Cognitive Behavioral Therapies for Insomnia and Hypnotic Medications: Considerations and Controversies

Sleep Med Clin. 2019 Jun;14(2):253-265. doi: 10.1016/j.jsmc.2019.01.006. Epub 2019 Mar 29.


Insomnia is a costly health problem, where management has remained suboptimal despite advances in the understanding and treatment of the condition. This article provides an overview of the evidence-based treatment options of insomnia, looking at short-term and long-term therapeutic outcomes for cognitive behavioral therapies and pharmacologic therapies. Key issues of treatment delivery and implementation are highlighted at the patient and health system levels, and novel approaches for combining and sequencing treatment to maximize therapeutic outcomes for insomnia are discussed. The impact of recent updates of major clinical guidelines and future research directions for the field are discussed.

Keywords: Cognitive behavioral therapy for insomnia; Combination therapy; Pharmacotherapy; Stepped care; Treatment preference; Treatment sequencing.

Publication types

  • Review

MeSH terms

  • Cognitive Behavioral Therapy / methods*
  • Combined Modality Therapy / standards*
  • Humans
  • Hypnotics and Sedatives / therapeutic use*
  • Sleep Initiation and Maintenance Disorders / drug therapy
  • Sleep Initiation and Maintenance Disorders / therapy*


  • Hypnotics and Sedatives