Practice parameters for the nonpharmacologic treatment of chronic insomnia

Insomnia is the most common sleep complaint reported to physicians. Treatme nt has traditionally involved medication. Behavioral approaches have been a vailable far decades, but lack of physician awareness and training, difficu lty in obtaining reimbursements, and questions about efficacy have limited their use. These practice parameters review the current evidence with regards to a var iety of nonpharmacologic treatments for insomnia. Using a companion paper w hich provides a background review, the available literature was analyzed. T he evidence was graded by previously reported criteria of the American Acad emy of Sleep Medicine with references to American Psychological Association criteria. Treatments considered include: stimulus control, progressive mus cle relaxation, paradoxical intention, biofeedback, sleep restriction, mult icomponent cognitive behavioral therapy sleep hygiene education, imagery tr aining, and cognitive therapy. Improved experimental design has significantly advanced the process of eval uation of nonpharmacologic treatments for insomnia using guidelines outline d by the American Psychological Association (APA). Recommendations for indi vidual therapies using the American Academy of Sleep Medicine recommendatio n levels for each are: Stimulus Control (Standard); Progressive Muscle Rela xation, Paradoxical Intention, and Biofeedback (Guidelines); Sleep Restrict ion, and Multicomponent Cognitive Behavioral Therapy (Options); Sleep Hygie ne Education, Imagery Training, and Cognitive Therapy had insufficient evid ence to be recommended as a single therapy. Optimal duration of therapy. wh o should perform the treatments, long term outcomes and safety concerns, an d the effect of treatment on quality of life are questions in need of futur e research.