The American Academy of Sleep Medicine (AASM) recently released a pair of recommendations in their 2026 clinical practice guideline on combination treatment for chronic insomnia disorder in adults. The two recommendations focus on combination treatment, particularly combination treatment over pharmacotherapy alone and combination treatment over cognitive behavioral therapy for insomnia (CBT-I) alone.
The Combination Treatment for Chronic Insomnia Disorder in Adults clinical practice guideline is the work of an AASM-sanction task force of sleep medicine experts whose work received approval from the AASM Board of Directors. Both recommendations that were approved received “conditional” recommendation strength, meaning it is a recommendation that requires the clinicant to use clinical knowledge and experience, along with considering the patient’s preferences, to determine the best course of action.
Overall, the guideline recommends combination therapy over pharmacotherapy alone for adults with chronic insomnia disorder. It recommends against using combination therapy over CBT-I alone, although some patients may prefer combination therapy. Enabling equitable access to CBT-I and addressing cost-related barriers to care are key in improving insomnia management for the widest patient population.
Recommendations from the 2026 AASM Guideline on Chronic Insomnia Disorder in Adults
Combination Treatment Over Pharmacotherapy Alone
In adults with chronic insomnia disorder, the AASM suggests the use of combination treatment with CBT-I plus insomnia medication over insomnia medication alone.
Combination Treatment Over CBT-I Alone
In adults with chronic insomnia disorder, the AASM suggests against the use of combination treatment of CBT-I plus insomnia medication over CBT-I alone.
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