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

Dieter Riemann^{1

2}, Colin A Espie³, Ellemarije Altena⁴, Erna Sif Arnardottir^{5

6}, Chiara Baglioni⁷, Claudio L A Bassetti⁸, Celyne Bastien⁹, Natalija Berzina¹⁰, Bjørn Bjorvatn¹¹, Dimitris Dikeos¹², Leja Dolenc Groselj¹³, Jason G Ellis¹⁴, Diego Garcia-Borreguero¹⁵, Pierre A Geoffroy¹⁶, Michaela Gjerstad¹⁷, Marta Gonçalves¹⁸, Elisabeth Hertenstein¹⁹, Kerstin Hoedlmoser²⁰, Tuuliki Hion²¹, Brigitte Holzinger²², Karolina Janku²³, Markus Jansson-Fröjmark^{24

25}, Heli Järnefelt²⁶, Susanna Jernelöv^{24

25}, Poul Jørgen Jennum²⁷, Samson Khachatryan²⁸, Lukas Krone^{3

8

19}, Simon D Kyle³, Jaap Lancee²⁹, Damien Leger³⁰, Adrian Lupusor³¹, Daniel Ruivo Marques^{32

33}, Christoph Nissen³⁴, Laura Palagini³⁵, Tiina Paunio³⁶, Lampros Perogamvros³⁴, Dirk Pevernagie³⁷, Manuel Schabus²⁰, Tamar Shochat³⁸, Andras Szentkiralyi³⁹, Eus Van Someren^{40

41}, Annemieke van Straten⁴², Adam Wichniak⁴³, Johan Verbraecken⁴⁴, Kai Spiegelhalder¹

Affiliations

¹ Department of Clinical Psychology and Psychophysiology, Centre for Mental Health (Department), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
² Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany.
³ Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK.
⁴ Université de Bordeaux, Bordeaux, France.
⁵ Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland.
⁶ Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
⁷ Human Sciences Department, University of Rome Guglielmo Marconi Rome, Rome, Italy.
⁸ Department of Neurology, Inselspital, University of Bern, Berne, Switzerland.
⁹ École de Psychologie, Université Laval, Québec, Québec, Canada.
¹⁰ Psychiatric Practice, Riga, Latvia.
¹¹ Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
¹² First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
¹³ Institute of Clinical Neurophysiology, University Medical Center Ljubljana, Ljubljana, Slovenia.
¹⁴ Northumbria Sleep Research Laboratory, Northumbria University, Newcastle, UK.
¹⁵ Sleep Research Institute, Madrid, Spain.
¹⁶ Department of Psychiatry, Paris Cite University, Paris, France.
¹⁷ Stavanger University Hospital, Stavanger, Norway.
¹⁸ Centro de Medicina de Sono, Hospital Cuf, Porto, Portugal.
¹⁹ University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
²⁰ Centre for Cognitive Neurosciences, University of Salzburg, Salzburg, Austria.
²¹ East-Viru Central Hospital, Kohtla-Järve, Estonia.
²² Institute for Consciousness and Dream Research, Vienna, Austria.
²³ Center for Sleep and Chronobiology Research, National Institute of Mental Health, Klecany, Czech Republic.
²⁴ Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
²⁵ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Stockholm Health Care Services, Stockholm, Sweden.
²⁶ Finnish Institute of Occupational Health, Helsinki, Finland.
²⁷ Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark.
²⁸ Department of Neurology and Neurosurgery, Armenian National Institute of Health, Yerevan, Armenia.
²⁹ Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
³⁰ Université Paris Cité, APHP, Hôtel Dieu de Paris, Centre du Sommeil et de la Vigilance, Paris, France.
³¹ Functional Neurology, Institute of Neurology and Neurosurgery, Chisinau, Moldova.
³² Department of Education and Psychology, University of Aveiro, Aveiro, Portugal.
³³ CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.
³⁴ Department of Psychiatry, University Hospital Geneve, Geneve, Switzerland.
³⁵ Psychiatry Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, Pisa, Italy.
³⁶ Department of Psychiatry and SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
³⁷ Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
³⁸ The Cheryl Spencer Institute of Nursing Research, University of Haifa, Haifa, Israel.
³⁹ Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
⁴⁰ Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.
⁴¹ Departments of Integrative Neurophysiology and Psychiatry, Center for Neurogenomics and Cognitive Research, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands.
⁴² Department of Clinical, Neuro- and Developmental Psychology & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
⁴³ Sleep Medicine Center and Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland.
⁴⁴ Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.

PMID: 38016484
DOI: 10.1111/jsr.14035

Free article

Review

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

Dieter Riemann et al. J Sleep Res. 2023 Dec.

