S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen

Riemann, Dieter; Baum, Erika; Cohrs, Stefan; Crönlein, Tatjana; Hajak, Göran; Hertenstein, Elisabeth; Klose, Petra; Langhorst, Jost; Mayer, Geert; Nissen, Christoph; Pollmächer, Thomas; Rabstein, Sylvia; Schlarb, Angelika; Sitter, H.; Weeß, H.-G.; Wetter, Thomas C.; Spiegelhalder, Kai

doi:10.1007/s11818-016-0097-x

Cited by 244 publications

(184 citation statements)

References 188 publications

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“…For Europe in general and Germany specifically, independently published guidelines (Riemann, Baglioni, et al, ; Riemann, Baum, et al, ) for the diagnosis and treatment of insomnia mirror the conclusions of the American College of Physicians. 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.…”

Section: A Summary Of Present Guidelinesmentioning

confidence: 92%

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

Baglioni

Altena

Bjorvatn

et al. 2019

Journal of Sleep Research

166

159

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Insomnia, the most prevalent sleep disorder worldwide, confers marked risks for both physical and mental health. Furthermore, insomnia is associated with considerable direct and indirect healthcare costs. Recent guidelines in the US and Europe unequivocally conclude that cognitive behavioural therapy for insomnia (CBT‐I) should be the first‐line treatment for the disorder. Current treatment approaches are in stark contrast to these clear recommendations, not least across Europe, where, if any treatment at all is delivered, hypnotic medication still is the dominant therapeutic modality. To address this situation, a Task Force of the European Sleep Research Society and the European Insomnia Network met in May 2018. The Task Force proposed establishing a European CBT‐I Academy that would enable a Europe‐wide system of standardized CBT‐I training and training centre accreditation. This article summarizes the deliberations of the Task Force concerning definition and ingredients of CBT‐I, preconditions for health professionals to teach CBT‐I, the way in which CBT‐I should be taught, who should be taught CBT‐I and to whom CBT‐I should be administered. Furthermore, diverse aspects of CBT‐I care and delivery were discussed and incorporated into a stepped‐care model for insomnia.

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Section: A Summary Of Present Guidelinesmentioning

confidence: 92%

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

Baglioni

Altena

Bjorvatn

et al. 2019

Journal of Sleep Research

166

159

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“…Chart review studies give us an idea of how hospital doctors usually solve this conflict; they often prescribe benzodiazepines and newer non-benzodiazepines (so-called Z-drugs) for patients who have trouble sleeping [3][4][5]. While these drugs may help patients to sleep in the hospital environment, they also have adverse effects, such as confusion, falls, fractures, and craving [6] so they are not recommended for the treatment of transient sleep problems in most guidelines [7]. Z-drugs, specifically, have been accompanied with conflicting information ranging from "[Z-drugs are] considered the safest and most effective prescription sleep aids for geriatric patients" [8] to "[Z-drugs are] not necessarily a safer alternative to traditional BZDs" [9].…”

Section: Introductionmentioning

confidence: 99%

Why Z-drugs are used even if doctors and nurses feel unable to judge their benefits and risks—a hospital survey

Heinemann

Brockmöller

Hagmayer

et al. 2019

Eur J Clin Pharmacol

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Background Many patients receive Z-drugs for hospital-associated sleep problems, in spite of well-known risks. The aim of this study was to learn more about the attractiveness of Z-drugs, seen from the doctors' and nurses' perspective. Methods Using a standardized questionnaire, doctors (63/116) and nurses (73/243) in a German general hospital were surveyed about the risks and benefits of Z-drugs, compared with benzodiazepines. Result "Reduced time to get to sleep" was perceived by doctors (51%) and nurses (53%) to be a strong benefit of Z-drugs; "confusion" and "falls" were perceived by ca. 10% of doctors and ca. 15% of nurses to be a frequent problem. Compared with benzodiazepines, respondents more often answered "unable to judge" for Z-drugs; e.g. for doctors, 18% (benzodiazepines) vs. 45% (Z-drugs) were unable to judge "improved daytime functioning" and 12% (benzodiazepines) vs. 37% (Z-drugs) were unable to judge "falls." Conclusion Z-drugs seem to be attractive because experiential knowledge overemphasizes their benefits and fails to take risks such as drug-related falls and confusion into account. Difficulties to judge a drug's risk-benefit ratio do not prevent doctors and nurses from using them. Interventions for reducing Z-drug usage should incorporate local quality assurance data about relevant patient risks.

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“…Neben der Klassifizierung der Insomnie nach ICD-10 mit den Diagnosekriterien Einschlafstörungen, Durchschlafstörungen, Beeinträchtigung der Alltagsaktivitäten sowie eine Mindestdauer der Insomniebeschwerden von einem Monat, werden im DSM-V das Zeitkriterium sowie die Einteilung in primäre und sekundäre Insomnie aufgehoben: Die insomnischen Beschwerden müssen mindestens drei Monate persistieren und obgleich Insomnie alleine oder in Begleitung anderer Diagnosen auftritt, kann die Diagnose "Insomnische Störung" vergeben werden. Dies ermöglicht die verhaltenstherapeutische Behandlung der Insomnie auch bei somatischen und psychiatrischen Komorbiditäten (18).…”

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“…kognitiven Umstrukturierung) sowie der Vermittlung von Regeln für einen gesunden Schlaf durch Psychoedukation (z.B. Stimuluskontrolle, Schlafhygiene, Schlafrestriktion) und Entspannungsverfahren zusammen (18). Diese einzelnen Bausteine werden in unterschiedlicher Reihenfolge und in unterschiedlicher Frequenz in der Insomniebehandlung verwendet.…”

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“…In der ersten Stufe wird die Selbsthilfe durch das Verfassen von Tagebüchern sowie Hören von edukativen CDs oder DVDs empfohlen. In der nächsten Stufe folgt die Gruppenbehandlung durch Gesundheitspersonal, danach die Behandlung durch (klinische) Psychologen und in der letzten Stufe steht die Behandlung durch schlafmedizinisch geschulte, ärztliche und psychologische Therapeuten in spezialisierten, schlafmedizinischen Zentren, welche sowohl Möglichkeiten der ambulanten, als auch der stationären Versorgung bieten (9,18). Ein weiterer Vorschlag, der zusätzlich internetbasierte Therapie sowie Schlafedukation als Präventionsmaßnahme vorschlägt, ist in der Abbildung 1 dargestellt (▶ Abb.…”

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Verhaltenstherapie der Insomnie

Richter¹

2018

Schlaf

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Die kognitive Verhaltenstherapie für Insomnien (KVT-I) ist neben der pharmakologischen Intervention der wichtigste Bestandteil des Kapitels „Insomnie bei Erwachsenen” innerhalb der S3-Leitlinie „Nicht erholsamer Schlaf”. Kognitive Verhaltenstherapie stellt eine effektive Behandlungsoption der Insomnie bei Erwachsenen, unabhängig vom Alter, dar. Die American Academy of Sleep Medicine empfiehlt die Behandlung mit KVT-I bei allen Formen der Insomnie (1, 19).

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S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen

Cited by 244 publications

References 188 publications

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

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

Why Z-drugs are used even if doctors and nurses feel unable to judge their benefits and risks—a hospital survey

Verhaltenstherapie der Insomnie

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