Treatment strategy for insomnia disorder: Japanese expert consensus

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...

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Main Authors: Yoshikazu Takaesu, Hitoshi Sakurai, Yumi Aoki, Masahiro Takeshima, Kenya Ie, Kentaro Matsui, Tomohiro Utsumi, Akiyoshi Shimura, Isa Okajima, Nozomu Kotorii, Hidehisa Yamashita, Masahiro Suzuki, Kenichi Kuriyama, Eiji Shimizu, Kazuo Mishima, Koichiro Watanabe, Ken Inada
Format: Article
Language:English
Published: Frontiers Media S.A. 2023-05-01
Series:Frontiers in Psychiatry
Subjects:
Online Access:https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1168100/full
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author 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
author_facet 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
author_sort Yoshikazu Takaesu
collection DOAJ
description 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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spelling doaj.art-a070f998a10d4db58129b7afca76789f2023-05-09T05:38:26ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402023-05-011410.3389/fpsyt.2023.11681001168100Treatment strategy for insomnia disorder: Japanese expert consensusYoshikazu Takaesu0Yoshikazu Takaesu1Hitoshi Sakurai2Yumi Aoki3Yumi Aoki4Masahiro Takeshima5Kenya Ie6Kenya Ie7Kentaro Matsui8Kentaro Matsui9Tomohiro Utsumi10Tomohiro Utsumi11Akiyoshi Shimura12Isa Okajima13Nozomu Kotorii14Nozomu Kotorii15Hidehisa Yamashita16Masahiro Suzuki17Kenichi Kuriyama18Kenichi Kuriyama19Eiji Shimizu20Eiji Shimizu21Kazuo Mishima22Koichiro Watanabe23Ken Inada24Department of Neuropsychiatry, Graduate School of Medicine, University of the Ryukyus, Okinawa, JapanDepartment of Neuropsychiatry, Faculty of Medicine, Kyorin University, Tokyo, JapanDepartment of Neuropsychiatry, Faculty of Medicine, Kyorin University, Tokyo, JapanDepartment of Neuropsychiatry, Faculty of Medicine, Kyorin University, Tokyo, JapanPsychiatric and Mental Health Nursing, St. Luke’s International University, Tokyo, JapanDepartment of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, JapanDivision of General Internal Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, JapanDivision of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, JapanDepartment of Clinical Laboratory, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, JapanDepartment of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, JapanDepartment of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, JapanDepartment of Psychiatry, The Jikei University School of Medicine, Tokyo, Japan0Department of Psychiatry, Tokyo Medical University, Tokyo, Japan1Department of Psychological Counseling, Faculty of Humanities, Tokyo Kasei University, Tokyo, Japan2Kotorii Isahaya Hospital, Nagasaki, Japan3Department of Psychiatry, School of Medicine, Kurume University, Fukuoka, Japan4Minna No Sleep and Stress Care Clinic, Hiroshima, Japan5Department of Psychiatry, Nihon University School of Medicine, Tokyo, JapanDepartment of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan6Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan7Research Center for Child Mental Development, Chiba University, Chiba, Japan8Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, JapanDepartment of Neuropsychiatry, Akita University Graduate School of Medicine, Akita, JapanDepartment of Neuropsychiatry, Faculty of Medicine, Kyorin University, Tokyo, Japan9Department of Psychiatry, School of Medicine, Kitasato University, Tokyo, JapanPurposeThere 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.https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1168100/fullinsomniahypnoticscognitive behavioral therapysleep hygiene education (SHE)orexin receptor antagonistsbenzodiazepine
spellingShingle 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
Treatment strategy for insomnia disorder: Japanese expert consensus
Frontiers in Psychiatry
insomnia
hypnotics
cognitive behavioral therapy
sleep hygiene education (SHE)
orexin receptor antagonists
benzodiazepine
title Treatment strategy for insomnia disorder: Japanese expert consensus
title_full Treatment strategy for insomnia disorder: Japanese expert consensus
title_fullStr Treatment strategy for insomnia disorder: Japanese expert consensus
title_full_unstemmed Treatment strategy for insomnia disorder: Japanese expert consensus
title_short Treatment strategy for insomnia disorder: Japanese expert consensus
title_sort treatment strategy for insomnia disorder japanese expert consensus
topic insomnia
hypnotics
cognitive behavioral therapy
sleep hygiene education (SHE)
orexin receptor antagonists
benzodiazepine
url https://www.frontiersin.org/articles/10.3389/fpsyt.2023.1168100/full
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