Frontiers in Psychiatry (May 2023)

Treatment strategy for insomnia disorder: Japanese expert consensus

  • Yoshikazu Takaesu,
  • Yoshikazu Takaesu,
  • Hitoshi Sakurai,
  • Yumi Aoki,
  • Yumi Aoki,
  • Masahiro Takeshima,
  • Kenya Ie,
  • Kenya Ie,
  • Kentaro Matsui,
  • Kentaro Matsui,
  • Tomohiro Utsumi,
  • Tomohiro Utsumi,
  • Akiyoshi Shimura,
  • Isa Okajima,
  • Nozomu Kotorii,
  • Nozomu Kotorii,
  • Hidehisa Yamashita,
  • Masahiro Suzuki,
  • Kenichi Kuriyama,
  • Kenichi Kuriyama,
  • Eiji Shimizu,
  • Eiji Shimizu,
  • Kazuo Mishima,
  • Koichiro Watanabe,
  • Ken Inada

DOI
https://doi.org/10.3389/fpsyt.2023.1168100
Journal volume & issue
Vol. 14

Abstract

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PurposeThere is a lack of evidence regarding answers for clinical questions about treating insomnia disorder. This study aimed to answer the following clinical questions: (1) how to use each hypnotic and non-pharmacological treatment differently depending on clinical situations and (2) how to reduce or stop benzodiazepine hypnotics using alternative pharmacological and non-pharmacological treatments.MethodsExperts were asked to evaluate treatment choices based on 10 clinical questions about insomnia disorder using a nine-point Likert scale (1 = “disagree” to 9 = “agree”). The responses of 196 experts were collected, and the answers were categorized into first-, second-, and third-line recommendations.ResultsThe primary pharmacological treatment, lemborexant (7.3 ± 2.0), was categorized as a first-line recommendation for sleep initiation insomnia, and lemborexant (7.3 ± 1.8) and suvorexant (6.8 ± 1.8) were categorized as the first-line recommendations for sleep maintenance insomnia. Regarding non-pharmacological treatments for primary treatment, sleep hygiene education was categorized as the first-line recommendation for both sleep initiation (8.4 ± 1.1) and maintenance insomnia (8.1 ± 1.5), while multicomponent cognitive behavioral therapy for insomnia was categorized as the second-line treatment for both sleep initiation (5.6 ± 2.3) and maintenance insomnia (5.7 ± 2.4). When reducing or discontinuing benzodiazepine hypnotics by switching to other medications, lemborexant (7.5 ± 1.8) and suvorexant (6.9 ± 1.9) were categorized as first-line recommendations.ConclusionExpert consensus indicates that orexin receptor antagonists and sleep hygiene education are recommended as first-line treatments in most clinical situations to treat insomnia disorder.

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