The European Insomnia Guideline: An update on the diagnosis and treatment of insomnia 2023.

Progress in the field of insomnia since 2017 necessitated this update of the European Insomnia Guideline. Recommendations for the diagnostic procedure for insomnia and its comorbidities are: clinical interview (encompassing sleep and medical history); the use of sleep questionnaires and diaries (and physical examination and additional measures where indicated) (A). Actigraphy is not recommended for the routine evaluation of insomnia (C), but may be useful for differential-diagnostic purposes (A). Polysomnography should be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders, etc.), treatment-resistant insomnia (A) and for other indications (B). Cognitive-behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (including patients with comorbidities), either applied in-person or digitally (A). When cognitive-behavioural therapy for insomnia is not sufficiently effective, a pharmacological intervention can be offered (A). Benzodiazepines (A), benzodiazepine receptor agonists (A), daridorexant (A) and low-dose sedating antidepressants (B) can be used for the short-term treatment of insomnia (≤ 4 weeks). Longer-term treatment with these substances may be initiated in some cases, considering advantages and disadvantages (B). Orexin receptor antagonists can be used for periods of up to 3 months or longer in some cases (A). Prolonged-release melatonin can be used for up to 3 months in patients ≥ 55 years (B). Antihistaminergic drugs, antipsychotics, fast-release melatonin, ramelteon and phytotherapeutics are not recommended for insomnia treatment (A). Light therapy and exercise interventions may be useful as adjunct therapies to cognitive-behavioural therapy for insomnia (B).

Managing daytime sleepiness with the help of sleepcoaching, a non-pharmacological treatment of non-restorative sleep.

PURPOSE: To measure the effect of a 2-day sleepcoaching seminar on daytime sleepiness and sleep-related variables of shift workers employed in an Austrian railway company (ÖBB: Österreichische Bundesbahnen). METHOD: Participants filled in pre- and post-intervention questionnaires, containing items of the PSQI and the ESS, questions about chronotype, personality factors and possible burnout risk factors. About 30 shift workers, working in shifts for more than 300 months on average (28 male; mean age = 24 ± 45.90, age range 24-56 years) voluntarily took part in the investigation twice. Sleep coaching by Holzinger and Kloesch™ (SC) is a new holistic approach for non-pharmacological treatment of non-restorative sleep and is based on Gestalt therapy. It includes psychotherapeutic aspects, which enable clients to improve their sleep quality by developing one's own coping strategies which can be implemented in daily routine. Dream work and relaxation techniques are also part of the programme. RESULTS: The 2-day SC seminar was beneficial by focusing on the sleep problems related to shift work. A significant improvement of the global PSQI score and the PSQI variables subjective sleep quality, diurnal fatigue, and sleep latency was achieved, with a medium effect size. However, the programme did not result in the reduction of daytime sleepiness (ESS). Six more variables did not change significantly. CONCLUSION: While some sleep problems related to shift work were successfully addressed by SC, daytime sleepiness (ESS) could not be reduced contrary to our expectations. More research with a greater sample and a longitudinal design is needed to examine the long-term effects of SC.

Aetiology and treatment of nightmare disorder: State of the art and future perspectives.

This consensus paper provides an overview of the state of the art in research on the aetiology and treatment of nightmare disorder and outlines further perspectives on these issues. It presents a definition of nightmares and nightmare disorder followed by epidemiological findings, and then explains existing models of nightmare aetiology in traumatized and non-traumatized individuals. Chronic nightmares develop through the interaction of elevated hyperarousal and impaired fear extinction. This interplay is assumed to be facilitated by trait affect distress elicited by traumatic experiences, early childhood adversity and trait susceptibility, as well as by elevated thought suppression and potentially sleep-disordered breathing. Accordingly, different treatment options for nightmares focus on their meaning, on the chronic repetition of the nightmare or on maladaptive beliefs. Clinically, knowledge of healthcare providers about nightmare disorder and the delivery of evidence-based interventions in the healthcare system is discussed. Based on these findings, we highlight some future perspectives and potential further developments of nightmare treatments and research into nightmare aetiology.

Sleep coaching: non-pharmacological treatment of non-restorative sleep in Austrian railway shift workers.

Sleep coaching by Holzinger & Klösch™ is a new, Gestalt therapy-based holistic approach to non-pharmacological treatment of non-restorative sleep. It includes psychotherapeutic aspects which enable participants to improve their sleep quality by developing their own coping strategies as a daily routine. Dream work and relaxation techniques are also part of the programme. The aim of this study was to measure the effectiveness of a two-day sleep coaching seminar on sleep quality, daytime sleepiness, and work and life quality in shift workers employed in an Austrian railway company (Österreichische Bundesbahnen, ÖBB). Thirty shift workers (28 male; mean age=24±45.90, age range 24-56 years) answered the same survey before and six months after the seminar (baseline and follow-up) containing items of the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), their chronotype, personality factors, and burnout risk factors. The baseline findings in this group were compared with those of non-completers (who did not take the follow-up survey) (N=154) to see if the two groups differed significantly enough to create a bias among completers (who took the follow-up survey as well). Groups differed significantly in burnout levels as well as sleep duration, but not in the distribution of critical PSQI and ESS values. The two-day sleep coaching seminar resulted in a significant improvement in total PSQI score and subjective sleep quality and in a significant reduction in diurnal fatigue, sleep latency, and daytime sleepiness. Nevertheless, more research with a larger sample and a longitudinal design is needed to establish the long-term effects of sleep coaching.