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Insomnia in General Practice

A Consensus Report Produced by Sleep Specialists and Primary-Care Physicians in Italy

Clinical Drug Investigation volume 25, pages 745–764 (2005)Cite this article

Abstract

Insomnia is an extremely common condition with major social and economic consequences worldwide. Two large epidemiological studies (Morfeo 1 and Morfeo 2) recently performed in Italy provided much-needed novel data on the impact of insomnia in patients whose primary healthcare is provided by general practitioners (GPs). These studies found that insomnia is managed relatively well by GPs in Italy, although diagnosis and treatment can be compromised because of the lack of standardised criteria. Although a number of consensus reports on insomnia have been published, these are mainly highly specific documents that are difficult to implement in general practice. To address this, a consensus group involving 695 GPs and over 60 specialists from the Italian Association of Sleep Medicine was established. The major objectives of the consensus study were to establish basic knowledge for the diagnosis and treatment of insomnia, and to produce guidelines for the management of insomnia by GPs. This is the first time that GPs have been directly involved in producing insomnia guidelines of this type, and this approach reflects their pivotal role in the diagnosis and management of this condition. Participants were carefully selected to ensure adequate representation of sleep specialists and GPs, with the group being headed by a steering committee and an advisory board. Guideline statements were selected following careful literature review and were voted on using formalised consensus procedures. This review describes current views on the diagnosis and management of insomnia from the perspective of the GP. In addition, the results of the consensus study are presented. They include recognition of the following principles: (i) insomnia is a genuine pathology that must be appropriately diagnosed and treated; (ii) when concomitant pathologies are present, additional significance should be given to treatment of insomnia since it can influence prognosis of coexistent disorders; (iii) appropriate treatment should consider the cause of insomnia as well as the characteristics of available pharmacological agents; (iv) with regard to hypnotic drugs, preference should be given to medications with a short half-life in order to limit residual effects; (v) non-benzodiazepine hypnotics are preferred to classic benzodiazepines as they have higher selectivity and present a lower risk of undesirable effects; (vi) tablets are preferable to liquid preparations as they are less likely to lead to dependence and to overdosing by the patient; and (vi) once treatment has been initiated, insomnia patients should be carefully followed up. These statements provide much needed criteria for better management of insomnia by GPs in Italy.

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Acknowledgements

This project was supported by an unrestricted grant from sanofi-aventis.

None of the authors has any potential conflicts of interest that are directly relevant to the contents of this article.

The following are members of the Advisory Board for Associazione Italiana Medicina del Sonno (AIMS; Italian Association of Sleep Medicine) centres: B. Brancasi (Bari), P. Lamberti (Bari), P. Livrea (Bari), M.P. Prudenzano (Bari); C. Servalli (Bergamo), E. Ubiali (Bergamo), M. Viscardi (Bergamo); S. Mondini (Bologna), P. Montagna (Bologna), F. Provini (Bologna); V. Fassari (Catania), S. Filetti (Catania), A. Scrofani (Catania); B. Gerbino Promis (Cuneo), F. Mondino (Cuneo); L. Nobili (Genova); R. Di Perri (Messina), G. Mento (Messina), M. Raffaele (Messina); M. Manconi (Milano), A. Oldani (Milano), M. Zucconi (Milano); A. Smerieri (Parma), M.C. Spaggiari (Parma); R. Manni (Pavia), M. Terzaghi (Pavia); A. Alberti (Perugia), G. Capocchi (Perugia), G. Mazzotta (Perugia); B. Guarnieri (Pescara), L. Ortenzi (Pescara); M. Fabrini (Pisa), A. Gemignani (Pisa), G. Gentili (Pisa), A. Iudice (Pisa), M. Maestri (Pisa), L. Murri (Pisa), L. Palagini (Pisa), P. Panicucci (Pisa), P. Petrini, (Pisa); O. Bruni (Roma), G. Della Marca (Roma), G. Mennuni (Roma), G. Rizzotto (Roma), E. Verrillo, (Roma); A Cicolin, (Torino), R. Mutani (Torino), A. Terreni (Torino); B. Lanuzza (Troina), R. Ferri (Troina), S. Miano (Troina); S. Brotini (Udine), P. Dolso (Udine), R. Marinig (Udine).

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Affiliations

  1. Department of Neurology, Sleep Disorders Centre, University of Parma, Parma, Italy

    Mario Giovanni Terzano & Liborio Parrino

  2. Department of Neurology, Sleep Disorders Centre, University of Pisa, Pisa, Italy

    Enrica Bonanni

  3. Unit of Neurology, Sleep Disorders Centre, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy

    Fabio Cirignotta

  4. Department of Motor Sciences, Sleep Disorders Centre, University of Genova, Genova, Italy

    Franco Ferrillo

  5. Department of Neurology, Sleep Disorders Centre, Santa Maria della Misericordia General Hospital, Udine, Italy

    Gian Luigi Gigli

  6. Department of Neurological and Psychiatric Sciences, Sleep Disorders Centre, University of Bari, Bari, Italy

    Mariantonietta Savarese

  7. Department of Neurology, Sleep Disorders Centre, University Vita-Salute San Raffaele, Milan, Italy

    Luigi Ferini-Strambi

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  1. Mario Giovanni Terzano
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Correspondence to Mario Giovanni Terzano.

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Terzano, M.G., Parrino, L., Bonanni, E. et al. Insomnia in General Practice. Clin. Drug Investig. 25, 745–764 (2005). https://doi.org/10.2165/00044011-200525120-00002

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Keywords

  • Zolpidem
  • Steering Committee
  • Triazolam
  • Zaleplon
  • Guideline Statement