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The assessment and management of insomnia: an update.

Publication ,  Journal Article
Krystal, AD; Prather, AA; Ashbrook, LH
Published in: World Psychiatry
October 2019

Insomnia poses significant challenges to public health. It is a common condition associated with marked impairment in function and quality of life, psychiatric and physical morbidity, and accidents. As such, it is important that effective treatment is provided in clinical practice. To this end, this paper reviews critical aspects of the assessment of insomnia and the available treatment options. These options include both non-medication treatments, most notably cognitive behavioral therapy for insomnia, and a variety of pharmacologic therapies such as benzodiazepines, "z-drugs", melatonin receptor agonists, selective histamine H1 antagonists, orexin antagonists, antidepressants, antipsychotics, anticonvulsants, and non-selective antihistamines. A review of the available research indicates that rigorous double-blind, randomized, controlled trials are lacking for some of the most commonly administered insomnia therapies. However, there are an array of interventions which have been demonstrated to have therapeutic effects in insomnia in trials with the above features, and whose risk/benefit profiles have been well characterized. These interventions can form the basis for systematic, evidence-based treatment of insomnia in clinical practice. We review this evidence base and highlight areas where more studies are needed, with the aim of providing a resource for improving the clinical management of the many patients with insomnia.

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Published In

World Psychiatry

DOI

ISSN

1723-8617

Publication Date

October 2019

Volume

18

Issue

3

Start / End Page

337 / 352

Location

Italy

Related Subject Headings

  • Psychiatry
  • 4203 Health services and systems
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

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Krystal, A. D., Prather, A. A., & Ashbrook, L. H. (2019). The assessment and management of insomnia: an update. World Psychiatry, 18(3), 337–352. https://doi.org/10.1002/wps.20674
Krystal, Andrew D., Aric A. Prather, and Liza H. Ashbrook. “The assessment and management of insomnia: an update.World Psychiatry 18, no. 3 (October 2019): 337–52. https://doi.org/10.1002/wps.20674.
Krystal AD, Prather AA, Ashbrook LH. The assessment and management of insomnia: an update. World Psychiatry. 2019 Oct;18(3):337–52.
Krystal, Andrew D., et al. “The assessment and management of insomnia: an update.World Psychiatry, vol. 18, no. 3, Oct. 2019, pp. 337–52. Pubmed, doi:10.1002/wps.20674.
Krystal AD, Prather AA, Ashbrook LH. The assessment and management of insomnia: an update. World Psychiatry. 2019 Oct;18(3):337–352.
Journal cover image

Published In

World Psychiatry

DOI

ISSN

1723-8617

Publication Date

October 2019

Volume

18

Issue

3

Start / End Page

337 / 352

Location

Italy

Related Subject Headings

  • Psychiatry
  • 4203 Health services and systems
  • 3202 Clinical sciences
  • 1103 Clinical Sciences