Management of Chronic Insomnia Disorder in Adults
Authors: Devan Kansagara, Timothy J. Wilt, Melissa Starkey, Amir Qaseem
Journal: Annals of Internal Medicine (2016)

Letters20 December 2016Management of Chronic Insomnia Disorder in AdultsDevan Kansagara, MD, MCR, Timothy J. Wilt, MD, MPH, Melissa Starkey, PhD, and Amir Qaseem, MD, PhDDevan Kansagara, MD, MCRFrom Portland Evidence-based Synthesis Program and Portland Veterans Affairs Medical Center, Portland, Oregon; Minneapolis VA Center for Chronic Disease Outcomes Research and University of Minnesota School of Medicine, Minneapolis, Minnesota; American College of Physicians, Philadelphia, Pennsylvania., Timothy J. Wilt, MD, MPHFrom Portland Evidence-based Synthesis Program and Portland Veterans Affairs Medical Center, Portland, Oregon; Minneapolis VA Center for Chronic Disease Outcomes Research and University of Minnesota School of Medicine, Minneapolis, Minnesota; American College of Physicians, Philadelphia, Pennsylvania., Melissa Starkey, PhDFrom Portland Evidence-based Synthesis Program and Portland Veterans Affairs Medical Center, Portland, Oregon; Minneapolis VA Center for Chronic Disease Outcomes Research and University of Minnesota School of Medicine, Minneapolis, Minnesota; American College of Physicians, Philadelphia, Pennsylvania., and Amir Qaseem, MD, PhDFrom Portland Evidence-based Synthesis Program and Portland Veterans Affairs Medical Center, Portland, Oregon; Minneapolis VA Center for Chronic Disease Outcomes Research and University of Minnesota School of Medicine, Minneapolis, Minnesota; American College of Physicians, Philadelphia, Pennsylvania.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L16-0542 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:We share Dr. Finucane's concern about the overuse of pharmacologic therapy, and this concern applies to many diseases beyond insomnia. Therefore, comparing the benefits of pharmacologic therapy for insomnia with the harms and costs before initiating it is incredibly important. We recommended cognitive behavioral therapy for insomnia as first-line treatment rather than pharmacologic therapy. We also advocated for a shared approach to decision making with the patient and caution when considering pharmacologic options. In addition, our guideline contains a high-value care section promoting cognitive behavioral therapy for insomnia over medications.We agree that focusing on patient-centered outcomes is ... Author, Article, and Disclosure InformationAffiliations: From Portland Evidence-based Synthesis Program and Portland Veterans Affairs Medical Center, Portland, Oregon; Minneapolis VA Center for Chronic Disease Outcomes Research and University of Minnesota School of Medicine, Minneapolis, Minnesota; American College of Physicians, Philadelphia, Pennsylvania.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-2175. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoManagement of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians Amir Qaseem , Devan Kansagara , Mary Ann Forciea , Molly Cooke , Thomas D. Denberg , and Management of Chronic Insomnia Disorder in Adults Thomas E. Finucane Metrics Cited bySleep disorders, daytime symptoms, and quality of life in veterans with multiple sclerosis: preliminary findingsSuan-Zao-Ren decoction for insomniaClinical effectiveness of Tui Na for insomnia compared with estazolam: A systematic review and meta-analysis of randomized controlled trials 20 December 2016Volume 165, Issue 12Page: 892KeywordsDecision makingDisclosureDrug therapyInsomniaPatient advocacyQuestionnairesSleep ePublished: 20 December 2016 Issue Published: 20 December 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...