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Treatment of insomnia in adults

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SBU Assessment

Presents a comprehensive, systematic assessment of available scientific evidence for effects on health, social welfare or disability. Full assessments include economic, social and ethical impact analyses. Assessment teams include professional practitioners and academics. Before publication the report is reviewed by external experts, and scientific conclusions approved by the SBU Board of Directors.

Published: Report no: 199

Tables of included studies

This is a summary of the results of SBU’s evaluation of “Treatment of insomnia in adults”. Insomnia is a general term which encompasses several types of sleep disorders. Most people who seek treatment for insomnia do so because of perceived problems such as inadequate hours of sleep or poor sleep quality, leading to a diminished sense of well-being and impaired daytime functioning. Examples of common sleep disorders are that it is hard to get to sleep, awakening after falling asleep and finding it hard to get back to sleep, awakening too early in the morning, or combinations of these disorders. Insomnia increases with age and is more common in women.

Those seeking professional help for relief of insomnia usually initially receive individually tailored counselling in self-care, eg to try to maintain a regular diurnal rhythm, to avoid eating and drinking habits known to disturb sleep and to ensure that the environment in the bedroom is conducive to sleep. However, the present evaluation has focused on treatment methods which can be used when such self-care does not give adequate relief.

SBU’s Conclusions

  • When a decision is made to treat insomnia by pharmacotherapy it is important that the prescriber gives preference to preparations with documented effectiveness. Compared with a placebo, short-term treatment with zolpidem, zopiclone and zaleplon – substances related to bensodiazepine – result in a patient falling asleep more quickly and sleeping for longer in total. Such treatment has some risk of side effects. The risk of developing dependence is higher in individuals who already have an addiction or a mental illness.
  • Psychological treatment methods, in the form of cognitive behavioural therapy (CBT) and other behavioural therapy results in the patient falling asleep more quickly and not being awake so long during the night. If greater reliance is to be placed on psychological treatment methods, it is a prerequisite that more
    therapists be trained.
  • In the elderly patient, both insomnia in itself and medication to treat the condition can increase the risk of accidentally falling. There is however, an inadequate scientific basis on which to assess the magnitude of these risks and the interrelationship between them.
  • There is an inadequate scientific basis on which to assess the effect of alternative and complementary methods for treatment of insomnia. The few studies available are of inadequate quality. This applies both to medication (valerian and various herbal medicines) and other methods (acupuncture, yoga, etc).

How to cite this report: SBU. Treatment of insomnia in adults. Stockholm: Swedish Council on Health Technology Assessment (SBU); 2010. SBU report no 199 (in Swedish).

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