Key Takeaways on the AASM Guidance for Combination Therapy in Chronic Insomnia: Salma Patel, MD, MPH, FACP, FAASM

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"At the end of the day, we're all clinicians, and even though these practice guidelines exist, we are treating the individual in front of us, so we always have to take patient preferences into consideration while also taking the clinical practice guidelines into consideration."

Chronic insomnia affects an estimated 10% to 15% of adults and remains one of the most common sleep disorders encountered in clinical practice.¹ Cognitive behavioral therapy for insomnia (CBT-I) has long been established as the first-line treatment, with pharmacologic therapy typically reserved as a second-line approach.

Although both CBT-I and medications for chronic insomnia are supported by existing clinical practice guidelines, clinicians frequently employ combination regimens that pair behavioral and pharmacologic strategies. Until recently, however, there has been limited formal guidance on how best to implement such combined approaches, leaving key questions.

At the recently concluded 2026 SLEEP Annual Meeting, held June 14-17 in Baltimore, Salma Patel, MD, MPH, FACP, FAASM, sleep medicine specialist at University of Arizona, presented on “Implementing The AASM Guideline for Combination Treatment of Chronic Insomnia: Evidence, Challenges, and Gaps.”² In her presentation, Patel reviewed a new American Academy of Sleep Medicine (AASM) clinical practice guideline that addressed the use of CBT-I in combination with pharmacologic agents for adults with chronic insomnia. Developed using a systematic review and GRADE methodology, the guideline seeks to fill a critical gap by offering structured, evidence-based recommendations for commonly used combination strategies in routine care.

In an interview with NeurologyLive^®, Patel detailed the guideline’s 2 conditional recommendations and the underlying evidence base. The task force found that combination therapy with CBT-I and medication is recommended over medication alone for adults with chronic insomnia. However, the group recommends against routinely favoring combination therapy over CBT-I alone.

Patel also underscored important evidence gaps, including small and less generalizable randomized controlled trials, the lack of data on sequential treatment approaches, and the exclusion of newer agents. She concluded by stressing that, despite the availability of guidelines, clinicians must ultimately individualize care based on the patient in front of them.

Click here for more coverage of SLEEP 2026.

REFERENCES
1. Buysse DJ, Arnedt JT, Buenaver L, et al. Combination treatment for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2026;22(1):56. Published 2026 Apr 13. doi:10.1007/s44470-025-00038-8
2. Patel S. Implementing The AASM Guideline for Combination Treatment of Chronic Insomnia: Evidence, Challenges, and Gaps. Presented at: 2026 SLEEP Annual Meeting; June 14-17; Baltimore, Maryland.