Objective:

To provide evidence-based recommendations for the management of chronic insomnia disorder in adults.

Key Findings:

• CBT-I remains the preferred first-line treatment for chronic insomnia.
• Combination therapy offers modest benefits over pharmacotherapy alone but not over CBT-I alone.
• Combination treatment is linked to slightly higher rates of adverse effects, particularly morning sleepiness.
• Individualized treatment decisions are essential, guided by patient preferences and clinical priorities.

Interpretation:

The recommendations support CBT-I as the primary treatment, with combination therapy considered in specific cases and pharmacotherapy as a last resort.

Limitations:

• Low certainty of evidence due to a small number of RCTs directly comparing treatment strategies.
• Limited long-term data and narrow representation of diverse populations.
• Lack of studies on newer medications in combination with CBT-I.

Conclusion:

A patient-centered approach is emphasized, with CBT-I as the first-line therapy and combination therapy favored over medication alone.