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

Dieter Riemann*, Colin A. Espie, Ellemarije Altena, Erna Sif Arnardottir, Chiara Baglioni, Claudio L.A. Bassetti, Celyne Bastien, Natalija Berzina, Bjørn Bjorvatn, Dimitris Dikeos, Leja Dolenc Groselj, Jason G. Ellis, Diego Garcia-Borreguero, Pierre A. Geoffroy, Michaela Gjerstad, Marta Gonçalves, Elisabeth Hertenstein, Kerstin Hoedlmoser, Tuuliki Hion, Brigitte HolzingerKarolina Janku, Markus Jansson-Fröjmark, Heli Järnefelt, Susanna Jernelöv, Poul Jørgen Jennum, Samson Khachatryan, Lukas Krone, Simon D. Kyle, Jaap Lancee, Damien Leger, Adrian Lupusor, Daniel Ruivo Marques, Christoph Nissen, Laura Palagini, Tiina Paunio, Lampros Perogamvros, Dirk Pevernagie, Manuel Schabus, Tamar Shochat, Andras Szentkiralyi, Eus Van Someren, Annemieke van Straten, Adam Wichniak, Johan Verbraecken, Kai Spiegelhalder

*Corresponding author for this work

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Abstract

Progress 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).

Original languageEnglish
Article numbere14035
Number of pages36
JournalJournal of Sleep Research
Volume32
Issue number6
Early online date28 Nov 2023
DOIs
Publication statusPublished - 1 Dec 2023

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