To provide evidence-based recommendations for the management of chronic insomnia disorder in adults.
Approach:
Key Findings:
CBT-I remains the preferred first-line treatment for chronic insomnia.
Combination therapy offers modest benefits over pharmacotherapy alone but not over CBT-I alone.
Combination treatment is linked to slightly higher rates of adverse effects, particularly morning sleepiness.
Individualized treatment decisions are essential, guided by patient preferences and clinical priorities.
Interpretation:
The recommendations support CBT-I as the primary treatment, with combination therapy considered in specific cases and pharmacotherapy as a last resort.
Limitations:
Low certainty of evidence due to a small number of RCTs directly comparing treatment strategies.
Limited long-term data and narrow representation of diverse populations.
Lack of studies on newer medications in combination with CBT-I.
Conclusion:
A patient-centered approach is emphasized, with CBT-I as the first-line therapy and combination therapy favored over medication alone.
