The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023.
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
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
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 |
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).