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Evaluation and management of insomnia in the clinical practice in Italy: a 2023 update from the Insomnia Expert Consensus Group

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Abstract

Background

Insomnia is the most reported sleep disorder in industrialized countries, affecting, in the chronic form, around 10% of the European population. In Italy, such a percentage seems to be even higher. Although insomnia can be an independent disorder, it is frequently described as comorbid condition and may precipitate, exacerbate, or prolong a broad range of physical and mental disorders. Evaluating and targeting insomnia in the Italian clinical practice should be a priority.

Methods

The present expert opinions and recommendations represent an update from 2020 and insights from Insomnia Expert Consensus Group, based on systematic reviews according to PRISMA on available options in Italy from January 2020 to March 2023.

Results

We evaluated 28 papers among international guidelines, expert opinions, systematic reviews, and meta-analysis produced during the last 26 months.

Conclusions

Our findings suggest that symptoms of insomnia must be assessed in the Italian clinical practice by evaluating nocturnal and daytime symptoms, comorbid conditions, and lifestyle. Cognitive behavioral therapy for insomnia should be the first option according to availability. The choice of the drug should be based on different factors including type of insomnia, age, comorbidities, and potential side effects. If the choice would be a Z-drug or a short-acting benzodiazepine (in subjects < 65 years old), the use should be in the short term (≤ 4 weeks). Indeed, eszopiclone, as a new option in Italy, may present a different profile and may be used for up to 6 months, also in the elderly. If the choice is melatonin, it should be used melatonin 2 mg prolonged release in adults ≥ 55 years for up to 13 weeks. A new dual orexin antagonist, daridorexant, is available in Italy; it has been shown to be effective in adults and elderly and it can be used for at least 3 months and up to 1 year.

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Authors and Affiliations

  1. Unit of Psychiatry, Department of Neuroscience, Azienda Ospedaliero Universitaria Pisana AUOP, Pisa, Italy

    Laura Palagini

  2. Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy

    Raffaele Manni

  3. Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy

    Claudio Liguori

  4. Neurology Unit, Sleep Medicine Centre, University Hospital of Rome Tor Vergata, Rome, Italy

    Claudio Liguori

  5. Department of Psychology, Sapienza University of Rome, 00185, Rome, Italy

    Luigi De Gennaro

  6. Body and Action Lab, IRCSS Fondazione Santa Lucia, 00179, Rome, Italy

    Luigi De Gennaro

  7. Psychology Unit, Department of Neuroscience, University of Pisa, Pisa, Italy

    Angelo Gemignani

  8. Respiratory Function and Sleep Medicine Unit, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy

    Francesco Fanfulla

  9. Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Troina, Italy

    Raffaele Ferri

  10. Department of Neuroscience (DINOGMI), University of Genoa, Genoa, Italy

    Lino Nobili

  11. Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genoa, Italy

    Lino Nobili

  12. Department of Clinical Neurosciences, Neurology Sleep Disorders Centre, RCCS San Raffaele Scientific Institute, Milan, Italy

    Luigi Ferini-Strambi

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Contributions

LP: none related to this paper; last year consultancy fee from Bruno Farmaceutici, Fidia, Idorsia, Piam, Pfizer, Sanofi. RM none related to this paper; last year none. CL none related to this paper; consultancy fee or research support from Bruno Farmaceutici, Idorsia, Italfarmaco, Polifarma. LDG none related to this paper; last year consultancy fee from Idorsia. AG none related to this paper; last year none. FF none related to this paper; last year none. LN none related to this paper; last year consultancy fee from Fidia, Idorsia, Sanofi. RF none related to this paper; last year consultancy fee from Idorsia. LF-S none related to this paper, last year consultancy fee from Bruno Farmaceutici, Idorsia, Sanofi.

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Correspondence to Laura Palagini.

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None related to this paper; this paper was promoted by the Italian Association of Sleep Medicine AIMS. No funding or grants were received for the current paper; no conflict of interest to disclose for this paper.

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Palagini, L., Manni, R., Liguori, C. et al. Evaluation and management of insomnia in the clinical practice in Italy: a 2023 update from the Insomnia Expert Consensus Group. J Neurol 271, 1668–1679 (2024). https://doi.org/10.1007/s00415-023-12112-3

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