British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update

Abstract

This British Association for Psychopharmacology guideline replaces the original version published in 2010, and contains updated information and recommendations. A consensus meeting was held in London in October 2017 attended by recognised experts and advocates in the field. They were asked to provide a review of the literature and identification of the standard of evidence in their area, with an emphasis on meta-analyses, systematic reviews and randomised controlled trials where available, plus updates on current clinical practice. Each presentation was followed by discussion, aiming to reach consensus where the evidence and/or clinical experience was considered adequate, or otherwise to flag the area as a direction for future research. A draft of the proceedings was circulated to all speakers for comments, which were incorporated into the final statement.

The European Academy for Cognitive Behavioural Therapy for Insomnia: An initiative of the European Insomnia Network to promote implementation and dissemination of treatment

“…Based on a thorough analysis of all meta‐analyses published in the field, these guidelines stated that CBT‐I should be the first‐line treatment for insomnia and that pharmacological treatment should only be considered when CBT‐I was unsuccessful or not available. In the UK, the British Association for Psychopharmacology (BAP) consensus statement has (since 2010) recommended that “CBT‐based treatment packages for chronic insomnia, including sleep restriction and stimulus control, are effective; and should be offered to patients as a first‐line treatment” (strength of evidence A: directly based on category I evidence) (Wilson et al, , ). The BAP also stated that increased availability of this therapy is required.…”

“…This model promotes the idea that the greatest numbers of patients could be managed through readily accessible self‐help therapies, including dCBT‐I via the internet and mobile devices, as well as books and audio resources. There is now a substantial evidence base for dCBT‐I and such approaches have been incorporated into clinical guidelines (e.g., Wilson et al, ). Dependent upon treatment response, clinical complexity and/or treatment preference, patients may be ‘stepped‐up’ to a more time and resource‐intensive level of CBT‐I; for example, including manualized treatment delivered by trained therapists.…”

“…There is now a substantial evidence base for dCBT-I and such approaches have been incorporated into clinical guidelines (e.g., Wilson et al, 2019). Dependent upon treatment response, clinical complexity and/or treatment preference, patients may be 'stepped-up' to a more time and resource-intensive level of CBT-I; for example, including manualized treatment delivered by trained therapists.…”

Co-Morbid Insomnia and Sleep Apnea (COMISA): Prevalence, Consequences, Methodological Considerations, and Recent Randomized Controlled Trials

“…The estimated prevalence of insomnia varies widely according to diagnostic criteria and specific populations of interest, however it is thought that 6%-10% of the general population suffer from chronic insomnia disorder, which includes clinically significant and frequent nocturnal sleep disturbances and impaired daytime functioning [6,7]. Although cognitive and behavioral therapy for insomnia (CBTi) leads to long-term improvement of insomnia and is the recommended 'first line' insomnia treatment [8][9][10][11], a lack of access to CBTi has resulted in the majority of insomnia sufferers receiving prescriptions for sedative-hypnotic medications as the initial and ongoing treatment [12,13].…”

Feasibility and utility of enhanced sleep management on in-patient psychiatry wards

“…There is also a falls risk in the elderly. 20 The total number of hypnotics issued to the wards decreased by 25% during the 3-month pilot period. This may reflect some hypnotic prescribing being partly attributable to a noisy environment and the observations themselves.…”