NIH State-of-the-Science Conference Statement on manifestations and management of chronic insomnia in adults

Abstract

Objective: To provide health care providers, patients, and the general public with a responsible assessment of currently available data on manifestations and management of chronic insomnia in adults.

Participants: A non-DHHS, non-advocate 12-member panel representing the fields of psychology, psychiatry, neuroscience, anesthesiology, sleep disorders, geriatric medicine, epidemiology, health services research, nursing, and community medicine. In addition, 19 experts from fields related to the subject matter of the conference presented data to the panel and to the conference audience.

Evidence: Presentations by experts and a systematic review of the medical literature prepared by the University of Alberta Evidence-based Practice Center, through the Agency for Healthcare Research and Quality's Evidence-based Practice Centers Program. Scientific evidence was given precedence over clinical anecdotal experience.

Conference process: Answering pre-determined questions, the panel drafted its statement based on scientific evidence presented in open forum and on the published scientific literature. The draft statement was read in its entirety on the final day of the conference and circulated to the audience for comment. The panel then met in executive session to consider the comments received, and released a revised statement later that day at http://www.consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government. This statement and all past statements from the NIH Consensus Development Program are available at the same web address of http://www.consensus.nih.gov.

Conclusions: Chronic insomnia is a major public health problem affecting millions of individuals, along with their families and communities. Little is known about the mechanisms, causes, clinical course, comorbidities, and consequences of chronic insomnia. Evidence supports the efficacy of cognitive-behavioral therapy and benzodiazepine receptor agonists in the treatment of this disorder, at least in the short term. Very little evidence supports the efficacy of other treatments, despite their widespread use. Moreover, even for those treatments that have been systematically evaluated, the panel is concerned about the mismatch between the potential lifelong nature of this illness and the longest clinical trials, which have lasted 1 year or less. A substantial public and private research effort is warranted, including developing research tools and conducting longitudinal studies of randomized clinical trials. Finally, there is a major need for educational programs directed at physicians, health care providers, and the public.