From the Guidelines
Cognitive behavioral therapy for insomnia (CBT-I) should be considered the first-line treatment for adults with chronic insomnia disorder. This recommendation is based on the most recent and highest quality study available, which suggests that CBT-I is effective in improving global outcomes, sleep outcomes, and quality of life in adults with chronic insomnia disorder 1.
Key Components of CBT-I
- Sleep restriction therapy
- Stimulus control
- Cognitive therapy
- Sleep hygiene education
Benefits of CBT-I
- Improved sleep onset latency
- Reduced wake after sleep onset
- Improved sleep efficiency and sleep quality
- Increased remission and treatment response
- Reduced symptoms of insomnia
Medication Options
While CBT-I is the preferred treatment, medication options may be considered for short-term use in adults with chronic insomnia disorder who have not responded to CBT-I alone. However, the evidence for pharmacological treatment is generally of low quality, and the risks of dependence and side effects must be carefully weighed against the potential benefits 1.
Recommendations for Medication Use
- Use a shared decision-making approach to determine whether to add pharmacological therapy
- Consider the benefits, harms, and costs of short-term medication use
- Use medication for the shortest duration possible to minimize the risk of dependence and side effects
Overall, CBT-I is the most effective and sustainable treatment for chronic insomnia disorder, and medication options should be used judiciously and with careful consideration of the potential risks and benefits.
From the FDA Drug Label
Zolpidem tartrate tablets are indicated for the short-term treatment of insomnia characterized by difficulties with sleep initiation. Zolpidem was evaluated in two controlled studies for the treatment of patients with chronic insomnia (most closely resembling primary insomnia, as defined in the APA Diagnostic and Statistical Manual of Mental Disorders, DSM-IV™) Zolpidem tartrate tablets have been shown to decrease sleep latency for up to 35 days in controlled clinical studies
Insomnia Treatment: Zolpidem is indicated for the short-term treatment of insomnia characterized by difficulties with sleep initiation, and has been shown to decrease sleep latency for up to 35 days in controlled clinical studies 2, 2.
- Key Points:
From the Research
Insomnia Treatment Options
- Non-pharmacologic treatments, such as cognitive/behavioral methods, relaxation strategies, and complementary and alternative medicine (CAM) approaches, are available for insomnia treatment 3.
- Cognitive-behavioral therapies have emerged as the treatment of choice for chronic insomnia, targeting behavioral, cognitive, and conditioning factors underlying insomnia 3.
- Cognitive Behavioral Therapy for Insomnia (CBT-I) is a multi-component treatment that targets difficulties with initiating and/or maintaining sleep, delivered over six to eight sessions 4.
Effectiveness of CBT-I
- CBT-I has a large evidence base and is recommended as the first line intervention for insomnia 4.
- CBT-I produces results equivalent to sleep medication, with no side effects, fewer episodes of relapse, and a tendency for sleep to continue to improve long past the end of treatment 5.
- A systematic review and meta-analysis found that CBT-I is an effective treatment for adults with chronic insomnia, with clinically meaningful effect sizes 6.
Components of CBT-I
- Core components of CBT-I include Sleep Restriction Therapy, Stimulus Control Therapy, Sleep Hygiene, and Cognitive Therapy 4.
- Other components of CBT-I may include relaxation techniques, such as exercise and relaxation techniques 7.
- Complementary and alternative approaches, such as light therapy, aromatherapy, music therapy, and herbal medicine, may also be used in conjunction with CBT-I 7.