European guideline for the diagnosis and treatment of insomnia

Dieter Riemann; Chiara Baglioni; Claudio Bassetti; Bjørn Bjorvatn; Leja Dolenc Groselj; Jason G. Ellis; Colin A. Espie; Diego Garcia-Borreguero; Michaela Gjerstad; Marta Gonçalves; Elisabeth Hertenstein; Markus Jansson-Fröjmark; Poul J. Jennum; Damien Leger; Christoph Nissen; Liborio Parrino; Tiina Paunio; Dirk Pevernagie; Johan Verbraecken; Hans Günter Weeß; Adam Wichniak; Irina Zavalko; Erna S. Arnardottir; Oana Claudia Deleanu; Barbara Strazisar; Marielle Zoetmulder; Kai Spiegelhalder

doi:10.1111/jsr.12594

European guideline for the diagnosis and treatment of insomnia

Dieter Riemann^*, Chiara Baglioni, Claudio Bassetti, Bjørn Bjorvatn, Leja Dolenc Groselj, Jason G. Ellis, Colin A. Espie, Diego Garcia-Borreguero, Michaela Gjerstad, Marta Gonçalves, Elisabeth Hertenstein, Markus Jansson-Fröjmark, Poul J. Jennum, Damien Leger, Christoph Nissen, Liborio Parrino, Tiina Paunio, Dirk Pevernagie, Johan Verbraecken, Hans Günter WeeßAdam Wichniak, Irina Zavalko, Erna S. Arnardottir, Oana Claudia Deleanu, Barbara Strazisar, Marielle Zoetmulder, Kai Spiegelhalder

^*Corresponding author for this work

Department of Clinical Medicine

411 Citations (Scopus)

Abstract

This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta-analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co-morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate- to high-quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders), in treatment-resistant insomnia, for professional at-risk populations and when substantial sleep state misperception is suspected (strong recommendation, high-quality evidence). Cognitive behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (strong recommendation, high-quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short-term treatment of insomnia (≤4 weeks; weak recommendation, moderate-quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low- to very-low-quality evidence). Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low-quality evidence). Complementary and alternative treatments (e.g. homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very-low-quality evidence).

Original language	English
Journal	Journal of Sleep Research
Volume	26
Issue number	6
Pages (from-to)	675-700
Number of pages	26
ISSN	0962-1105
DOIs	https://doi.org/10.1111/jsr.12594
Publication status	Published - Dec 2017

Keywords

CBT-I
evidence-based medicine
hypnotics

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Riemann, D., Baglioni, C., Bassetti, C., Bjorvatn, B., Dolenc Groselj, L., Ellis, J. G., Espie, C. A., Garcia-Borreguero, D., Gjerstad, M., Gonçalves, M., Hertenstein, E., Jansson-Fröjmark, M., Jennum, P. J., Leger, D., Nissen, C., Parrino, L., Paunio, T., Pevernagie, D., Verbraecken, J., ... Spiegelhalder, K. (2017). European guideline for the diagnosis and treatment of insomnia. Journal of Sleep Research, 26(6), 675-700. https://doi.org/10.1111/jsr.12594

Riemann, D, Baglioni, C, Bassetti, C, Bjorvatn, B, Dolenc Groselj, L, Ellis, JG, Espie, CA, Garcia-Borreguero, D, Gjerstad, M, Gonçalves, M, Hertenstein, E, Jansson-Fröjmark, M, Jennum, PJ, Leger, D, Nissen, C, Parrino, L, Paunio, T, Pevernagie, D, Verbraecken, J, Weeß, HG, Wichniak, A, Zavalko, I, Arnardottir, ES, Deleanu, OC, Strazisar, B, Zoetmulder, M & Spiegelhalder, K 2017, 'European guideline for the diagnosis and treatment of insomnia', Journal of Sleep Research, vol. 26, no. 6, pp. 675-700. https://doi.org/10.1111/jsr.12594

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abstract = "This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta-analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co-morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate- to high-quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders), in treatment-resistant insomnia, for professional at-risk populations and when substantial sleep state misperception is suspected (strong recommendation, high-quality evidence). Cognitive behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (strong recommendation, high-quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short-term treatment of insomnia (≤4 weeks; weak recommendation, moderate-quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low- to very-low-quality evidence). Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low-quality evidence). Complementary and alternative treatments (e.g. homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very-low-quality evidence).",

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AU - Riemann, Dieter

AU - Baglioni, Chiara

AU - Bassetti, Claudio

AU - Bjorvatn, Bjørn

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AU - Ellis, Jason G.

AU - Espie, Colin A.

AU - Garcia-Borreguero, Diego

AU - Gjerstad, Michaela

AU - Gonçalves, Marta

AU - Hertenstein, Elisabeth

AU - Jansson-Fröjmark, Markus

AU - Jennum, Poul J.

AU - Leger, Damien

AU - Nissen, Christoph

AU - Parrino, Liborio

AU - Paunio, Tiina

AU - Pevernagie, Dirk

AU - Verbraecken, Johan

AU - Weeß, Hans Günter

AU - Wichniak, Adam

AU - Zavalko, Irina

AU - Arnardottir, Erna S.

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AU - Zoetmulder, Marielle

AU - Spiegelhalder, Kai

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AB - This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta-analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co-morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate- to high-quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders), in treatment-resistant insomnia, for professional at-risk populations and when substantial sleep state misperception is suspected (strong recommendation, high-quality evidence). Cognitive behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (strong recommendation, high-quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short-term treatment of insomnia (≤4 weeks; weak recommendation, moderate-quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low- to very-low-quality evidence). Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low-quality evidence). Complementary and alternative treatments (e.g. homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very-low-quality evidence).

KW - CBT-I

KW - evidence-based medicine

KW - hypnotics

U2 - 10.1111/jsr.12594

DO - 10.1111/jsr.12594

M3 - Journal article

C2 - 28875581

AN - SCOPUS:85035020111

SN - 0962-1105

VL - 26

SP - 675

EP - 700

JO - Journal of Sleep Research

JF - Journal of Sleep Research

IS - 6

ER -

European guideline for the diagnosis and treatment of insomnia

Abstract

Keywords

UN SDGs

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