Department of Veterans Affairs and Department of Defense
Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea
This guideline holds 29 recommendations, 234 references, 14 tables and 4 figures.
Summary
This clinical practice guideline provides evidence-based recommendations for the screening, diagnosis, and management of chronic insomnia disorder and obstructive sleep apnea (OSA) in adult patients. It emphasizes objective diagnostic testing, prioritizes cognitive behavioral therapy for insomnia (CBT-I) as a first-line treatment for chronic insomnia, and advocates for positive airway pressure (PAP) and mandibular advancement devices (MAD) as initial therapies for OSA. The guideline heavily incorporates shared decision-making and patient-centered care.
Sleep disturbances, specifically chronic insomnia disorder and obstructive sleep apnea, are highly prevalent in the general population, and even more so among military personnel and Veterans. These conditions cause significant morbidity, including cardiovascular disease, poor mental health, and impaired daytime functioning. The VA and DOD developed this guideline to standardize care and improve outcomes for these high-burden sleep disorders.
Key takeaways
Screen at-risk patients using validated instruments like the Insomnia Severity Index (ISI) and STOP questionnaire.
Diagnose OSA objectively using polysomnography or home sleep apnea testing (HSAT).
Cognitive behavioral therapy for insomnia (CBT-I) is strongly recommended over pharmacotherapy as a first-line treatment for chronic insomnia disorder.
Mild to moderate OSA should be treated initially with a mandibular advancement device (MAD) or positive airway pressure (PAP) therapy.
Avoid the use of antipsychotics, benzodiazepines, trazodone, and diphenhydramine for treating insomnia.
Leverage shared decision-making to tailor therapy choices and improve patient adherence.