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Cited by 264Sleep and related disordersAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesObstructive Sleep Apnea Research

Practice Parameters for the Nonpharmacologic Treatment of Chronic Insomnia

Chesson, Andrew L., Anderson, W. McDowell, Littner, Michael, Davila, David, Hartse, Kristyna, Johnson, Stephen, Wise, Merrill, Rafecas, Jose·1999·Sleep
DOI 10.1093/sleep/22.8.1128
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Abstract

Insomnia is the most common sleep complaint reported to physicians. Treatment has traditionally involved medication. Behavioral approaches have been available for decades, but lack of physician awareness and training, difficulty in obtaining reimbursements, and questions about efficacy have limited their use. These practice parameters review the current evidence with regards to a variety of nonpharmacologic treatments for insomnia. Using a companion paper which provides a background review, the available literature was analyzed. The evidence was graded by previously reported criteria of the American Academy of Sleep Medicine with references to American Psychological Association criteria. Treatments considered include: stimulus control, progressive muscle relaxation, paradoxical intention, biofeedback, sleep restriction, multicomponent cognitive behavioral therapy, sleep hygiene education, imagery training, and cognitive therapy. Improved experimental design has significantly advanced the process of evaluation of nonpharmacologic treatments for insomnia using guidelines outlined by the American Psychological Association (APA). Recommendations for individual therapies using the American Academy of Sleep Medicine recommendation levels for each are: Stimulus Control (Standard); Progressive Muscle Relaxation, Paradoxical Intention, and Biofeedback (Guidelines); Sleep Restriction, and Multicomponent Cognitive Behavioral Therapy (Options); Sleep Hygiene Education, Imagery Training, and Cognitive Therapy had insufficient evidence to be recommended as a single therapy. Optimal duration of therapy, who should perform the treatments, long term outcomes and safety concerns, and the effect of treatment on quality of life are questions in need of future research.

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Crossref · 10.1093/sleep/22.8.1128

Cites

10 of 10 references verified0 citation errors · 0 not checkable

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  • Multicomponent therapy without cognitive therapy is effective in treating chronic insomnia.

    “Multicomponent therapy (without cognitive therapy) is effective and recommended therapy in the treatment of chronic insomnia. (Guideline)”

    From Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults (2008) · cites this paper as [4]

    Section 6 (p. 5) calls multicomponent behavioral therapy effective and says cognitive therapy is not always an integral part of it. But the paper grades multicomponent therapy as an “Option,” not the “Guideline” stated in the citing sentence. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

  • Psychological and behavioral interventions are effective in treating chronic primary and comorbid insomnia.

    “Psychological and behavioral interventions are effective and recommended in the treatment of chronic primary and comorbid (secondary) insomnia. (Standard)”

    From Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults (2008) · cites this paper as [4]

    The recommendations (pp. 4–5) identify several behavioral treatments as effective for chronic insomnia, but assign different recommendation levels to individual therapies. The scope statement (p. 2) says secondary insomnia is not addressed in detail, so this paper does not establish effectiveness or a Standard-level recommendation for both primary and comorbid insomnia. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Psychological and behavioral treatments are effective for adults of all ages, including older adults, and chronic hypnotic users.

    “These treatments are effective for adults of all ages, including older adults, and chronic hypnotic users. (Standard)”

    From Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults (2008) · cites this paper as [4]

    The practice parameters recommend several nonpharmacologic treatments for chronic insomnia (p. 1), and the multicomponent therapy section points to evidence involving elderly subjects (p. 5). Our copy does not establish effectiveness across all adult ages or specifically in chronic hypnotic users. It also assigns a Standard recommendation to stimulus control, not to these treatments collectively. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Physical and mental status examination may provide important information regarding comorbid conditions and differential diagnosis.

    “Physical and mental status examination may provide important information regarding comorbid conditions and differential diagnosis. (Standard)”

    From Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults (2008) · cites this paper as [4]

    The Background (p. 2) distinguishes primary from secondary insomnia by associated medical and psychiatric conditions. It does not say that physical or mental status examinations provide information for identifying those conditions or making a differential diagnosis. Searches for the quoted sentence and for examination-related terms found no such recommendation in our copy. (LLM, conf=0.73)

    Experimental — accuracy not yet measured

  • Stimulus control has received the most empirical support and is identified as an effective and recommended therapy in the treatment of insomnia.

    “Although there is no particular order that has been specified in which these modalities are delivered, stimulus control has received the most empirical support and is identified as an “effective and recommended therapy in the treatment of insomnia” [17,18].”

    From Non-Pharmacological Treatment of Insomnia (2012) · cites this paper as [17]

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Cites

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Research works printed but not linked: 2

  1. [1]1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th Edition. Washington, DC: American Psychiatric Association, 1994.
  2. [4]4. Morin, C.M., Hauri, P.J., Espie, C., Spielman, A., Buysse, D., and Bootzin, R. Nonpharmacologic Treatment of Insomnia. Sleep, 1999;8:1134-1156.

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Authors
Chesson, A. L., Anderson, W. M., Littner, M., Davila, D., Hartse, K., Johnson, S., Wise, M., & Rafecas, J.
Affiliations
  • Louisiana State University (US)
  • United States Department of Veterans Affairs (US)
  • Baptist Health Foundation (US)
  • Baylor College of Medicine (US)
ORCID
Wise, Merrill
Venue
Sleep
Publisher
Oxford University Press (OUP)
Published
1999-12
Volume
22
Issue
8
Pages
1128-1133
ISSN
  • 0161-8105 (ISSN-L)
  • 1550-9109
DOI
10.1093/sleep/22.8.1128
OpenAlex
W2321367967
Cited by
264
References
10
Citations by year
2026: 3 · 2025: 6 · 2024: 1 · 2023: 3 · 2022: 2 · 2021: 6 · 2020: 4 · 2019: 7 · 2018: 3 · 2017: 10 · 2016: 9 · 2015: 12 · 2014: 15 · 2013: 8 · 2012: 12
FWCI
16.63
Type
journal article
Language
en
Open access
closed
Locations
  • SLEEP (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
Keywords
chronic insomnia, non-pharmacological treatment, stimulus control, progressive muscle relaxation, paradoxical intention, biofeedback, sleep restriction, cognitive behavioral therapy, sleep hygiene education, imagery training, cognitive therapy, treatment guidelines, level of evidence
MeSH terms
Academic Medical Centers, Biofeedback, Psychology, Chronic Disease, Humans, Sleep Initiation and Maintenance Disorders, Relaxation Therapy, Cognitive Behavioral Therapy, Imagery, Psychotherapy

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