![]() Furthermore, a large prospective study of former and current insomnia sufferers found that 70% of patients using a prescription sleep aid continued to do so at 1-year follow-up but did not demonstrate significant improvements in sleep compared to non-users. Despite this, the rate of prescription sleep aid use, particularly non-benzodiazepines and off-label use of antidepressants, has risen significantly over the last 20 years, in some cases outpacing the diagnosis of sleep disorders among the general population. Evidence for over-the-counter (e.g., diphenhydramine) or natural remedies (melatonin, valerian) is considered weak or inconclusive, and these approaches are not recommended for acute or chronic insomnia. Ĭlinical practice guidelines published in the USA, Canada, and Europe unanimously recommend that non-pharmacological approaches, especially cognitive behavioral therapies, should be the first-line treatment for chronic insomnia (symptoms for > 3 months) and that pharmacological treatment should only be used in acute cases (< 3 months) or as a short-term supplement to non-pharmacological approaches. Furthermore, studies have indicated that insomnia may be an important risk factor for the onset of mental health disorders such as depression, anxiety, and substance abuse. Insomnia can contribute to significant functional impairments at work or at home and is linked to reduced quality of life, problems with attention and memory, mood disturbances, and reduced ability to carry out normal daily activities. While precise estimates vary, multiple population-based studies in different countries have consistently found that approximately one third of adults ( > 18 years of age) reported dissatisfaction with their sleep and at least one symptom of insomnia and 6–10% of the adult population met stricter criteria for a diagnosis of insomnia such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or International Classification of Sleep Disorders (ICSD). Insomnia is a common disorder in the general population. Short courses of pharmacological interventions can be supplements to CBT or behavioral therapy however, no evidence regarding the appropriate duration of pharmacological therapy is available from these reviews. ConclusionsĪssuming non-pharmacological interventions are preferable from a safety perspective CBT can be considered an effective first-line therapy for adults with insomnia followed by other behavioral interventions. These interventions were mostly evaluated in the short term ( < 16 weeks), and there was very little harms data available for the pharmacological interventions making it difficult to evaluate their risk-benefit ratio. Consistent evidence of effectiveness across multiple outcomes based on more than one high- or moderate quality review with meta-analysis was found for zolpidem, suvorexant, doxepin, melatonin, and cognitive behavioral therapy (CBT), and evidence of effectiveness across multiple outcomes based on one high-quality review with meta-analysis was found for temazepam, triazolam, zopiclone, trazodone, and behavioral interventions. Eight of the included reviews were rated as high quality using the Assessment of Multiple Systematic Reviews 2 (AMSTAR2) tool, and over half of the included articles ( n = 40) were rated as low or critically low quality. ResultsĪ total of 64 systematic reviews (35 with meta-analysis) were included after screening 5024 titles and abstracts and 525 full-text articles. Two reviewers independently screened titles/abstracts and full-text articles, and a single reviewer with an independent verifier completed charting, data abstraction, and quality appraisal. MEDLINE, Embase, PsycINFO, The Cochrane Library, and PubMed were searched from inception until June 14, 2017, along with relevant gray literature sites. This review aimed to assess the existing evidence regarding the clinical effectiveness and safety of pharmacological and non-pharmacological interventions in adults with insomnia and identify where research or policy development is needed.
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