Clinician reference tool — not medical advice. This is a clinical decision-aid intended for healthcare professionals: it gives deterministic suggestions to think with, not a diagnosis or a prescription. If you’re a patient, you’re welcome to look around — but please review anything here with your own doctor; it isn’t a substitute for personalized medical care.

Evidence: AASM — Pharmacologic Treatment of Chronic Insomnia (JCSM … 2026 · sources last checked 2026-08-20

Reference tool — not medical advice. Thresholds, targets, and first-line agents differ by guideline body and change over time — switch the lens to compare. Clinician judgement, dosing/monitoring, contraindications, and live coverage always required. Runs entirely in your browser — no data is collected.

Insomnia selector

Choose the guideline lens (AASM / ESRS / ACP), the insomnia pattern, age and comorbidities — get the plan: CBT-I first-line for everyone, then (if a drug is added) a pattern-matched, Beers-aware choice — DORAs / low-dose doxepin for maintenance, short-acting agents for onset — with the drugs to avoid flagged.

Guideline lens

Insomnia patternchoose one

Chronicitychoose one

Age groupchoose one

Comorbidities

CBT-I statuschoose one

First-line (all guidelines)

CBT-I — for every patient with chronic insomnia, before or instead of medication

If a drug is added

sleep-maintenance → DORA / low-dose doxepin — adjunct, time-limited, shared decision

Notes

  • • CBT-I is first-line for ALL chronic insomnia (ACP, AASM, ESRS) — offer it before or instead of medication; digital/guided-digital CBT-I is an accepted alternative when in-person access is limited. Medication is an adjunct, generally time-limited.
  • • CBT-I not yet tried: prioritize it. If a drug is used while CBT-I is arranged, keep it short-term and pattern-matched (onset vs maintenance).
  • • AASM rates each drug individually (all weak-strength) and, in 2026, suggests CBT-I alone over routinely starting CBT-I + drug together. Trazodone and OTC antihistamines are recommended against.

Suggested drug classesPer AASM 2026.

Select the insomnia pattern to begin.

Switch the lens to see the DORA/melatonin difference: ESRS ranks DORAs strongest; AASM rates each drug (all weak) and is against trazodone/antihistamines.

Guidelines

References

  1. [1]AASM — Pharmacologic Treatment of Chronic Insomnia (JCSM 2017) + Behavioral and Psychological Treatments (2021) + Combination Treatment (2026). CBT-I first-line; per-drug GRADE (all weak); trazodone/antihistamines against. Beers Criteria 2023 (avoid benzodiazepines/Z-drugs/anticholinergics in older adults). link
  2. [2]Riemann D, et al. European Insomnia Guideline update. J Sleep Res 2023;32:e14035. CBT-I very strong; DORAs (daridorexant) strongest pharmacologic; prolonged-release melatonin age ≥55. link
  3. [3]Qaseem A, et al. Management of Chronic Insomnia Disorder in Adults: ACP Clinical Practice Guideline. Ann Intern Med 2016;165:125 (CBT-I first). Canadian: PEER simplified guideline, CFP 2024; Choosing Wisely Canada (deprescribe sedative-hypnotics). link