Advances in the Treatment of Chronic Insomnia: A Narrative Review of New Nonpharmacologic and Pharmacologic Therapies

Abstract

Chronic insomnia disorder, which affects 6–10% of the population, is diagnostically characterized by ongoing difficulties with initiating or maintaining sleep occurring at least three times per week, persisting for at least 3 months, and associated with daytime impairment. While chronic insomnia is often considered a condition primarily related to impaired sleep, the disorder can also adversely affect domains of physical and mental health, quality of life, and daytime function, which highlights the importance of treating the multidimensional sleep disorder. Owing to misperceptions about the safety and effectiveness of treatment options, many individuals with insomnia may not seek professional treatment, and alternatively use ineffective home remedies or over-the-counter medications to improve sleep. Some physicians may even believe that insomnia is remediated by simply having the patient “get more sleep”. Unfortunately, treatment of insomnia is not always that simple. The disorder’s complex underlying pathophysiology warrants consideration of different nonpharmacologic and pharmacologic treatment options. Indeed, recent insights gained from research into the pathophysiology of insomnia have facilitated development of newer treatment approaches with more efficacious outcomes. This narrative review provides a summary of the diagnostic criteria and pathophysiology of insomnia and its subtypes. Further, this review emphasizes new and emerging nonpharmacologic and pharmacologic treatments for chronic insomnia, including recent enhancements in approaches to cognitive behavioral therapy for insomnia (CBT-I) and the new dual orexin receptor antagonist (DORA) pharmacologics. These advances in treatment have expanded the treatment options and are likely to result in improved outcomes in patients with chronic insomnia.

Mindfulness-based Cognitive Therapy to Improve Sleep Quality in Older Adults with Insomnia

“…Davidson et al (2019) concluded that a sleep program with stimulus control and sleep restriction based on behavioral components showed better effects on sleep latency and awakenings after the onset of sleep, as well as on the general reduction in severity evaluated with the ISI scale. Cognitive components have also been shown to be effective in reducing insomnia by facilitating the identification and modification of dysfunctional thoughts, redirection of unrealistic expectations and misperceptions of sleep, elimination of worry, and modification of attentional bias (Harvey et al, 2014;Rosenberg et al, 2021).…”

Efficacy and safety of Qigong Baduanjin exercise in the treatment of depression with insomnia

“…Baduanjin exercise is a traditional Chinese exercise that can improve the function of the internal organs of the body by regulating the flow of Qi and blood through the meridians to achieve the effect of fitness and dispel diseases [20] . At present, Baduanjin exercise has been widely used in the treatment of diabetes mellitus, [21] chronic obstructive pulmonary disease, [22] and heart failure, [23] and has achieved good results.…”

A 2023 Update on Managing Insomnia in Primary Care

“…2,16 This misperception has contributed to significant undertreatment of sleep disturbances. 10 In the DSM-5, however, the distinction between primary and secondary insomnia was eliminated, and the term insomnia disorder was adopted. Insomnia disorder is therefore now recognized as a condition that often coexists with, and is not merely secondary to, another condition such as depression.…”