Validation of the Insomnia Severity Index as an outcome measure for insomnia research

Insomnia is the most prevalent sleep disorder in the general population, and is commonly encountered in medical practices. Insomnia is defined as the subjective perception of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep, and that results in some form of daytime impairment.1 Insomnia may present with a variety of specific complaints and etiologies, making the evaluation and management of chronic insomnia demanding on a clinician's time. The purpose of this clinical guideline is to provide clinicians with a practical framework for the assessment and disease management of chronic adult insomnia, using existing evidence-based insomnia practice parameters where available, and consensus-based recommendations to bridge areas where such parameters do not exist. Unless otherwise stated, "insomnia" refers to chronic insomnia, which is present for at least a month, as opposed to acute or transient insomnia, which may last days to weeks.

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Clinical Guideline for the Evaluation and Management of Chronic Insomnia in Adults

OBJECTIVE: The goal of this study was to determine risk factors for depression among elderly community subjects. METHOD: MEDLINE and PsycINFO were searched for potentially relevant articles published from January 1966 to June 2001 and from January 1967 to June 2001, respectively. The bibliographies of relevant articles were searched for additional references. Twenty studies met the following six inclusion criteria: original research reported in an English or French publication, study group of community residents, age of subjects 50 years or more, prospective study design, examination of at least one risk factor, and use of an acceptable definition of depression. The validity of studies was assessed according to the four primary criteria for risk factor studies described by the Evidence-Based Medicine Working Group. Information about group size at baseline and follow-up, age, proportion of men, depression criteria, exclusion criteria at baseline, length of follow-up, number of incident cases of depression,...

Risk Factors for Depression Among Elderly Community Subjects: A Systematic Review and Meta-Analysis

These new guideline recommendations from the American College of Physicians provide evidence-based advice for the management of chronic insomnia disorder in adults. Implementation of these guidelin...

Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians

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).

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jsr.12594

European guideline for the diagnosis and treatment of insomnia

ContextInsomnia is a prevalent health complaint in older
adults. Behavioral and pharmacological treatments have their benefits
and limitations, but no placebo-controlled study has compared their
separate and combined effects for late-life insomnia.ObjectiveTo evaluate the clinical efficacy of behavioral and
pharmacological therapies, singly and combined, for late-life insomnia.Design and SettingRandomized, placebo-controlled clinical trial,
at a single academic medical center. Outpatient treatment lasted 8
weeks with follow-ups conducted at 3, 12, and 24 months.SubjectsSeventy-eight adults (50 women, 28 men; mean age, 65
years) with chronic and primary insomnia.InterventionsCognitive-behavior therapy (stimulus control, sleep
restriction, sleep hygiene, and cognitive therapy)
(n=18), pharmacotherapy (temazepam)
(n=20), or both (n=20) compared with
placebo (n=20).Main Outcome MeasuresTime awake after sleep onset and sleep
efficiency as measured by sleep diaries and polysomnography; clinical
ratings from subjects, significant others, and clinicians.ResultsThe 3 active treatments were more effective than placebo
at posttreatment assessment; there was a trend for the combined
approach to improve sleep more than either of its 2 single components
(shorter time awake after sleep onset by sleep diary and
polysomnography). For example, the percentage reductions of time awake
after sleep onset was highest for the combined condition (63.5%),
followed by cognitive-behavior therapy (55%), pharmacotherapy
(46.5%), and placebo (16.9%). Subjects treated with behavior therapy
sustained their clinical gains at follow-up, whereas those treated with
drug therapy alone did not. Long-term outcome of the combined
intervention was more variable. Behavioral treatment, singly or
combined, was rated by subjects, significant others, and clinicians as
more effective than drug therapy alone. Subjects were also more
satisfied with the behavioral approach.ConclusionsBehavioral and pharmacological approaches are
effective for the short-term management of insomnia in late life; sleep
improvements are better sustained over time with behavioral
treatment.

/pdf/behavioral-and-pharmacological-therapies-for-late-life-132xmwhyvj.pdf

Rakesh K. Sood

Papers

Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial.

Cognitive behavior therapy to facilitate benzodiazepine discontinuation among hypnotic-dependent patients with insomnia *