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Insomnien – Stand der Forschung

Insomnia – state of the science

Zusammenfassung

ICD-10 und DSM-IV wurden häufig kritisiert, der Komplexität und Heterogenität von Insomnien nicht gerecht zu werden. Mit der ICSD-2 (International Classification of Sleep Disorders) und den RDC (Research Diagnostic Criteria) konnten besser geeignete diagnostische Systeme etabliert werden. Das vor kurzem veröffentlichte DSM-5 etablierte die Diagnose „insomnia disorder“ (insomnische Störung), wodurch die Dichotomie primäre vs. sekundäre Insomnien aufgegeben wurde. Neue Befunde aus der Grundlagenforschung weisen auf relevante genetische und epigenetische Faktoren bei der Genese von Insomnien hin. Pathophysiologische Modelle werden vom sog. 3-P-Modell („predisposing“, „precipitating“ und „perpetuating“ Faktoren) und dem Hyperarousalkonzept dominiert. Die nichtpharmakologische Insomniebehandlung, insbesondere die kognitiv-verhaltenstherapeutische Behandlung der Insomnien (KVT-I), die durch viele Evidenzen sowohl als kurz- als auch langfristig wirksam bestätigt wurde, sollte als „First-line“-Behandlung akzeptiert werden. Leider besteht jedoch nur für eine Minderheit von Betroffenen wegen mangelnder Ressourcen eine gute Zugangsmöglichkeit zu dieser Behandlungsform. Sogenannte „Stepped-care“-Modelle schlagen zur Lösung dieses Versorgungsproblems Selbsthilfeprogramme, internetbasierte Ansätze, gemeindezentrierte Aktivitäten und erst zuletzt Fachärzte/Psychotherapeuten und Schlafspezialisten als Behandlungsoptionen vor.

Summary

Diagnostic systems such as the international classification of diseases (ICD-10) or the diagnostic and statistical manual of mental disorders (DSM IV) have frequently been criticized as not adequately reflecting the complexity and heterogeneity of insomnia. Progress was made through the introduction of the international classification of sleep disorders (ICSD-2) and the research diagnostic criteria (RDC). The DSM-5 introduced the new category of insomnia disorder, thus relinquishing the traditional dichotomy of primary versus secondary insomnia. Recent basic research indicates that genetic and epigenetic factors are involved in the etiology of insomnia; the so-called three P model (i.e. predisposing, precipitating and perpetuating factors) and the hyperarousal concept have gained much attention in trying to explain the pathophysiology of insomnia. With respect to the cognitive-behavioral therapy of insomnia (CBT-I), a plethora of empirical evidence supports the first-line character of this type of treatment for insomnia. Unfortunately, CBT-I is still administered to only a minority of afflicted patients, probably due to a lack of resources in the healthcare system. As a consequence, stepped-care models to improve insomnia therapy encompass self-help programs, internet-based treatment avenues, community-centered activities (specially trained nurses) and as a last resort medical specialists/psychotherapists and sleep experts to deal with insomnia.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. D. Riemann, C. Baglioni, B. Feige und K. Spiegelhalder geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren

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Correspondence to D. Riemann.

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Riemann, D., Baglioni, C., Feige, B. et al. Insomnien – Stand der Forschung. Nervenarzt 85, 43–49 (2014). https://doi.org/10.1007/s00115-013-3892-7

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Schlüsselwörter

  • Insomnie
  • Genetik
  • Pathophysiologie
  • Hyperarousal
  • Kognitiv-verhaltenstherapeutische Therapie der Insomnie (KVT-I)

Keywords

  • Insomnia
  • Genetics
  • Pathophysiology
  • Hyperarousal
  • Cognitive behavioral treatment for insomnia (CBT-I)