Free article

. 2023 Dec;32(6):e14035.

doi: 10.1111/jsr.14035.

Authors

Affiliations

¹ Department of Clinical Psychology and Psychophysiology, Centre for Mental Health (Department), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
² Center for Basics in NeuroModulation (NeuroModulBasics), Faculty of Medicine, University of Freiburg, Freiburg, Germany.
³ Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neuroscience at the University of Oxford, Oxford, UK.
⁴ Université de Bordeaux, Bordeaux, France.
⁵ Reykjavik University Sleep Institute, School of Technology, Reykjavik University, Reykjavik, Iceland.
⁶ Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
⁷ Human Sciences Department, University of Rome Guglielmo Marconi Rome, Rome, Italy.
⁸ Department of Neurology, Inselspital, University of Bern, Berne, Switzerland.
⁹ École de Psychologie, Université Laval, Québec, Québec, Canada.
¹⁰ Psychiatric Practice, Riga, Latvia.
¹¹ Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
¹² First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
¹³ Institute of Clinical Neurophysiology, University Medical Center Ljubljana, Ljubljana, Slovenia.
¹⁴ Northumbria Sleep Research Laboratory, Northumbria University, Newcastle, UK.
¹⁵ Sleep Research Institute, Madrid, Spain.
¹⁶ Department of Psychiatry, Paris Cite University, Paris, France.
¹⁷ Stavanger University Hospital, Stavanger, Norway.
¹⁸ Centro de Medicina de Sono, Hospital Cuf, Porto, Portugal.
¹⁹ University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
²⁰ Centre for Cognitive Neurosciences, University of Salzburg, Salzburg, Austria.
²¹ East-Viru Central Hospital, Kohtla-Järve, Estonia.
²² Institute for Consciousness and Dream Research, Vienna, Austria.
²³ Center for Sleep and Chronobiology Research, National Institute of Mental Health, Klecany, Czech Republic.
²⁴ Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
²⁵ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Stockholm Health Care Services, Stockholm, Sweden.
²⁶ Finnish Institute of Occupational Health, Helsinki, Finland.
²⁷ Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark.
²⁸ Department of Neurology and Neurosurgery, Armenian National Institute of Health, Yerevan, Armenia.
²⁹ Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands.
³⁰ Université Paris Cité, APHP, Hôtel Dieu de Paris, Centre du Sommeil et de la Vigilance, Paris, France.
³¹ Functional Neurology, Institute of Neurology and Neurosurgery, Chisinau, Moldova.
³² Department of Education and Psychology, University of Aveiro, Aveiro, Portugal.
³³ CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.
³⁴ Department of Psychiatry, University Hospital Geneve, Geneve, Switzerland.
³⁵ Psychiatry Unit, Department of Clinical and Experimental Medicine, School of Medicine, University of Pisa, Pisa, Italy.
³⁶ Department of Psychiatry and SleepWell Research Program, Faculty of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
³⁷ Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
³⁸ The Cheryl Spencer Institute of Nursing Research, University of Haifa, Haifa, Israel.
³⁹ Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
⁴⁰ Department of Sleep and Cognition, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.
⁴¹ Departments of Integrative Neurophysiology and Psychiatry, Center for Neurogenomics and Cognitive Research, Amsterdam UMC, Amsterdam Neuroscience, VU University, Amsterdam, The Netherlands.
⁴² Department of Clinical, Neuro- and Developmental Psychology & Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
⁴³ Sleep Medicine Center and Third Department of Psychiatry, Institute of Psychiatry and Neurology, Warsaw, Poland.
⁴⁴ Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.

PMID: 38016484
DOI: 10.1111/jsr.14035

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).

Keywords: diagnosis; evidence-based medicine; guideline; insomnia; treatment.

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References

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1. Abetz, L., Arbuckle, R., Allen, R. P., Garcia-Borreguero, D., Hening, W., Walters, A., Mavraki, E., & Kirsch, J. M. (2006). The reliability, validity and responsiveness of the IRLSSG rating scale and subscales in a clinical-trial setting. Sleep Medicine, 4, 340-349.
1. Alimoradi, Z., Jafari, E., Broström, A., Ohayon, M. M., Lin, C. Y., Griffiths, M. D., Blom, K., Jernelöv, S., Kaldo, V., & Pakpour, A. H. (2022). Effects of cognitive behavioral therapy for insomnia (CBT-I) on quality of life: A systematic review and meta-analysis. Sleep Medicine Reviews, 64, 101646. https://doi.org/10.1016/j.smrv.2022.101646
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The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023

Affiliations

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

Authors

Affiliations

Abstract

References

REFERENCES

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical