AASM’s Strong Recommendation for Cognitive Behavioral Therapy: Jennifer Martin, PhD

"The main strength of cognitive behavioral therapy for insomnia is that it works for so many different kinds of patients... even in patients who had chronic medical issues, depression, or anxiety issues, along with their insomnia, the treatment is still very effective.”

New clinical guidelines for the treatment of chronic insomnia disorder in adults by the American Academy of Sleep Medicine (AASM) included a strong recommendation for the use of cognitive behavioral therapy for insomnia (CBT-I). Conditional recommendations were made for multi-component brief therapies, stimulus control, sleep restriction therapy, and relaxation therapy. The AASM recommended against the use of sleep hygiene therapy as a single-component therapy.

The guidelines recommend that physicians should prescribe the use of CBT-I for almost all patients, based on a large body of moderate quality evidence from 49 studies, including multiple, recent, large randomized clinical trials. The AASM found clinically meaningful improvements in critical outcomes and favorable information on cost-effectiveness of CBT-I. A number of studies published in the past year have suggested it is both cost-effective and particularly effective for woman both during pregnancy and post-childbirth.

NeurologyLive reached out to one of the authors of the guideline, Jennifer Martin, PhD, AASM board of directors, and professor of medicine, UCLA David Geffen School of Medicine, to learn more about CBT and its strengths. Martin also discussed the strengths of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system in evaluating the efficacy of insomnia treatments.

REFERENCE

Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J. Clin. Sleep Med. Published online November 9, 2020. doi: 10.5664/jcsm.8986