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The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023.

Journal of sleep research
December 1, 2023
Dieter Riemann et al. (45 authors)
Journal ArticleReviewResearch Support, Non-U.S. Gov'tHuman Study
Study Details

Study Goal

The researchers aimed to evaluate the potential utility of light therapy as an adjunct treatment to cognitive-behavioral therapy for insomnia.

Results Summary

The study found that light therapy may be useful as an adjunct therapy to cognitive-behavioral therapy for insomnia, though it was not recommended as a standalone treatment. The evidence supporting its efficacy was graded as level B, indicating moderate confidence.

Population

Adults with insomnia, including those with comorbidities.

Effective Dosage

Not specified

Duration

Not specified

Interactions

None mentioned

Extracted Claims (21)
InterventionDirectionEndpointPopulationDosageImpactClaim #
Actigraphy
no change
routine evaluation of insomnia
-
-
not recommended
#1
Actigraphy
increase
differential-diagnostic purposes
-
-
may be useful
#2
Polysomnography
increase
evaluation of other sleep disorders if suspected
-
-
should be used
#3
Polysomnography
increase
treatment-resistant insomnia
-
-
should be used
#4
Cognitive-behavioural therapy for insomnia
increase
chronic insomnia
adults of any age (including patients with comorbidities)
-
recommended as the first-line treatment
#5
Cognitive-behavioural therapy for insomnia
no change
-
-
-
not sufficiently effective
#6
pharmacological intervention
increase
-
-
-
can be offered
#7
Benzodiazepines
increase
short-term treatment of insomnia
-
≤ 4 weeks
can be used
#8
benzodiazepine receptor agonists
increase
short-term treatment of insomnia
-
≤ 4 weeks
can be used
#9
daridorexant
increase
short-term treatment of insomnia
-
≤ 4 weeks
can be used
#10
low-dose sedating antidepressants
increase
short-term treatment of insomnia
-
≤ 4 weeks
can be used
#11
Benzodiazepines, benzodiazepine receptor agonists, daridorexant and low-dose sedating antidepressants
increase
-
-
-
longer-term treatment may be initiated
#12
Orexin receptor antagonists
increase
-
-
periods of up to 3 months or longer
can be used
#13
Prolonged-release melatonin
increase
-
patients ≥ 55 years
up to 3 months
can be used
#14
Antihistaminergic drugs
no change
insomnia treatment
-
-
not recommended
#15
antipsychotics
no change
insomnia treatment
-
-
not recommended
#16
fast-release melatonin
no change
insomnia treatment
-
-
not recommended
#17
ramelteon
no change
insomnia treatment
-
-
not recommended
#18
phytotherapeutics
no change
insomnia treatment
-
-
not recommended
#19
Light therapy
increase
adjunct therapies to cognitive-behavioural therapy for insomnia
-
-
may be useful
#20
exercise interventions
increase
adjunct therapies to cognitive-behavioural therapy for insomnia
-
-
may be useful
#21
Abstract

Progress in the field of insomnia since 2017 necessitated this update of the European Insomnia Guideline. Recommendations for the diagnostic procedure for insomnia and its comorbidities are: clinical interview (encompassing sleep and medical history); the use of sleep questionnaires and diaries (and physical examination and additional measures where indicated) (A). Actigraphy is not recommended for the routine evaluation of insomnia (C), but may be useful for differential-diagnostic purposes (A). Polysomnography should be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders, etc.), treatment-resistant insomnia (A) and for other indications (B). Cognitive-behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (including patients with comorbidities), either applied in-person or digitally (A). When cognitive-behavioural therapy for insomnia is not sufficiently effective, a pharmacological intervention can be offered (A). Benzodiazepines (A), benzodiazepine receptor agonists (A), daridorexant (A) and low-dose sedating antidepressants (B) can be used for the short-term treatment of insomnia (≤ 4 weeks). Longer-term treatment with these substances may be initiated in some cases, considering advantages and disadvantages (B). Orexin receptor antagonists can be used for periods of up to 3 months or longer in some cases (A). Prolonged-release melatonin can be used for up to 3 months in patients ≥ 55 years (B). Antihistaminergic drugs, antipsychotics, fast-release melatonin, ramelteon and phytotherapeutics are not recommended for insomnia treatment (A). Light therapy and exercise interventions may be useful as adjunct therapies to cognitive-behavioural therapy for insomnia (B).

Medical Subject Headings (MeSH)
AdultHumansSleep Initiation and Maintenance DisordersMelatoninSleepBenzodiazepinesAntidepressive Agents
Study Links
Quality Scores
SafetyNot Assessed
Efficacy65/10
Quality75/10
Citation Metrics
Total Citations206
Citations/Year103.0
Relative Citation Ratio66.37
NIH Percentile100%
Research Impact Scores
APT Score0.95
Weight Score3.35
Normalized Score0.61
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