A newly-published clinical practice guideline is the first from the American Academy of Sleep Medicine to provide evidence-based analyses of individual agents commonly used in the treatment of chronic insomnia disorder. The guideline does not recommend one drug over another since few comparative efficacy studies have been conducted among these agents.
Published in the Journal of Clinical Sleep Medicine, the includes 14 specific recommendations for individual agents, including prescription medications such as zolpidem and eszopiclone; over-the-counter medications such as diphenhydramine; and dietary supplements such as melatonin and valerian.
Each recommendation suggests whether clinicians should or should not use the individual drug for sleep onset insomnia or sleep maintenance insomnia, versus no treatment. The authors noted that the data available to support these recommendations is often less than certain. As a result, the strength of each recommendation is classified as “weak.”
The guideline emphasizes that medications for chronic insomnia disorder should be considered mainly in patients who are unable to participate in cognitive behavioral therapy for insomnia (CBT-I), patients who still have symptoms after this therapy, or those who require a temporary adjunct to CBT-I.
Developed by an expert task force and approved by the AASM board of directors, the guideline was based on a systematic literature review, meta-analyses, and assessment of the evidence using the GRADE methodology. A draft of the guideline was previously made available for public comment.
“The publication of this clinical practice guideline is an important step forward for the field of sleep medicine,” AASM President Ronald D. Chervin, MD, MS said in a press release about the guidelines.
Although transient insomnia symptoms occur in 30 to 35% of the population, the full clinical syndrome of chronic insomnia disorder occurs in about 10% of people.
Sateia MJ. Buysse DJ, Krystal AD. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. Clin Sleep Med. 2017;13(2):307–349.