potential side effects when pharmacological treatment is necessary 1
For sleep onset insomnia, the American Academy of Sleep Medicine suggests zaleplon 10 mg, zolpidem 10 mg, ramelteon 8 mg, or triazolam 0.25 mg 2
For sleep maintenance insomnia, the American Academy of Sleep Medicine recommends eszopiclone 2-3 mg, zolpidem 10 mg, or temazepam 15-30 mg (7.5 mg for elderly or debilitated patients) 2
Doxepin 3-6 mg is recommended for sleep maintenance insomnia by the American Academy of Sleep Medicine 2
Trazodone is not recommended (50 mg dose) despite common use in clinical practice, according to the American Academy of Sleep Medicine 2

The American Academy of Sleep Medicine does not recommend over-the-counter antihistamines (diphenhydramine) for chronic insomnia 1, 2
Melatonin (2 mg dose), valerian, and L-tryptophan are not recommended for chronic insomnia by the American Academy of Sleep Medicine 2
Barbiturates and chloral hydrate are not recommended for chronic insomnia, as stated by the American Academy of Sleep Medicine 1

The American Academy of Sleep Medicine suggests following patients regularly (every few weeks initially) to assess effectiveness, side effects, and need for ongoing medication 1
Pharmacological treatment should be supplemented with behavioral and cognitive therapies when possible, according to the American Academy of Sleep Medicine 1
Patient education should include treatment goals, safety concerns, potential side effects, drug interactions, and rebound insomnia potential, as recommended by the American Academy of Sleep Medicine 1