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J Sleep Res. 2017 Dec;26(6):675-700. doi: 10.1111/jsr.12594. Epub 2017 Sep 5.

European guideline for the diagnosis and treatment of insomnia.

Author information

1
Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
2
University Hospital for Neurology, Inselspital Bern, Bern, Switzerland.
3
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
4
Institute of Clinical Neurophysiology, University Medical Center Ljubljana, Ljubljana, Slovenia.
5
Northumbria Sleep Research Laboratory, Northumbria University, Newcastle, UK.
6
Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK.
7
Sleep Research Institute Madrid, Madrid, Spain.
8
Stavanger University Hospital, Stavanger, Norway.
9
Centro de Medicina de Sono, Hospital Cuf, Porto, Portugal.
10
Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
11
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
12
Centre du Sommeil et de la Vigilance et EA 7330 VIFASOM, Université Paris Descartes, Clinic Hotel-Dieu, Sorbonne Paris Cité, APHP, HUPC, Hotel Dieu de Paris, Paris, France.
13
University Hospital of Psychiatry, Bern, Switzerland.
14
Department of Medicine and Surgery, University of Parma, Parma, Italy.
15
National Institute for Health and Welfare Helsinki, Helsinki, Finland.
16
Sleep Medicine Centre, Kempenhaeghe Foundation, Heeze, The Netherlands.
17
Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Edegem-Wilrijk, Belgium.
18
Sleep Center Pfalzklinikum, Klingenmünster, Germany.
19
Sleep Medicine Center and Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland.
20
Burnasyan Federal Medical Biophysical Center of the Federal Medical Biological Agency, Moscow, Russia.
21
Sleep Measurements, National University Hospital of Iceland, Reykjavik, Iceland.
22
Institute for Pneumology, Medical Faculty, University of Bucharest, Bucharest, Romania.
23
Centre for Sleep Disorders in Children and Adolescents, General Hospital Celje, Ljubljana, Slovenia.
24
Department of Neurology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.

Abstract

This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta-analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co-morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate- to high-quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders), in treatment-resistant insomnia, for professional at-risk populations and when substantial sleep state misperception is suspected (strong recommendation, high-quality evidence). Cognitive behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (strong recommendation, high-quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short-term treatment of insomnia (≤4 weeks; weak recommendation, moderate-quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low- to very-low-quality evidence). Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low-quality evidence). Complementary and alternative treatments (e.g. homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very-low-quality evidence).

KEYWORDS:

CBT-I; evidence-based medicine; hypnotics

PMID:
28875581
DOI:
10.1111/jsr.12594
[Indexed for MEDLINE]

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