Summary of Recommendations

Document Overview

Design and created by Guideline Central in participation with the Veterans Health Administration / Department of Defense.

Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea

Veterans Health Administration / Department of Defense

Publication Date: Feb 7, 2025

Page Last Updated: May 5, 2026

Strength of Recommendations in GRADE

Strength	Interpretation	Implications for clinicians	Implications for policymakers
Strong for	Almost all informed patients would choose to receive the intervention	Should be accepted by most patients to whom it is offered	Should be adopted as policy
Weak for	Most informed patients would choose the intervention, but a sizable minority would not	Large role for education and shared decision-making	Requires stakeholder engagement and discussion
Weak against	Most informed patients would not choose the intervention, but a small minority would	Large role for education and shared decision-making	Requires stakeholder engagement and discussion
Strong against	Most patients should not receive the intervention	Should not be offered to patients	Should be adopted as policy

Document Overview

Document Title: Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea

Authoring Society: Veterans Health Administration / Department of Defense

Document Publication Date: Feb 7, 2025

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.healthquality.va.gov/HEALTHQUALITY/guidelines/CD/insomnia/I-OSA-CPG_2025-Guideline_final_20250915.pdf

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: The Chronic Insomnia Disorder and OSA CPG includes objective, evidence-based information on the management of selected sleep disorders (chronic insomnia disorder and OSA). It is intended to assist healthcare providers in all aspects of patient care, including, but not limited to, screening, assessment, treatment, and follow-up. The system-wide goal of evidence-based guidelines is to improve patient health and well-being by guiding health providers who are taking care of patients with chronic insomnia disorder and/or OSA along management pathways that are supported by evidence. The expected outcome of the successful implementation of this guideline is to: assess patient condition and determine, in collaboration with the patient, the best treatment method(s); optimize patient health outcomes and improve quality of life; minimize preventable complications and morbidity; emphasize the use of patient-centered care (PCC).

Scope: Assessment and Screening, Diagnosis, Management, Prevention, Treatment

Diseases/Conditions (MeSH)

D020181 - Sleep Apnea, Obstructive

D012890 - Sleep

D000070263 - Sleep Hygiene

D012891 - Sleep Apnea Syndromes

D020181 - Sleep Apnea, Obstructive

D012890 - Sleep

D000070263 - Sleep Hygiene

D012891 - Sleep Apnea Syndromes

Keywords: Chronic Insomia, Insomnia, OSA, obstructive sleep apnea

Target Patient Population: Adult patients with chronic insomnia disorder and/or obstructive sleep apnea

Target Provider Population: VA, DOD, community providers, and others involved in the health care team evaluating and managing adults with chronic insomnia disorder and/or obstructive sleep apnea

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Ambulatory, Long Term Care

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant, Respiratory Therapist, Social Worker

Recommendation Development Processes & Methodology

Supplemental Methodology Resource: Additional Resources

Number of Source Documents: 234

Literature Search End Date: Sunday, March 31, 2024

Includes peer/external review process?: Yes

Methodologist involvement?: Yes

Patient involvement?: Yes

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: Yes

Grades quality of strength of recommendation?: Yes

Discloses funding source?: Yes

Discloses conflicts of interest?: Yes

Includes benefits/harms analysis with recommendations?: No

Identifies study selection process?: Yes

Identifies study selection criteria?: Yes

Identifies methods used to evaluate and analyze the evidence?: Yes

Identifies key questions addressed by the systematic review?: Yes

Identifies search strategy?: Yes

Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea

Summary of Recommendations

Screening

Obstructive Sleep Apnea Diagnosis

Treatment of Chronic Insomnia Disorder

Behavioral and Psychological Treatments

Pharmacotherapy for Insomnia

Complementary and Integrative

Pharmacotherapy Considerations for Chronic Insomnia Disorder

Module B: Management of Chronic Insomnia Disorder

Treatment of Obstructive Sleep Apnea

Risk of OSA

Appropriateness for HSAT

AHI 5 to <15 on HSAT

Treatment of Obstructive Sleep Apnea (OSA)

Module C: Management of Obstructive Sleep Apnea

Clinical Features of OSA and Chronic Insomnia Disorder

Other Sleep Disorders

Components of Sleep Education, Overview of Behavioral Interventions, and Contraindications

Module A: Screening for Sleep Disorders

Strength of Recommendations in GRADE

Document Overview

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Recommendation Development Processes & Methodology