The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023

Abstract

SummaryProgress in the field of insomnia since 2017 necessitated this update of the European Insomnia Guideline. Recommendations for the diagnostic procedure for insomnia and its comorbidities are: clinical interview (encompassing sleep and medical history); the use of sleep questionnaires and diaries (and physical examination and additional measures where indicated) (A). Actigraphy is not recommended for the routine evaluation of insomnia (C), but may be useful for differential‐diagnostic purposes (A). Polysomnography should be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep‐related breathing disorders, etc.), treatment‐resistant insomnia (A) and for other indications (B). Cognitive‐behavioural therapy for insomnia is recommended as the first‐line treatment for chronic insomnia in adults of any age (including patients with comorbidities), either applied in‐person or digitally (A). When cognitive‐behavioural therapy for insomnia is not sufficiently effective, a pharmacological intervention can be offered (A). Benzodiazepines (A), benzodiazepine receptor agonists (A), daridorexant (A) and low‐dose sedating antidepressants (B) can be used for the short‐term treatment of insomnia (≤ 4 weeks). Longer‐term treatment with these substances may be initiated in some cases, considering advantages and disadvantages (B). Orexin receptor antagonists can be used for periods of up to 3 months or longer in some cases (A). Prolonged‐release melatonin can be used for up to 3 months in patients ≥ 55 years (B). Antihistaminergic drugs, antipsychotics, fast‐release melatonin, ramelteon and phytotherapeutics are not recommended for insomnia treatment (A). Light therapy and exercise interventions may be useful as adjunct therapies to cognitive‐behavioural therapy for insomnia (B).

Acceptance and Commitment Therapy, Combined with Bedtime Restriction, versus Cognitive Behavioral Therapy for Insomnia: A Randomized Controlled Pilot Trial

“…That is, even after optimal treatment, a considerable number of patients remain symptomatic or do not benefit at all. In case of insufficient response to CBT-I, according to evidence-based guidelines, medication with benzodiazepines (BZD), benzodiazepine receptor agonists (BZDRA), or sedating antidepressants can be offered [10]. Of note, remission rates of CBT-I combined with medication are comparable to those for CBT-I alone [9].…”

Comparative Analysis of the Sedative and Hypnotic Effects among Various Parts of Zizyphus spinosus Hu and Their Chemical Analysis

“…Insomnia manifests as challenges in falling asleep, maintaining sleep, or achieving restorative sleep. This condition is accompanied by notable symptoms, including fatigue, decreased concentration, impaired cognitive function, irritability, anxiety, and depressed mood [ 1 , 2 , 3 , 4 , 5 ]. The onset of insomnia could be associated with certain neurotransmitters, like γ-aminobutyric acid (GABA), 5-hydroxytryptamine (5-HT), and brain-derived neurotrophic factor (BDNF).…”

How patients with insomnia interpret and respond to the consensus sleep diary: a cognitive interview study

“…According to international guidelines, patient reported sleep diaries are important tools for assessing and treating insomnia [ 28 , 32 ]. They are used to gather subjective information on sleep and sleep habits that is not addressed by objective measures such as actigraphy.…”

“…Previous studies on the clinical usefulness of the CSD have shown that the diary items are easy to understand, not too complex, and measure what they are intended to measure [ 12 , 24 ]. The CSD is recommended to be used in the clinical assessment of insomnia [ 32 ]. The CSD is available in two versions: a core version, consisting of nine questions on night related aspects of sleep, and an expanded version, consisting of 20 questions including questions on daytime related aspects of sleep.…”