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Consensus on Drug Treatment, Definition and Diagnosis for Insomnia

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Abstract

Thirty-four experts and a literature supervisor got together in order to reach a ‘consensus’ regarding the definition, diagnosis and pharmacological treatment of insomnia. Insomnia is a subjective perception of dissatisfaction with the amount and/or quality of sleep. It includes difficulty in initiating or maintaining sleep or early awakening with inability to fall asleep again. It is associated with complaints of non-restorative sleep and dysfunction of diurnal alertness, energy, cognitive function, behaviour or emotional state, with a decrease in quality of life. The diagnosis is based on clinical and sleep history, physical examination and additional tests, although polysomnography is not routinely indicated. Therapy should include treatment of the underlying causes, cognitive and behavioural measures and drug treatment. Hypnotic therapy can be prescribed from the onset of insomnia and non-benzodiazepine selective agonists of the GABA-A receptor complex are the drugs of first choice. It is recommended that hypnotic treatment be maintained in cases where withdrawal impairs the patient’s quality of life and when all other therapeutic measures have failed. Experience suggests that intermittent treatment is better than continuous therapy. The available data do not confirm safety of hypnotics in pregnancy, lactation and childhood insomnia. Benzodiazepines are not indicated in decompensated chronic pulmonary disease but no significant adverse effects on respiratory function have been reported with zolpidem and zopiclone in stable mild to moderate chronic obstructive pulmonary disease and in treated obstructive sleep apnoea syndrome. Data for zaleplon are inconclusive. If the patient recovers subjective control over the sleep process, gradual discontinuation of hypnotic treatment can be considered.

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Acknowledgements

This consensus was supported by an unrestricted grant from Sanofi-Synthélabo Spain.

Members of the consensus group: F. Abad, Servicio de Neurofisiología Clínica, Hosp. Clínico Lozano Blesa, Zaragoza; J. Albares, Unidad del Sueño, Hosp. de La Paz, Madrid; F. Almansa, Servicio Psiquiatría. Hosp. Carlos Haya, Málaga; M. Barbanoj, Dep. Farmacología y Terapéutica, Hosp. de la Santa Creu i Sant Pau, Barcelona; F.J. Barrasa, Servicio de Neurofisiología, Hosp. Universitario Marqués de Valdecilla, Santander; A. Benetó, Unidad del Sueño, Servicio de Neurofisiología Clínica, Hosp. Universitario La Fe, Valencia; A. Candina, Centro de Salud Mental Ercilla, Bilbao; T. Canet, Unidad de Sueño, Servicio de Neurofisiología, Hosp. Virgen de los Lirios, Alcoy, Alicante; F. Cañellas, Servicio de Psiquiatría, Hosp. Son Dureta, Palma de Mallorca; R. Cilveti, Unidad d Trastornos de Sueño, Instituto Universitario Dexeus, Barcelona; P. Cuartero, Unidad de Trastornos del Sueño, Clínica MAZ, Zaragoza; V. De la Fuente, Unidad de Trastornos de Sueño, Instituto Universitario Dexeus, Barcelona; M. Escudero, Servicio de Neurofisiología Clínica, Hosp. Universitario Dr. Peset Aleixandre, Valencia; D. Espeleta, Servicio de Neurología, Hosp. Mútua de Terrasa, Terrasa, Barcelona; L. Ferrando, Instituto de Investigación y Asistencia Psiquiátrica, Madrid; J.L. García; Centro de Salud de Los Santos de Humosa, Madrid; T. Garzón, Unidad del Sueño, Servicio de Neurofisiología, Hosp. Militar Central Gómez Ulla, Madrid; F. González, Psiquiatra, Centro de Salud Poniente Norte, Córdoba; L. Heras, Servicio de Psiquiatría, Hosp. Gral. Universitario Gregorio Marañón, Madrid; J. Medina, Ambulatorio Isabel II, Parla, Madrid; F.J. Mejuto, Unidad del Sueño, Instituto Médico-Quirúrgico San Rafael, La Coruña; A. Pérez, Unidad del Sueño, Servicio de Neurofisiología, Complejo Hospitalario Xeral-Cies, Vigo, La Coruña; E. Recuero, Servicio de Neurofisiología. Hosp. Universitario Virgen de la Arrixaca, El Palmar, Murcia; E. Rodríguez-Sáez, Unidad del Sueño, Servicio de Neurofisiología, Complejo Hospitalario Xeral-Cies, Vigo, La Coruña; J.R. Toledano, Unidad de Sueño, Servicio de Neurofisiología Clínica, Hosp. Universitario Virgen de las Nieves, Granada; J. Vera, Servicio de Geriatría, Hosp. San Lázaro, Sevilla; R. Villanueva, Servicio de Psiquiatría, Hosp. La Paz, Madrid. Adhesions: Ma. D. de la Calzada, Servicio de Neurofisiología. Hosp. Vall d’Hebron; Barcelona. G. de la Torre, Servicio de Neurofisiología, Hosp. Txagorritxu, Vitoria, Álava; I. Galofré, Unidad del Sueño, Clínica Quirón, Barcelona; M. García, Unidad del Sueño, Servicio de Neurofisiología, Hosp. Militar Central Gómez Ulla, Madrid; Mordf. A. García, Servicio de Neurofisiología, Hosp.Virgen de la Luz, Cuenca; Mordf A. Idiazábal, Servicio de Neurofisiología, Hosp. del Mar, Barcelona; M. Maíz, Unidad del Sueño, Clínica Incosol, Marbella, Málaga; R. Rubio, Servicio de Neurofisiología, Hosp. Txagorritxu, Vitoria, Álava; T. Sagalés, Servicio de Psiquiatría, Hosp. Vall d’Hebrón, Barcelona; P. Santacana, Hosp. Dr Josep Trueta, Girona; J.M. Tejeira, Servicio de Neurofisiología, Complejo Hosp. Toledo; F. Paradinas, P. Quintana, J.Sáez, J.M. Galán, Sección EEG-Sueño, Servicio de Neurofisiología Clínica, Hosp. Ramón y Cajal, Madrid.

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Authors and Affiliations

  1. Unidad de Trastornos de Sueño, Instituto Universitario Dexeus, Barcelona, Spain

    E. Estivill & R. Cilveti

  2. Unidad de Sueño y Neumología., Hosp. de Sant Pau i Santa Tecla. Tarragona, Centro de Sueño de Tarragona, Tarragona, Spain

    A. Bové

  3. Unidad del Sueño, Fundación Jiménez Díaz, Madrid, Spain

    D. García-Borreguero

  4. Dep. Neuropsicofarmacología, Facultad de Medicina, Universidad de Cádiz, Cadiz, Spain

    J. Gibert

  5. Unidad de Sueño, Servicio de Neurofisiología Clínica, Hosp. Universitario Virgen de las Nieves, Granada, Spain

    J. Paniagua

  6. Unidad del Sueño, Departamento de Pediatría, Clínica Quirón, Valencia, Spain

    G. Pin

  7. Unidad de Trastornos del Sueño, Hosp. de la Ribera, Alzira, Valencia, Spain

    F. J. Puertas

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Estivill, E., Bové, A., García-Borreguero, D. et al. Consensus on Drug Treatment, Definition and Diagnosis for Insomnia. Clin. Drug Investig. 23, 351–386 (2003). https://doi.org/10.2165/00044011-200323060-00001

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