![]() CBT-I also appeared to improve global and some sleep outcomes in older adults and in patients with pain conditions and insomnia (low SOE for most outcomes).Effectiveness was demonstrated across modes of delivery and was sustained in the long term (at least 6 months) for some outcomes (low to moderate SOE). CBT-I improved global and sleep outcomes in the general adult population (low to moderate strength of evidence ).Conclusions Psychological and Behavioral Therapy: Effectiveness ( Table 1) The systematic review assessed the efficacy, comparative effectiveness, and adverse effects of a broad range of management strategies for insomnia disorder in adults. These include nonbenzodiazepine hypnotics (zaleplon, zolpidem, eszopiclone), an orexin receptor antagonist (suvorexant), a melatonin agonist (ramelteon), some benzodiazepines (e.g., triazolam, temazepam), and an antidepressant (doxepin). Food and Drug Administration (FDA) has approved several prescription drugs for insomnia, typically for short-term use. Guidelines 2,3 recommend CBT-I as first-line treatment for all adults with chronic insomnia disorder. Psychological and behavioral interventions include cognitive behavioral therapy for insomnia (CBT-I), brief or multicomponent behavioral therapy, stimulus control, relaxation training, and sleep restriction ( Appendix). Many treatments are available for insomnia symptoms, including sleep hygiene education, behavioral and psychological interventions, prescription medications, over-the-counter medications and supplements, and complementary and alternative medicine (CAM) treatments. Diagnostic criteria for insomnia disorder require that sleep symptoms cause clinically significant distress or impairment in functioning, occur despite adequate opportunity for sleep, and are experienced on a chronic basis (at least 3 nights per week for at least 3 months). Insomnia involves dissatisfaction with sleep quantity or quality and is associated with difficulty initiating sleep, maintaining sleep, returning to sleep after early morning waking, or a combination thereof. However, reviews of evidence should not be construed to represent clinical recommendations or guidelines. This summary is provided to assist in informed clinical decisionmaking. ![]() The systematic review synthesized evidence from 169 randomized controlled trials and 12 observational studies published through January 2015. This is a summary of a systematic review that evaluated current evidence regarding the effectiveness, comparative effectiveness, and adverse effects of management strategies for insomnia disorder in adults.
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