{Reference Type}: Journal Article
{Title}: Treatment strategy for insomnia disorder: Japanese expert consensus.
{Author}: Takaesu Y;Sakurai H;Aoki Y;Takeshima M;Ie K;Matsui K;Utsumi T;Shimura A;Okajima I;Kotorii N;Yamashita H;Suzuki M;Kuriyama K;Shimizu E;Mishima K;Watanabe K;Inada K;
{Journal}: Front Psychiatry
{Volume}: 14
{Issue}: 0
{Year}: 2023
{Factor}: 5.435
{DOI}: 10.3389/fpsyt.2023.1168100
{Abstract}: <B>UNASSIGNED: </B>There is a lack of evidence regarding answers for clinical questions about treating insomnia disorder. This study aimed to answer the following clinical questions: (1) how to use each hypnotic and non-pharmacological treatment differently depending on clinical situations and (2) how to reduce or stop benzodiazepine hypnotics using alternative pharmacological and non-pharmacological treatments.<BR><B>UNASSIGNED: </B>Experts were asked to evaluate treatment choices based on 10 clinical questions about insomnia disorder using a nine-point Likert scale (1 = "disagree" to 9 = "agree"). The responses of 196 experts were collected, and the answers were categorized into first-, second-, and third-line recommendations.<BR><B>UNASSIGNED: </B>The primary pharmacological treatment, lemborexant (7.3 ± 2.0), was categorized as a first-line recommendation for sleep initiation insomnia, and lemborexant (7.3 ± 1.8) and suvorexant (6.8 ± 1.8) were categorized as the first-line recommendations for sleep maintenance insomnia. Regarding non-pharmacological treatments for primary treatment, sleep hygiene education was categorized as the first-line recommendation for both sleep initiation (8.4 ± 1.1) and maintenance insomnia (8.1 ± 1.5), while multicomponent cognitive behavioral therapy for insomnia was categorized as the second-line treatment for both sleep initiation (5.6 ± 2.3) and maintenance insomnia (5.7 ± 2.4). When reducing or discontinuing benzodiazepine hypnotics by switching to other medications, lemborexant (7.5 ± 1.8) and suvorexant (6.9 ± 1.9) were categorized as first-line recommendations.<BR><B>UNASSIGNED: </B>Expert consensus indicates that orexin receptor antagonists and sleep hygiene education are recommended as first-line treatments in most clinical situations to treat insomnia disorder.