Table 2.

Practice parameters for the treatment of sleep disorders.

American Academy of Sleep Medicine Clinical Practice Guidelines
	Age Group	As of	Primary Recommendations	Reference
Behavioral and Psychological Treatment Chronic Insomnia Disorder	Adults	2021	Therapist assessment to offer: -Multicomponent Cognitive Behavioral Therapy or -Multicomponent Brief Therapies or -Stimulus Control Therapy or -Sleep Restriction Therapy or -Relaxation Therapy Sleep Hygiene best used as component to other therapy	[27]
Pharmacologic Treatment of Chronic Insomnia	Adults	2017	Clinician's decision on therapy. CBTi should be first-line treatment. Onset insomnia: suvorexant (+other orexin antagonists), zaleplon, triazolam, ramelteon Onset + Maintenance: zolpidem, eszopiclone, temazepam, doxepin Risks: falls, memory disturbance, dependence requires monitoring	[57]
Positive Airway Pressure (PAP) in Obstructive Sleep Apnea	Adult	2019	Use PAP when sleepiness present. AutoPAP initiation at home when no significant comorbidities Ongoing education and monitoring	[55]
Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy	Adults	2015	Primary snoring (without obstructive sleep apnea). Use a custom, titratable appliance over non-custom oral devices. (Guideline) Patients who are intolerant of CPAP therapy or prefer alternate therapy.	[56]
Intrinsic Circadian Rhythm Sleep-Wake Disorders: (Advanced, Delayed, Non-24-Hour, and Irregular). Update 2015	Any	2015	Strategically timed, certified melatonin for delay, blind adults with non-24-h, children/adolescents with irregular schedule + comorbid neurological disorders. Light therapy with or without accompanying behavioral interventions in adults with advance, children/adolescents with delay, and elderly with dementia).	[58]
Nightmare Disorder; PTSD Nightmares	Adults	2018	Clinician decision. First-line: image rehearsal therapy. Secondary options: -PTSD-associated nightmares: CBT; CBTi; EMDR; exposure, relaxation, and rescripting therapy. Meds: olanzapine, risperidone or aripiprazole; clonidine; cyproheptadine; fluvoxamine; gabapentin; nabilone; phenelzine; prazosin; topiramate; trazodone; and tricyclic antidepressants. -Nightmare disorder: CBT; exposure, relaxation, and rescripting therapy; hypnosis; lucid dreaming therapy; progressive deep muscle relaxation; sleep dynamic therapy; self-exposure therapy; systematic desensitization; testimony method. Meds: nitrazepam; prazosin; and triazolam.	[61]
Chronic Opioid Therapy and Sleep (Position statement)	Adult; Elderly	2019	Opioid therapy can alter sleep architecture, sleep quality, daytime sleepiness, respiratory function, including sleep-related hypoventilation, central sleep apnea (CSA), and obstructive sleep apnea (OSA). Monitoring and collaboration among providers strongly recommended.	[62]
Treatment Guidelines from other Professional Organizations
European guideline for the diagnosis and treatment of insomnia from European Sleep Research Society	Adults	2017	Primary intervention is CBTi. If CBTi ineffective then short trials of benzodiazepines, benzodiazepine receptor agonists and some antidepressants are options. Antihistamines, antipsychotics, and melatonin are not recommended for insomnia disorder. Light therapy and exercise need to be further evaluated.	[28]
Restless legs syndrome and periodic limb movement disorder from IRLSSG	Adults	2016	For ≥ moderate RLS, gabapentin or gabapentin enacarbil is first line. Ropinirole, pramipexole, rotigotine are second line because of potential augmentation. Assess and replace low iron stores. Opioids used for refractory RLS under close monitoring.	[59]
Insomnia and disrupted sleep behavior in autism spectrum disorder from Academy of Neurology	Children and Adolescents	2020	Improved sleep habits with behavioral strategies alone or in combination with medications. Adjust sleep disruptive medications. Pharmaceutical-grade melatonin. Debate about weighted blankets.	[61]

CBT=Cognitive Behavioral Therapy; CBTi=Cognitive Behavioral Therapy for insomnia; EMDR = eye movement desensitization and reprocessing.

IRLSSG: International Restless Legs Syndrome Study Group.