RECOMMENDATIONS FOR THE DIAGNOSTIC AND TH ERAPEUTIC HANDLING OF INSOMNIA - GERMAN SLEEP SOCIETY

There exist a variety of American and European recommendations regardi ng treatment with hypnotics, especially the duration of treatment. The German Sleep Society now publishes its own view to help physicians to cope with these different recommendations, some of which are contradi ctory. Therapy with hypnotics must include substantial information on the type of drug, dose, timing and duration as well as information abo ut the possibility of interval treatment. Agonists at the benzodiazepi ne receptor, like the conventional benzodiazepines and zopiclone or zo lpideme, are indicated in short-lasting adjustment insomnia as well as in longlasting psychophysiological insomnia. Regarding the duration o f prescription the German Sleep Society recommends a period of 14 days in de novo patients, which can be repeated once only. In persisting i nsomnias further approaches should disregard benzodiazepine receptor a gonists, but rely on other classes of substances such as tricyclic ant idepressants instead. If such approaches are ineffective, the intake o f benzodiazepine receptor agonists may be extended to 6 months, when a sleep log and objective observations have documented a true sleep def icit, when daytime impairment arises, when rebound insomnia, organic o r mental insomnias and dependencies have been excluded, and when the i ndication is monitored at 14-day intervals. If the insomnia persists, during and in spite of therapy a specialist in sleep medicine should b e consulted. If therapy is still ineffective after 3 months of daily t reatment, a sleep laboratory should be consulted.