Table 6. Special recommendations for non-pharmacological treatment of insomnia.
| Recommendation | Consensus rate | Voting rounds |
|---|---|---|
| Multicomponent CBT-I is recommended as the gold standard for treating chronic insomnia, suggesting a greater number of sessions and techniques and observing the clinical caveats described in the text. | 100.00% | 1 |
| CBT-I via online services is not inferior to in-person service. | 93.75% | 1 |
| Sleep hygiene is not recommended as an isolated form of intervention, but should be included in the practice of CBT-I. | 100.00% | 1 |
| ACT is recommended as an adjuvant treatment to CBT-I. | 93.75% | 1 |
| Mindfulness practices are recommended as adjuvants to CBT-I. | 96.88% | 1 |
| Patients with objectively measured TST < 6h should receive multicomponent CBT-I intervention associated with mindfulness and/or ACT strategies. At clinical discretion, it can be associated with pharmacotherapy. | 96.88% | 1 |
| Biofeedback therapies, although safe, show inconsistent results for the treatment of chronic insomnia disorder and, therefore, should not be recommended. There is a clear need for well-designed and adequately powered studies to understand the role of this form of therapy. | 100.00% | 1 |
| Acupuncture is safe, but current literature is limited to formally recommend this therapeutic strategy for treating insomnia. | 100.00% | 1 |
| Physical exercise (mainly aerobic) appears to have benefits in objective and subjective parameters in patients with chronic insomnia and can be used as an adjuvant therapy. | 87.10% | 1 |
| Mind-body techniques are safe but with limited evidence as a therapeutic tool for treating insomnia. The formal approach can be adopted as an adjuvant practice. | 100.00% | 1 |
| The use of aromatherapy has limited evidence for treating insomnia and should not be formally recommended. | 94.77% | 1 |
Abbreviations: ACT, Acceptance and commitment therapy; CBT-I, Cognitive-behavioral therapy applied to insomnia. TST, Total sleep time.