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Behavioral and psychological treatments for chronic insomnia disorder in adults-AASM guidelines

Written By : Hina Zahid |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2021-01-24T19:45:15+05:30  |  Updated On 25 Jan 2021 12:15 PM IST
Behavioral and psychological treatments for chronic insomnia disorder in adults-AASM guidelines
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DARIEN, IL - The American Academy of Sleep Medicine has published a new clinical practice guideline establishing recommendations for the use of behavioral and psychological treatments for chronic insomnia disorder in adults.

The guideline updates the AASM's 2006 practice parameters. It was developed by an expert task force and approved by the AASM board of directors. The process included a systematic literature review, meta-analyses, and assessment of the evidence using the GRADE methodology. A draft of the guideline was made available for public comment.

The guidelines have been published in the Journal of Clinical Sleep Medicine.

Insomnia involves difficulty falling asleep or staying asleep, or regularly waking up earlier than desired, despite allowing enough time in bed for sleep. Daytime symptoms include fatigue or sleepiness; feeling dissatisfied with sleep; having trouble concentrating; feeling depressed, anxious, or irritable; and having low motivation or energy. Chronic insomnia disorder, which affects about 10 percent of the adult population, is distinguished by a sleep disturbance with associated daytime symptoms occurring at least three times per week for at least three months.

The guideline includes one strong recommendation -- which is one that clinicians should follow under most circumstances -- for the use of cognitive behavioral therapy for insomnia. CBT-I combines one or more cognitive therapy strategies with education about sleep regulation plus behavioral strategies such as stimulus control instructions and sleep restriction therapy. Treatment typically involves four to eight sessions.

"There have been significant advancements in behavioral and psychological treatments for chronic insomnia, which affects millions of American adults," said AASM President Dr. Kannan Ramar. "The AASM guideline will help optimize patient-centered care by providing actionable recommendations for clinicians and patients."

The guideline includes several conditional recommendations -- which require the clinician to use clinical knowledge and experience while considering the patient's values and preferences -- suggesting that clinicians use multi-component brief therapies and three single-component therapies: stimulus control, sleep restriction therapy, and relaxation therapy. The guideline also suggests that sleep hygiene should not be used as a single-component treatment for chronic insomnia disorder in adults.

"Although sleep hygiene practices are often suggested and well-understood by patients, sleep hygiene recommendation do not constitute an effective stand-alone therapy," said Edinger.


Recommendations-

The following recommendations are intended as a guide for clinicians in choosing a specific behavioral and psychological therapy for the treatment of chronic insomnia disorder in adult patients. Each recommendation statement is assigned a strength ("strong" or "conditional"). A "strong" recommendation (ie, "We recommend…") is one that clinicians should follow under most circumstances. A "conditional" recommendation is one that requires that the clinician use clinical knowledge and experience, and to strongly consider the patient's values and preferences to determine the best course of action.

1. We recommend that clinicians use multi-component cognitive behavioral therapy for insomnia for the treatment of chronic insomnia disorder in adults. (STRONG)

2. We suggest that clinicians use multi-component brief therapies for insomnia for the treatment of chronic insomnia disorder in adults. (CONDITIONAL)

3. We suggest that clinicians use stimulus control as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL)

4. We suggest that clinicians use sleep restriction therapy as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL)

5. We suggest that clinicians use relaxation therapy as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL)

6. We suggest that clinicians not use sleep hygiene as a single-component therapy for the treatment of chronic insomnia disorder in adults. (CONDITIONAL)

The AASM's previously published clinical practice guideline for the pharmacologic treatment of chronic insomnia also emphasizes that medications for chronic insomnia disorder should be considered mainly in patients who are unable to participate in CBT-I, patients who still have symptoms after this therapy, or those who require a temporary adjunct to CBT-I.

https://jcsm.aasm.org/doi/10.5664/jcsm.8986


journal of clinical sleep medicinechronic insomnia disordersleep hygiene practicesbehavioral and psychological treatmentsfatiguesleepiness
Source : Journal of Clinical Sleep Medicine
Hina Zahid
Hina Zahid

    Hina Zahid Joined Medical Dialogue in 2017 with a passion to work as a Reporter. She coordinates with various national and international journals and association and covers all the stories related to Medical guidelines, Medical Journals, rare medical surgeries as well as all the updates in the medical field. Email: editorial@medicaldialogues.in. Contact no. 011-43720751

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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