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

Abstract

Sleep disorders are common in the general population and even more so in clinical practice, yet are relatively poorly understood by doctors and other health care practitioners. These British Association for Psychopharmacology guidelines are designed to address this problem by providing an accessible up-to-date and evidence-based outline of the major issues, especially those relating to reliable diagnosis and appropriate treatment. A consensus meeting was held in London in May 2009. Those invited to attend included BAP members, representative clinicians with a strong interest in sleep disorders and recognized experts and advocates in the field, including a representative from mainland Europe and the USA. Presenters 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 randomized controlled trials where available, plus updates on current clinical practice. Each presentation was followed by discussion, aimed 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 then circulated to all participants for comment. Key subsequent publications were added by the writer and speakers at draft stage. All comments were incorporated as far as possible in the final document, which represents the views of all participants although the authors take final responsibility for the document.

New perspectives on the role of melatonin in human sleep, circadian rhythms and their regulation

“…hypertension, diabetes, cardiovascular disease and AD) and concomitant medications for these comorbidities. Based on the clinical evidence, PRM was approved in the EU and many other countries and recommended as a first‐line treatment for insomnia characterized by poor sleep quality (non‐restorative sleep) in patients aged 55 and older (Wilson et al, 2010). Interestingly, efficacy increases with time reaching a plateau after 13 weeks and thereafter (Zisapel, 2012).…”

Therapeutic rationale for low dose doxepin in insomnia patients

“…depression, anxiety) and possibly cardiovascular disorders. Main goals of insomnia treatment are to produce less suffering and to improve daytime function [4] .…”

“…[4,6,13] . The current mainstay for the pharmacotherapy of insomnia is as below [4][5][6][7][8][9]13,14] :…”

“…The adaptive changes in GABA receptor cause withdrawal, characterized by neurological, physical and cognitive symptoms, and rebound insomnia [4,9,14,15] .…”

“…It does not cause daytime sedation (no next-day sedation). 4. Published clinical trials demonstrated that it is effective in adult as well as elderly patients with primary insomnia and current data suggest that it is also safe and well tolerated at 6 mg dose [19,25,27,29] .…”