New guideline provides clinical recommendations for specific insomnia drugs

February 15, 2017

A new clinical practice guideline is the first from the American Academy of Sleep Medicine to provide comprehensive, evidence-based analyses of individual agents commonly used in the treatment of chronic insomnia disorder.

The guideline, which is published in the Feb. 15 issue of the Journal of Clinical Sleep Medicine, provides recommendations to help clinicians choose a specific pharmacological agent for the treatment of chronic insomnia in adults, when such treatment is indicated. 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 is an important step forward for the field of ," said AASM President Ronald D. Chervin, MD, MS. "It further equips clinicians to provide high quality, patient-centered care for millions of people who suffer from chronic insomnia."

Although transient insomnia symptoms occur in 30 to 35 percent of the population, the full clinical syndrome of chronic insomnia disorder occurs in about 10 percent of people. The CDC has estimated that 4.1 percent of U.S. adults report having taken a prescription sleep aid in the past month, based on survey data collected from 2005 - 2010.

The guideline 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. However, the guideline does not recommend one drug over another since few comparative efficacy studies have been conducted among these agents.

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," reflecting a lower degree of certainty in the appropriateness of the patient-care strategy. Therefore, clinicians must continue to exercise sound clinical judgment in their care for patients with chronic insomnia. Decisions should be based not only on these recommendations but also on a clinician's experience and the individual circumstances presented by the patient.

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. A clinical guideline previously published by the American Academy of Sleep Medicine indicates that CBT-I is an effective treatment that should be utilized as an initial intervention for , and this position was reiterated by the AASM in a 2014 Choosing Wisely statement.

Anyone who is having trouble falling asleep or staying asleep should discuss the concern with a doctor. Help for an ongoing sleep problem is available from more than 2,500 sleep centers that are accredited by the American Academy of Sleep Medicine.

Explore further: New clinical guideline to help clinicians treat circadian rhythm sleep-wake disorders

More information: Michael J. Sateia et al, Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American Academy of Sleep Medicine Clinical Practice Guideline, Journal of Clinical Sleep Medicine (2017). DOI: 10.5664/jcsm.6470

Related Stories

New clinical guideline to help clinicians treat circadian rhythm sleep-wake disorders

October 14, 2015
A new clinical practice guideline published by the American Academy of Sleep Medicine provides clinicians with updated recommendations for the treatment of intrinsic circadian rhythm sleep-wake disorders (CRSWDs).

Study finds that melatonin content of supplements varies widely

February 14, 2017
A new study suggests that the melatonin content of dietary supplements often varies widely from what is listed on the label.

Insomnia linked to higher risk of developing asthma

February 1, 2017
People experiencing insomnia symptoms have a higher risk of developing asthma, according to a new study published in the European Respiratory Journal.

Insomnia prevalent in patients with asthma

December 8, 2016
A team of researchers from the University of Pittsburgh has found that insomnia is highly prevalent in adults with asthma and is also associated with worse asthma control, depression and anxiety symptoms and other quality ...

Sleep is key to curing chronic pain

September 21, 2016
Research from the University of Warwick reveals that the way chronic pain patients think about pain and sleep leads to insomnia and poor management of pain.

Recommended for you

Breathing dirty air may harm kidneys, study finds

September 21, 2017
Outdoor air pollution has long been linked to major health conditions such as heart disease, stroke, cancer, asthma and chronic obstructive pulmonary disease. A new study now adds kidney disease to the list, according to ...

Excess dietary manganese promotes staph heart infection

September 21, 2017
Too much dietary manganese—an essential trace mineral found in leafy green vegetables, fruits and nuts—promotes infection of the heart by the bacterium Staphylococcus aureus ("staph").

Being active saves lives whether a gym workout, walking to work or washing the floor

September 21, 2017
Physical activity of any kind can prevent heart disease and death, says a large international study involving more than 130,000 people from 17 countries published this week in The Lancet.

Frequent blood donations safe for some, but not all

September 21, 2017
(HealthDay)—Some people may safely donate blood as often as every eight weeks—but that may not be a healthy choice for all, a new study suggests.

Higher manganese levels in children correlate with lower IQ scores, study finds

September 21, 2017
A study led by environmental health researchers at the University of Cincinnati (UC) College of Medicine finds that children in East Liverpool, Ohio with higher levels of Manganese (Mn) had lower IQ scores. The research appears ...

One e-cigarette with nicotine leads to adrenaline changes in nonsmokers' hearts

September 20, 2017
A new UCLA study found that healthy nonsmokers experienced increased adrenaline levels in their heart after one electronic cigarette (e-cigarette) with nicotine but there were no increased adrenaline levels when the study ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.