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Special Issue "Insomnia Treatments: New Perspectives"

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (15 February 2023) | Viewed by 1689

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Special Issue Editor

Prof. Dr. Nathaniel Watson

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Guest Editor

Sleep Medicine Center, University of Washington, Seattle, WA, USA
Interests: sleep medicine; sleep duration; sleep epidemiology; narcolepsy; central nervous system hypersomnia

Special Issue Information

Dear Colleagues,

Sleep disorders are among the most common medical complaints worldwide, affecting approximately 30% of the general population. Insomnia is the most common sleep disorder and the clinical diagnostic criteria defining insomnia disorder include not only sleep disruption but also consequent daytime impairment. Insomnia can also have devastating effects on human health, including a higher risk of obesity, cardiovascular disease, diabetes, alcohol abuse, and incident and recurrent depression.

The identification of a person’s specific insomnia symptoms can help guide treatments. While cognitive behavioral therapy for insomnia (CBT-I) is considered first-line treatment, not all patients respond to or have access to CBT-I. Pharmacological treatments include several different drug classes, such as benzodiazepines; non-BZD hypnotic “Z-drugs,” such as zolpidem or eszopiclone; dual orexin receptor antagonists; melatonin receptor agonists; histamine antagonists; and classes, such as sedating antidepressants.

Insomnia management is complex and changed significantly in the past decade. Several new pharmacologic treatments have been introduced, expanding the scope of options for therapy. Y the availability of newer pharmacologic therapies and optimal treatments for specific insomnia outcomes is not well-defined, and there is a dire need for improved education on treatment options and patient-physician dialogue.

Submissions of original research articles on the clinical management of insomnia are welcomed for this Special Issue. In particular, reviews focusing on the latest pharmacologic treatment options are encouraged.

Prof. Dr. Nathaniel Watson
Guest Editor

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Keywords

insomnia
insomnia medications
drug therapy
daytime function
sleep disorders

Published Papers (3 papers)

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Research

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Open AccessArticle

The Associations between Insomnia Severity and Health Outcomes in the United States

François-Xavier Chalet

and

J. Clin. Med. 2023, 12(6), 2438; https://doi.org/10.3390/jcm12062438 - 22 Mar 2023

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Abstract

Little is known about the associations between insomnia severity, insomnia symptoms, and key health outcomes. Using 2020 United States National Health and Wellness Survey (NHWS) data, we conducted a retrospective, cross-sectional analysis to determine the associations between insomnia severity and a number of health outcomes germane to patients (health-related quality of life (HRQoL), employers and government (workplace productivity), and healthcare payers (healthcare resource utilization (HCRU)). The Insomnia Severity Index (ISI) questionnaire was used to evaluate overall insomnia severity. HRQoL was assessed using the physical and mental component summary scores of the Short Form-36v2 (SF-36v2) questionnaire, and health utility status was measured using the Short Form-6D (SF-6D) and EuroQoL-5D (EQ-5D) questionnaires. Workplace productivity was measured using the Work Productivity and Activity Impairment (WPAI) questionnaire. After adjusting for confounders, greater insomnia severity was significantly associated with worsened quality of life, decreased productivity, and increased HCRU in an apparent linear fashion. These findings have important implications for future research, including the need for specific assessment of insomnia symptoms and their impact on key health outcomes. Full article

(This article belongs to the Special Issue Insomnia Treatments: New Perspectives)

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Review

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Open AccessReview

What Should Be the Focus of Treatment When Insomnia Disorder Is Comorbid with Depression or Anxiety Disorder?

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J. Clin. Med. 2023, 12(5), 1975; https://doi.org/10.3390/jcm12051975 - 02 Mar 2023

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Abstract

Insomnia is a significant, highly prevalent, persistent public health problem but often remains undiagnosed and untreated. Current treatment practices are not always evidence-based. When insomnia is comorbid with anxiety or depression, treatment often targets that comorbid condition with the expectation that improvement of the mental health condition will generalize to sleep symptoms. An expert panel of seven members conducted a clinical appraisal of the literature regarding the treatment of insomnia when comorbid anxiety or depression are also present. The clinical appraisal consisted of the review, presentation, and assessment of current published evidence as it relates to the panel’s predetermined clinical focus statement, “Whenever chronic insomnia is associated with another condition, such as anxiety or depression, that psychiatric condition should be the only focus of treatment as the insomnia is most likely a symptom of the condition”. The results from an electronic national survey of US-based practicing physicians, psychiatrists, and sleep (N = 508) revealed that >40% of physicians agree “at least somewhat” that treatment of comorbid insomnia should focus solely on the psychiatric condition. Whereas 100% of the expert panel disagreed with the statement. Thus, an important gap exists between current clinical practices and evidence-based guidelines and more awareness is needed so that insomnia is treated distinctly from comorbid anxiety and depression. Full article

(This article belongs to the Special Issue Insomnia Treatments: New Perspectives)

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Open AccessReview

Long-Term Use of Insomnia Medications: An Appraisal of the Current Clinical and Scientific Evidence

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J. Clin. Med. 2023, 12(4), 1629; https://doi.org/10.3390/jcm12041629 - 17 Feb 2023

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Abstract

While evidence supports the benefits of medications for the treatment of chronic insomnia, there is ongoing debate regarding their appropriate duration of use. A panel of sleep experts conducted a clinical appraisal regarding the use of insomnia medications, as it relates to the evidence supporting the focus statement, “No insomnia medication should be used on a daily basis for durations longer than 3 weeks at a time”. The panelists’ assessment was also compared to findings from a national survey of practicing physicians, psychiatrists, and sleep specialists. Survey respondents revealed a wide range of opinions regarding the appropriateness of using the US Food and Drug Administration (FDA)-approved medications for the treatment of insomnia lasting more than 3 weeks. After discussion of the literature, the panel unanimously agreed that some classes of insomnia medications, such as non-benzodiazepines hypnotics, have been shown to be effective and safe for long-term use in the appropriate clinical setting. For eszopiclone, doxepin, ramelteon and the newer class of dual orexin receptor antagonists, the FDA label does not specify that their use should be of a limited duration. Thus, an evaluation of evidence supporting the long-term safety and efficacy of newer non-benzodiazepine hypnotics is timely and should be considered in practice recommendations for the duration of pharmacologic treatment of chronic insomnia. Full article

(This article belongs to the Special Issue Insomnia Treatments: New Perspectives)

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