Treatment strategy for insomnia disorder: Japanese expert consensus

PurposeThere is a lack of evidence regarding answers for clinical questions about treating insomnia disorder. This study aimed to answer the following clinical questions: (1) how to use each hypnotic and non-pharmacological treatment differently depending on clinical situations and (2) how to reduce or stop benzodiazepine hypnotics using alternative pharmacological and non-pharmacological treatments. MethodsExperts were asked to evaluate treatment choices based on 10 clinical questions about insomnia disorder using a nine-point Likert scale (1 = disagree to 9 = agree). The responses of 196 experts were collected, and the answers were categorized into first-, second-, and third-line recommendations. ResultsThe primary pharmacological treatment, lemborexant (7.3 +/- 2.0), was categorized as a first-line recommendation for sleep initiation insomnia, and lemborexant (7.3 +/- 1.8) and suvorexant (6.8 +/- 1.8) were categorized as the first-line recommendations for sleep maintenance insomnia. Regarding non-pharmacological treatments for primary treatment, sleep hygiene education was categorized as the first-line recommendation for both sleep initiation (8.4 +/- 1.1) and maintenance insomnia (8.1 +/- 1.5), while multicomponent cognitive behavioral therapy for insomnia was categorized as the second-line treatment for both sleep initiation (5.6 +/- 2.3) and maintenance insomnia (5.7 +/- 2.4). When reducing or discontinuing benzodiazepine hypnotics by switching to other medications, lemborexant (7.5 +/- 1.8) and suvorexant (6.9 +/- 1.9) were categorized as first-line recommendations. ConclusionExpert consensus indicates that orexin receptor antagonists and sleep hygiene education are recommended as first-line treatments in most clinical situations to treat insomnia disorder.

Automated summary

This study investigated the answers to clinical questions about treating insomnia disorder, finding that the use of hypnotic and non-pharmacological treatments varies depending on clinical situations, and alternative treatments can help reduce or stop benzodiazepine hypnotics. Expert consensus suggests that orexin receptor antagonists and sleep hygiene education are recommended as first-line treatments in most clinical situations.