[Update on Current Care Guideline: Insomnia]. / KÄYPÄ HOITO-SUOSITUS (Päivitystiivistelmä). Unettomuus.

Insomnia symptoms must be differentiated from insomnia disorder. The correct aiagnosis or insomnia aisoraer is important, as insomnia may also be a symptom of many other diseases. Cognitive behavioral methods are recommended as first-line treatment options. Treatment of acute insomnia with hypnotics should not exceed two weeks. In elderly persons adverse effects of hypnotics may exceed their beneficial effects in long-term use. Antidepressive medications acting on the histamine-1 system may be used in very small doses. The new guideline includes e.g. insomnia in pregnant and menopausal women and in cancer patients, and driving issues.

Cognitive behavior therapy for chronic insomnia in occupational health services.

INTRODUCTION: The aim of this study was to examine the implementation and effectiveness of a cognitive behavioral group intervention model for chronic insomnia (CBT-I) in occupational health services (OHS). We also studied if insomnia symptoms and intervention effects differed on work days and days off. METHODS: The study design was a non-randomized group intervention, including a waiting period prior to CBT as a control condition. We followed up the results for a period of 6 months. Outcomes were assessed using a sleep diary, questionnaires, and actigraphy. The CBT-I groups were led by trained OHS nurses. RESULTS: A total of 26 participants completed the study. The intervention improved significantly participants' different self-reported sleep variables, perceived severity of insomnia, sleep-related dysfunctional cognitions, and psychiatric and somatic symptoms. The effects lasted, and partly increased during the follow-up. The participants generally slept significantly better on days off than on work days, but the treatment improved sleep on both. CONCLUSIONS: The study showed that a non-pharmacological treatment of insomnia can be implemented into OHS with a reasonable amount of effort and that the treatment delivered by trained OHS nurses yields promising results. These findings, however, need to be interpreted cautiously, due to the non-randomized design and small sample size.

Cognitive behavioral therapy for shift workers with chronic insomnia.

OBJECTIVE: Shift work is a challenge in the screening and treatment of chronic insomnia. The aim of this study was to examine the implementation and effectiveness of a cognitive behavioral group intervention for insomnia (CBT-I) among shift workers with chronic insomnia. We also studied whether insomnia symptoms and intervention effects differed on work days and days off. METHODS: The study design was a non-randomized group intervention, including a waiting period prior to CBT-I as a control condition. A total of 19 media workers who worked irregular hours and had non-organic insomnia with features of psychological insomnia completed the study. We followed up with the results for a period of 6 months. Outcomes were assessed using a sleep diary, questionnaires, and actigraphy. The CBT-I groups were led by trained nurses of occupational health services (OHS). RESULTS: The post-intervention results showed significant improvements in self-reported and actigraphic sleep onset latency, and in self-reported sleep efficiency, sleep quality, and restedness. In addition, the perceived severity of insomnia, sleep-related dysfunctional cognitions, psychiatric and somatic symptoms, and the mental component of health-related quality of life improved significantly. The improvements lasted and even strengthened over the follow-up period. The participants generally slept significantly better on days off than on work days, but the treatment improved sleep on both. CONCLUSIONS: The study showed that non-pharmacological treatment of insomnia can be implemented among shift workers with chronic insomnia, and delivery of the treatment by trained OHS nurses yields promising results. Some caution, however, is needed when interpreting the results because of the non-randomized study design and small sample size.