New Guidelines for Sleep Disorders

The British Association for Psychopharmacology (BAP) released yesterday, through the Journal of Psychopharmacology, a consensus statement on evidence-based treatment of insomnia, parasomnias, and circadian rhythm disorders, meant to guide psychiatrists and other physicians who care for patients with sleep problems.

Members of BAP and sleep experts for the US and Europe convened in London in May 2009 to share their knowledge, experiences, and the latest literature and come to a consensus on best treatments. The BAP used the consensus information and follow-up consultations with participants to create the comprehensive guide to clinicians.

Key points made in the consensus statement include the following:

• Because insomnia impairs daytime well-being, subjective abilities, and functioning, it can be considered a “24-hour” disorder
• Insomnia diagnosis is subjective and based on clinical observations rather than measurements
• The inability to determine a cause for insomnia shouldn’t prevent a diagnosis
• Anxiety, depression, cancer, arthritis, anxiety about sleep, maladaptive sleep habits, and “the possibility of an underlying vulnerability in sleep regulating mechanisms” are likely causes for insomnia
• Cognitive behavioral therapy (CBT) is as effective for insomnia as prescription medications are for short-term treatment of chronic insomnia, but CBT is more likely to have longer-lasting effects
• Circadian rhythm disorders are most often caused by shift work and jet lag
• Referral to a sleep center for polysomnography and video recording may be needed for correctly diagnosing night terrors, sleep walking, and violent behavior at night
• Stopping prescription sleep medications can lead to issues in some cases
• Long-term medication of insomnia is controversial and was discouraged in past, but this was based on no longer-term trials looking at long-term use
• Many millions of patients worldwide are on long-term treatment with hypnotic drugs despite recommendations of use for only 2-4 weeks, as long-term safety and efficacy of many of these agents is uncertain
• Studies show that the risk/benefit ratio for many insomnia agents doesn’t change after 3 or 4 weeks, so taking these drugs “as needed” rather than every night could be a solution

More on Insomnia in the News:

• Short Sleep Duration in Prevalent and Persistent Psychological Distress in Young Adults: The DRIVE Study
• Insomnia with Short Sleep Duration and Mortality: The Penn State Cohort
• The Association of Sleep Duration with Adolescents’ Fat and Carbohydrate Consumption
• The Perilipin Homologue, Lipid Storage Droplet 2, Regulates Sleep Homeostasis and Prevents Learning Impairments Following Sleep Loss