Interventions for Insomnia Disorder

Insomnia is a sleep disorder affecting approximately 13% of the Canadian population. People with insomnia often have difficulty falling asleep or difficulty remaining asleep. They may also wake up frequently, experience early awakening, have a limited amount of sleep, or have a poor quality of sleep. Insomnia may be acute, meaning it generally starts suddenly and lasts for less than three months, or it may be chronic, meaning it lasts for a longer duration. Insomnia may affect a person’s ability to work or study, and can negatively affect their relationships with others. People with insomnia may experience a reduced quality of life because of the consequences of poor sleep.

Approaches to treating insomnia include several different interventions, including psychological and behavioural therapies, drug therapies, or a combination of drug and psychological or behavioural therapies. Examples of psychological and behavioural therapies include approaches such as sleep hygiene (e.g., habits to encourage better sleep) and cognitive behavioural therapy. However, there may be limited availability of psychological and behavioural therapies.

Regarding drug therapy, many hypnotic and sedative drugs are used to treat insomnia, including benzodiazepines (e.g., temazepam, bromazepam) and “z-drugs” (e.g., zopiclone, zolpidem). There is a concern that these drugs may be harmful to people who use them for a long duration (e.g., becoming dependent on the drug; experiencing memory problems or falls), while other alternatives could be used.

Choice of treatment may be affected by a number of factors, including whether the insomnia is acute or chronic, patient preferences, availability of therapies, and the clinical judgment of the physician.

To explore some of these questions and concerns, CADTH has undertaken a project to assess the clinical effectiveness and safety of interventions for adults with acute or chronic insomnia disorder. This project also includes a review of patient perspectives and experiences, as well as an analysis of current clinical practice.

The project has three key components:

• an analysis of current prescriber practice
• a patient perspectives and experiences report
• a clinical report