Emerging treatments

Your Organisational Guidance

ebpracticenet urges you to prioritise the following organisational guidance:

Aanpak van slaapklachten en insomnie (slapeloosheid) bij volwassenen in de eerste lijnPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2018Prise en charge des problèmes de sommeil et de l’insomnie chez l’adulte en première lignePublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2018

Selective orexin-2 receptor antagonists

Seltorexant, an investigational selective orexin-2 receptor antagonist, has shown promise in treating insomnia comorbid with depression.[211]

Melatonin

Melatonin, a neurohormone that regulates circadian rhythm disruption, is available over the counter in some countries for the treatment of jet lag. In other countries, it may only be available by prescription. Meta-analysis of its use in primary sleep disorders shows some evidence for reducing sleep onset latency, but larger randomised controlled trials are needed to establish therapeutic use.[172]

5HT2A antagonists

5HT2A antagonists may help to improve sleep maintenance and have effects on sleep architecture that include increases in slow-wave sleep.[212] These agents are in development.

Anticonvulsants

Gabapentin has been shown to increase slow-wave sleep and sleep efficiency, and decrease arousals in persons with primary insomnia; however, further studies are needed.[213][214]

Alternative therapies

Alternate approaches to CBT-I have been studied, although the results have been inconclusive. Alternative approaches include aromatherapy - the rationale being that such exposure reduces sympathetic activity.[215]​ Religion and spirituality has been proposed as an intervention for insomnia.[216]​ Hypnotherapy has also been proposed as a treatment modality, owing to studies suggesting that deep sleep waves increase among healthy people in hypnotic states, although research on this topic is hampered by the absence of a standard definition of hypnotic states.[217]​ Other approaches include trigeminal nerve stimulation and acupuncture.[218][219][220][221]​​​​​​​​​ Tai chi, along with mindfulness and paradoxical intention approaches, are additional interventions used in the management of insomnia, and have produced positive results.[222][223][224]​​​​​​

Use of this content is subject to our disclaimer