AASM: Drug Therapy Guidelines for Treating Chronic Insomnia

The guidelines include recommendations for prescription and over-the-counter medications
The guidelines include recommendations for prescription and over-the-counter medications

The American Academy of Sleep Medicine (AASM) has issued clinical practice guidelines on the pharmacologic treatment of chronic insomnia in adults. The recommendations, which are published in the Journal of Clinical Sleep Medicine, were developed by an expert task force to help clinicians choose a specific drug therapy based on evidence-based analyses. 

The panel recommends that treatment of chronic insomnia with medication should be considered for patients who are unable to participate in cognitive behavioral therapy for insomnia (CBT-I), for those who have symptoms after this therapy, or for those who need a temporary adjunct to CBT-I. In the 2014 Choosing Wisely statement released by the AASM, CBT-I was mentioned as an effective treatment that should be used as an initial intervention for chronic insomnia. 

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The new guidelines include 14 recommendations for both prescription and over-the-counter medications with suggestions on whether clinicians should use the drugs for sleep onset or sleep maintenance insomnia as compared to no treatment at all. Since few comparative efficacy studies have been conducted, the guidelines do not recommend one therapy over another. 

For the treatment of sleep onset insomnia, the following therapies may be used:

  • Eszopiclone
  • Zaleplon
  • Zolpidem
  • Triazolam
  • Temazepam
  • Ramelteon

For the treatment of sleep maintenance insomnia, the following therapies may be used:

  • Suvorexant
  • Eszopiclone
  • Zolpidem
  • Temazepam
  • Doxepin

The following treatments are NOT recommended for sleep onset or sleep maintenance insomnia:

  • Trazodone
  • Tiagabine
  • Diphenhydramine
  • Melatonin
  • Tryptophan
  • Valerian

While data is available to support these guidelines, each recommendation is considered to be "weak", therefore clinicians should still use their clinical judgement when prescribing, and take into account an individual patient's circumstances. 

"The publication of this clinical practice guideline is an important step forward for the field of sleep medicine," 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."

To access the full guidelines visit www.aasmnet.org.