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Treatment strategy for insomnia disorder: Japanese expert consensus
Yoshikazu Takaesu1,2, Hitoshi Sakurai2, Yumi Aoki2,3
1Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
Frontiers in Psychiatry
|May 25, 2023
Summary
Expert consensus recommends orexin receptor antagonists and sleep hygiene education as top choices for treating insomnia disorder. These treatments are advised for various clinical scenarios and for reducing benzodiazepine use.
Area of Science:
- Sleep Medicine
- Pharmacology
- Behavioral Science
Background:
- Insomnia disorder lacks clear clinical guidelines for treatment selection.
- Evidence is needed to differentiate hypnotic and non-pharmacological approaches.
- Guidance is required for tapering benzodiazepine hypnotics.
Purpose of the Study:
- To establish expert consensus on clinical questions regarding insomnia disorder treatment.
- To guide the differential use of hypnotics and non-pharmacological therapies.
- To provide strategies for reducing or discontinuing benzodiazepine hypnotics.
Main Methods:
- A survey of 196 experts on 10 clinical questions about insomnia treatment.
- Utilized a nine-point Likert scale for treatment choice evaluation.
- Categorized expert responses into first-, second-, and third-line recommendations.
Main Results:
- Lemborexant and suvorexant (orexin receptor antagonists) were first-line for sleep initiation and maintenance.
- Sleep hygiene education was a first-line non-pharmacological treatment.
- Multicomponent cognitive behavioral therapy for insomnia was a second-line treatment.
- Orexin receptor antagonists were first-line for switching from benzodiazepines.
Conclusions:
- Expert consensus supports orexin receptor antagonists as first-line pharmacological treatments.
- Sleep hygiene education is a recommended first-line non-pharmacological intervention.
- These treatments are advised for most clinical situations in insomnia management.
Keywords:
benzodiazepinecognitive behavioral therapyhypnoticsinsomniaorexin receptor antagonistssleep hygiene education (SHE)More Related Videos
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