Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine systematic review, meta-analysis and GRADE assessment

INTRODUCTION The purpose of this systematic review is to provide supporting evidence for a clinical practice guideline on the use of behavioral and psychological treatments for chronic insomnia disorder in adult populations. METHODS The American Academy of Sleep Medicine commissioned a task force of nine experts in sleep medicine. A systematic review was conducted to identify randomized controlled trials that addressed behavioral and psychological interventions for the treatment of chronic insomnia disorder in adults. Statistical analyses were performed to determine if the treatments produced clinically significant improvements in a range of critical and important outcomes. Finally, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to evaluate the evidence for making specific treatment recommendations. RESULTS The literature search identified 1274 studies; 124 studies met the inclusion criteria; 89 studies provided data suitable for statistical analyses. Evidence for the following interventions are presented in this review: Cognitive Behavioral Therapy for Insomnia (CBT-I), Brief Therapies for Insomnia (BTIs), stimulus control, sleep restriction therapy, relaxation training, sleep hygiene, biofeedback, paradoxical intention, intensive sleep retraining and mindfulness. This review provides a detailed summary of the evidence along with the quality of evidence, the balance of benefits versus harms, patient values and preferences, and resource use considerations.