The American Academy of Sleep Medicine (AASM) guideline states that the 2 primary goals of treatment are to improve sleep quality and to improve related daytime impairments. Strategies for achieving these goals will vary depending on the underlying etiology. If the patient had a medical, neurological, or sleep disorder, treat the disorder. In particular, adequate pain control can greatly relieve the insomnia associated with pain syndromes. In 2017, the AASM released an updated guideline for the pharmacologic treatment of chronic insomnia in adults.

The  AASM guideline recommends psychological and behavioural interventions (including, but not limited to, cognitive-behavioural therapy [CBT]) as effective in the treatment of chronic co-morbid insomnia as well as primary insomnia. The guideline also encourages these interventions as initial therapy when appropriate.

The treatment of primary (psychophysiologic) insomnia begins with education about the sleep problem and appropriate sleep hygiene measures (elements of good sleep hygiene are describes in Patient Education). Before therapy is instituted, most patients are asked to maintain a sleep diary fro 1-2 weeks (see Sleep Diary). This provides a clearer picture of the degree of sleep disturbance and allows development of a tailored treatment.

Strong evidence supports the use of non-pharmacologic interventions (e.g. CBT) for insomnia. Head-to-head comparison has shown that he long-term benefits of non-pharmacologic interventions are superior to those of medication. CBT is now considered the most appropriate treatment for patients with primary insomnia. Use of his therapy is based on the fact that primary insomnia is associated with physiologic, emotional, and cognitive arousal and conditioning to arousal in bed.