Treatment
Recommended non-pharmacological, cognitive and behavioural treatments for insomnia disorder strategies include:
Therapeutic components of BBTi include:
CBTi adds cognitive restructuring to the above therapeutic components as well as having more therapeutic sessions of a longer duration.
These treatments can be administered by:
- GPs and other primary health care professionals, e.g. BBTi
- Clinical psychologists (with a Mental Healthcare Plan), e.g. face-to-face CBTi for patients:
- Who require more specialised support
- Who do not experience improvement of their insomnia disorder with BBTi or digital CBTi
- Who prefer not to use digital CBTi
- The use of digital CBTi (e.g. This Way Up) while being monitored regularly for changes in symptoms, and to encourage adherence
Identify patients that may benefit from specialist care (e.g. referral to a ‘sleep’ psychologist)” e.g., Patients with;
- Patients with epilepsy or seizure disorders
- Patients with co-morbid sleep disorder (e.g. OSA, restless legs syndrome, circadian rhythm disorder)
- Shift workers
- People who drive or operate heavy machinery for work
- Patients with previous motor vehicle accident
- Patients with severe or uncontrolled psychiatric condition (e.g., Bi-polar disorder, Schizophrenia disorder)
- Currently pregnant patient or caring for very young children
- Patients with Epworth Sleepiness Scale score > 15
It may be reasonable to use pharmacotherapy as a short-term therapy in addition to CBTi for patients with significant distress or for those not responding to CBTi alone.
If pharmacotherapy is used, e.g. sedative-hypnotic medicines (benzodiazepines, 'z-drugs');
- They should be prescribed at the lowest effective dose
- For the shortest possible duration (i.e. <4 weeks)
- With an early established strategy to withdraw from sedative-hypnotic use to prevent patterns of long-term use and/or dependence
AHI - Apnoea-Hypopnoea Index
BBTi - Brief Behavioural Therapy for Insomnia
BMI - Body Mass Index (kg/m2)
BQ - Berlin Questionnaire
CBTi - Cognitive Behavioural Therapy for Insomnia
CELL - Coblation Endoscopic Lingual Lightening
COPD - Chronic Obstructive Pulmonary Disease
CVA - Cerebrovascular Accident
CPAP - Continuous Positive Airway Pressure
CSA - Central Sleep Apnoea
DASS - Depression Anxiety Stress Scale
DBAS - Dysfunctional Beliefs and Attitudes about Sleep
DBP - Diastolic Blood Pressure
DIMS - Difficulties Initiating and/or Maintaining Sleep
DISE - Drug-Induced Sleep Endoscopy
DISS - Daytime Insomnia Symptom Scale
ENT - Ear Nose and Throat
ESS - Epworth Sleepiness Scale
FOSQ - Functional Outcomes of Sleep Questionnaire
FSH - Follicle-Stimulating Hormone
FTP - Friedman Tong Position
GP - General Practitioner
HANDI - RACGP Handbook of Non-Drug Interventions
HGNS - Hypoglossal Herve Htimulation
ISI - Insomnia Severity Index
K10 - Kessler Psychological Distress Scale
MAD - Mandibular Advancement Device
MAS - Mandibular Advancement Rplint
MBS - Medicare Benefits Schedule
MMA - Maxillomandibular Advancement Surgery
MRA - Mandibular Repositioning Appliance
ODI - Oxygenation Desaturation Index
OSA - Obstructive Sleep Apnoea
PLMD - Periodic Limb Movement Disorder
PT - Positional Therapy
PTSD - Post-Traumatic Stress Disorder
PSG - Polysomnography
QSQ - Quebec Sleep Questionnaire
REM - Rapid Eye Movement
RFTB - Radiofrequency Thermotherapy of the Tongue Base
SBP - Systolic Blood Pressure
SCI - Sleep Condition Indicator
SE - Sleep Efficiency
SF36 - Short-Form (36) Health Survey
SMILE - Submucosal Minimally Invasive Lingual Excision
SNRIs - Serotonin-Norepinephrine Reuptake Inhibitors
SOL - Sleep Onset Latency
SSRI - Selective Serotonin Reuptake Inhibitors
TFTs - Thyroid Function Tests
TIB - Time In Bed
TORS - Transoral Robotic Surgery
TST - Total Sleep Time
UPPP - Uvulopalatopharyngoplasty
WASO - Wake After Sleep Onset