This guideline reviews the available literature with a special focus on the situation in Europe. The literature on insomnia in children and adolescents was not reviewed. The guideline addresses adult patients (≥18 years). This includes all subtypes of insomnia, for example, non-organic insomnia and insomnia co-morbid with somatic or mental disorders. Thus, the target population of this guideline comprises patients suffering from insomnia as defined by ICD-10/ICSD-3. The guideline focuses on insomnia, defined as difficulties initiating or maintaining sleep, or early morning awakening associated with impaired daytime functioning, for example, reduced cognitive performance, fatigue or mood disturbances. A more detailed version of this guideline's report can be found in the supplemental material. This European guideline for the diagnosis and treatment of insomnia was developed on the basis of the guideline for insomnia by the German Sleep Society (Riemann et al., 2017), and has been modified and extended through the involvement of experts from various European countries and the European Insomnia Network under the umbrella of the European Sleep Research Society (ESRS). homeopathy, acupuncture) are not recommended for insomnia treatment (weak recommendation, very-low-quality evidence). Complementary and alternative treatments (e.g. Light therapy and exercise need to be further evaluated to judge their usefulness in the treatment of insomnia (weak recommendation, low-quality evidence). Antihistamines, antipsychotics, melatonin and phytotherapeutics are not recommended for insomnia treatment (strong to weak recommendations, low- to very-low-quality evidence). Benzodiazepines, benzodiazepine receptor agonists and some antidepressants are effective in the short-term treatment of insomnia (≤4 weeks weak recommendation, moderate-quality evidence). A pharmacological intervention can be offered if cognitive behavioural therapy for insomnia is not sufficiently effective or not available. Cognitive behavioural therapy for insomnia is recommended as the first-line treatment for chronic insomnia in adults of any age (strong recommendation, high-quality evidence). periodic limb movement disorder, sleep-related breathing disorders), in treatment-resistant insomnia, for professional at-risk populations and when substantial sleep state misperception is suspected (strong recommendation, high-quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. blood tests, electrocardiogram, electroencephalogram strong recommendation, moderate- to high-quality evidence). The diagnostic procedure for insomnia, and its co-morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The guideline is based on a systematic review of relevant meta-analyses published till June 2016. This European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia.
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