Summary of Recommendations

Document Overview

Design and created by Guideline Central in participation with the American Academy of Sleep Medicine.

Combination Treatment for Chronic Insomnia Disorder in Adults

American Academy of Sleep Medicine

Publication Date: Apr 13, 2026

Page Last Updated: Jul 1, 2026

Grading of Recommendations, Assessment, Development, and Evaluation (GRADE)-Based Recommendations

Implications for:	Strong Recommendation (S)	Conditional Recommendation (C)
Patients	Most individuals in this situation would want the recommended course of action, and only a small proportion would not.	The majority of individuals in this situation would want the suggested course of action, but many would not.
Clinicians	Most individuals should receive the intervention. Adherence to this recommendation according to the guideline could be used as a quality criterion or performance indicator. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences.	Recognize that different choices will be appropriate for individual patients and that you must help each patient arrive at a management decision consistent with his or her values and preferences. Decision aids may be useful in helping individuals to make decisions consistent with their values and preferences.
Policy	The recommendation can be adopted as policy in most situations.	Policymaking will require substantial debate and involvement of various stakeholders.

Certainty in the Evidence
High	H	Low	L
Moderate	M	Very Low	VL

Source: Grading of Recommendations Assessment, Development and Evaluation Working Group (Schunemann HJ et al. Am J Respir Crit Care Med. 2006;174:605-14. Guyatt GH et al. BMJ 2008;336:924-6).

Document Overview

Document Title: Combination Treatment for Chronic Insomnia Disorder in Adults

Authoring Society: American Academy of Sleep Medicine

Document Publication Date: Apr 13, 2026

Page Last Reviewed/Updated: Jul 1, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: link.springer.com/article/10.1007/s44470-025-00038-8

Source Citation: Buysse DJ, Arnedt JT, Buenaver L, Chang JL, Fernandez-Mendoza J, Patel SI, Zhou ES, Falck-Ytter Y, Hyer S, Kazmi U, Singh M, Wickwire EM. Combination treatment for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2026 Apr 13;22(1):56. doi: 10.1007/s44470-025-00038-8. PMID: 41975142.

Document Scope, Criteria, and Use Cases

Document Objectives: This guideline establishes clinical practice recommendations for combination treatment of chronic insomnia disorder in adults, defined here as treatment with cognitive-behavioral therapy for insomnia (CBT-I) started concurrently with pharmacotherapy.

Scope: Management, Treatment

Diseases/Conditions (MeSH)

D012890 - Sleep

D000077260 - Sleepiness

D012892 - Sleep Deprivation

Keywords: Chronic Insomnia disorder, Insomnia

Inclusion Criteria: Male, Female, Adult, Older Adult

Health Care Settings: Ambulatory

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

PICO Questions

For adult patients in ICU for whom there is a need for EOL decisions, do interventions to enhance shared decision-making between patient, surrogate decision makers/family and the multidisciplinarymulti-professional health care team improve patient, family, clinician, and institutional outcomes?
For adult patients in ICU for whom there is a need for EOL decisions and who are decisionally incapable, do interventions to ensure procedural due process for identifying and educating substitute decision-makers improve patient, family, clinician, and instititional outcomes?
For adult patients in ICU for whom there are potential or actual conflicts over treatment decisions at EOL, does consultation with services with relevant expertise, including clinical ethics, moral distress, palliative medicine, ICU psychology, and/or pastoral/ spiritual care, improve patient, family, clinician, and instutional outcomes?
For adult patients in ICU for whom there are actual conflicts over treatment decisions at EOL, do institutional policies/practices with due process elements improve patient, family, clinician, and instutitional outcomes?
For adult patients in the ICU who are expected to die following withdrawal of life-sustaining therapies or due to disease progression, do protocolized/standardized approaches for symptom management (including pharmacological and non-pharmacological treatments) improve patient, family, clinician, and institutional outcomes?
For adult patients in the ICU at end of life, do specific interventions to address cultural, spiritual, and family traditions and needs improve patient, family, clinician, and institutional outcomes?
For adult patients in the ICU at end of life, does collaboration with palliative medicine, mental health, spiritual care improve quality patient, family, clinician, and instutitional outcomes?
For adult ICU patients at risk of dying, do specific interventions to identify and address discrimination and inequities in end of life care driven by gender, gender identity, sexual identity, race, ethnicity, faith traditions, country of origin or socioeconomic status improve patient, family, clinician, or institutional outcomes?
For clinicians working in adult ICUs, do interventions to incrase capacity of ICU team members to provide palliative care (eg. education) improve patient, family, clinician, and institutional outcomes?
For adults patients and their families, do interventions and strategies to improve understanding and expectations for end of life care in the ICU improve understanding of EOL treatment options, advance directive completion, and decision-making at end of life?

Supplemental Methodology Resource: Methods Overview

Number of Source Documents: 79

Literature Search End Date: Tuesday, October 8, 2024

Methodologist 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?: Yes

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