Insomnia disorder: clinical and research challenges for the 21st century

Abstract

Background and purpose Insomnia is a common and debilitating disorder that is frequently associated with important consequences for physical health and well‐being. Methods An international expert group considered the current state of knowledge based on the most relevant publications in the previous 5 years, discussed the current challenges in the field of insomnia and identified future priorities. Results The association of trajectories of insomnia with subsequent quality of life, health and mortality should be investigated in large populations. Prospective health economics studies by separating the costs driven specifically by insomnia and costs attributable to its long‐term effects are needed. Ignoring the heterogeneity of insomnia patients leads to inadequate diagnosis and inefficient treatment. Individualized interventions should be promoted. More data are needed on both the impact of sleep on overnight effects, such as emotion regulation, and the potential compensatory effort to counteract diurnal impairments. Another gap is the definition of neurocognitive deficits in insomnia patients compared to normal subjects after chronic sleep loss. There are also a number of key gaps related to insomnia treatment. Expert guidelines indicate cognitive–behavioural therapy for insomnia as first‐line treatment. They neglect, however, the reality of major healthcare providers. The role of combined therapy, cognitive–behavioural therapy for insomnia plus pharmacological treatment, should be evaluated more extensively. Conclusion Whilst insomnia disorder might affect large proportions of the population, there are a number of significant gaps in the epidemiological/clinical/research studies carried out to date. In particular, the identification of different insomnia phenotypes could allow more cost‐effective and efficient therapies.

Targeting Orexin Receptors for the Treatment of Insomnia: From Physiological Mechanisms to Current Clinical Evidence and Recommendations

“…Among the disorders in which orexins are involved, a particularly important position is held by insomnia because of its distinct epidemiology and health and socioeconomic impact. 4 Despite the undoubtful efficacy of cognitive-behavioral therapy for insomnia (CBT-I), which currently remains the first-line treatment, there still is a considerable number of patients who do not remit with this approach. 5 This implies that the use of drugs to treat insomnia is often needed and useful.…”

Long-Term Safety and Tolerability of Daridorexant in Patients with Insomnia Disorder

“…Some 50 years ago, sleep alterations were at the forefront of emerging biological psychiatry as specific changes in sleep architecture were recognised as biological markers of, for example, depressive illnesses [ 1 ]. In the International Classification of Diseases, Tenth Revision , difficulties to initiate or maintain sleep were operationalised as symptoms of mental disorders leaving just a small group of patients with primary insomnia to be treated with specific sleep-related therapy [ 2 , 3 ]. Over the past 30 years, pivotal functions of sleep have been described including its influence on brain maturation, neuronal plasticity, memory consolidation, learning processes, metabolic coordination and immune system functioning [ 4 ].…”

Assessing Measurement Properties of a Simplified Chinese Version of Sleep Condition Indicator (SCI-SC) in Community Residents

“…Good sleep is essential to good health, and conversely, insomnia affects health and quality of life [ 1 , 2 ]. Insomnia complaints are the most ubiquitous sleep–wake problems in both community-dwelling individuals and clinical populations, with approximately one-tenth of the population meeting the diagnostic criteria of clinical insomnia [ 3 ].…”

“…Associated with significant distress and impairment in daytime functioning [ 4 , 5 ], insomnia has a vast socioeconomic burden and impact on public health. However, assessment and treatment can be challenging in practice, as insomnia within each demographic group is commonly associated with multiple interacting psychiatric and medical comorbidities [ 2 , 6 ]. To arrive at an accurate evaluation of insomnia, healthcare providers preferably should assess the sleep complaints and patterns with a structured clinical interview, together with prospective sleep diary and actigraphy [ 3 , 7 ].…”