What is the first-line treatment for insomnia?

From the Guidelines

Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for insomnia, as it has been shown to improve global outcomes and sleep quality in adults with chronic insomnia disorder. This approach typically includes a combination of cognitive therapy, behavioral interventions such as sleep restriction and stimulus control, and education on sleep hygiene 1. CBT-I can be delivered in various formats, including individual or group therapy, telephone- or Web-based modules, or self-help books, and has been found to be effective in improving sleep outcomes, including reduced sleep onset latency and wake after sleep onset, and improved sleep efficiency and sleep quality 1.

Key Components of CBT-I

• Cognitive therapy to address sleep-related thoughts and behaviors
• Behavioral interventions, such as sleep restriction and stimulus control, to establish a consistent sleep schedule and improve sleep environment
• Education on sleep hygiene, including maintaining a consistent sleep schedule, creating a comfortable sleep environment, avoiding caffeine and alcohol before bedtime, limiting screen time, and exercising regularly but not close to bedtime

Benefits of CBT-I

• Improved global outcomes, including increased remission and treatment response
• Reduced symptoms of insomnia, including reduced sleep onset latency and wake after sleep onset
• Improved sleep quality and efficiency
• Long-lasting benefits without the risks associated with sleep medications

Considerations for Pharmacological Therapy

If CBT-I is not immediately available or effective, short-term use of medications may be considered, with a shared decision-making approach that includes a discussion of the benefits, harms, and costs of pharmacological therapy 1. However, medications should be used cautiously due to potential side effects, including daytime drowsiness, dependence, and rebound insomnia.

From the FDA Drug Label

Zolpidem tartrate tablets are indicated for the short-term treatment of insomnia characterized by difficulties with sleep initiation. The first-line treatment for insomnia is not explicitly stated in the provided drug labels.

• No conclusion can be drawn about the first-line treatment for insomnia from the given information 2 2.

From the Research

First-Line Treatment for Insomnia

The first-line treatment for insomnia is cognitive behavioral therapy for insomnia (CBT-I) [ 3, 4,5,6,7 ].

Key Components of CBT-I

CBT-I is a multimodal intervention that incorporates several key components, including:

• Cognitive therapy
• Stimulus control
• Sleep restriction
• Sleep hygiene
• Relaxation training

Effectiveness of CBT-I

Studies have shown that CBT-I is an effective treatment for adults with chronic insomnia, with clinically meaningful effect sizes [ 3 ]. CBT-I has been found to improve sleep onset latency, wake after sleep onset, total sleep time, and sleep efficiency [ 3 ].

CBT-I for Comorbid Insomnia

CBT-I is also effective for patients with insomnia comorbid with other mental disorders, such as depression, post-traumatic stress disorder (PTSD), and alcohol dependency 5, 6.

Recommendations

CBT-I should be considered as a first-line treatment for insomnia, including both uncomplicated insomnia and insomnia that occurs comorbidly with other chronic disorders 4, 6, 7.