New guidelines from the American College of Physicians suggest cognitive behavioral therapy first, and not medication, should be used to treat insomnia.

Specifically, the ACP recommends that all adult patients with chronic insomnia receive sleep-related cognitive behavioral therapy (CBT) as initial treatment (Grade: strong recommendation, moderate-quality evidence), with shared decision making, including discussion of the benefits and risks of sleep medication, to decide whether adding drug treatment is appropriate when CBT alone is unsuccessful (Grade: weak recommendation, low-quality evidence), according to Amir Qaseem, MD, PhD, MHA, and colleagues, of the Clinical Guidelines Committee of the ACP.

The guidelines are based on a review done by Michelle Brasure, PhD, MSPH, of the University of Minnesota School of Public Health in Minneapolis, and colleagues. They found CBT to be an effective insomnia treatment that can be implemented in the primary care setting, with fewer potential harms than medical management.

Both the guidelines and the review appear in the Annals of Internal Medicine.

In an interview with MedPage Today, ACP president Wayne J. Riley, MD, of Vanderbilt University School of Medicine in Nashville, said the review, which included several new studies examining the efficacy of CBT for sleep issues, prompted the policy change.

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