[Recommendations for the diagnosis and therapy of insomnia. German Society of Sleep Research and Sleep Medicine DGSM].
There exist a variety of American and European recommendations regarding treatment with hypnotics, especially the duration of treatment. The German Sleep Society now publishes its own view to help physicians to cope with these different recommendations, some of which are contradictory. Therapy with hypnotics must include substantial information on the type of drug, dose, timing and duration as well as information about the possibility of interval treatment. Agonists at the benzodiazepine receptor, like the conventional benzodiazepines and zopiclone or zolpideme, are indicated in short-lasting adjustment insomnia as well as in long-lasting psychophysiological insomnia. Regarding the duration of prescription the German Sleep Society recommends a period of 14 days in de novo patients, which can be repeated once only. In persisting insomnias further approaches should disregard benzodiazepine receptor agonists, but rely on other classes of substances such as tricyclic antidepressants instead. If such approaches are ineffective, the intake of benzodiazepine receptor agonists may be extended to 6 months, when a sleep log and objective observations have documented a true sleep deficit, when daytime impairment arises, when daytime impairment arises, when rebound insomnia, organic or mental insomnias and dependencies have been excluded, and when the indication is monitored at 14-day intervals. If the insomnia persists, during and in spite of therapy a specialist in sleep medicine should be consulted. If therapy is still ineffective after 3 months of daily treatment, a sleep laboratory should be consulted.
Clarenbach
P
P
Neurologische Klinik, Evangelisches Johannes-Krankenhaus, Bielefeld.
Steinberg
R
R
Weess
H G
HG
Berger
M
M
D014151:Anti-Anxiety Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D001569:Benzodiazepines; D006207:Half-Life; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D008657:Metabolic Clearance Rate / Q000502:physiology; D010348:Patient Care Team; D007319:Sleep Initiation and Maintenance Disorders / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D013375:Substance Withdrawal Syndrome / Q000209:etiology; D016896:Treatment Outcome
D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines