Insomnia disorder: clinical and research challenges for the 21st century

BACKGROUND: Insomnia is a common and debilitating disorder that is frequently associated with important consequences for physical health and well-being. METHODS: An international expert group considered the current state of knowledge based on the most relevant publications in the previous 5 years, discussed the current challenges in the field of insomnia, and identified future priorities. RESULTS: The association of trajectories of insomnia with subsequent quality of life, health, and mortality should be investigated in large populations. Prospective health economic studies by separating the specific costs driven specifically by insomnia and costs attributable to its long-term effects are needed. Ignoring the heterogeneity of insomnia patients leads to inadequate diagnosis and inefficient treatment. Individualized interventions should be promoted. More data are needed on both the impact of sleep on overnight effects, such as emotion regulation, and the potential compensatory effort to counteract diurnal impairments. Another gap is the definition of neurocognitive deficits in insomnia patients compared to normal subjects after chronic sleep loss. There are also a number of key gaps related to insomnia treatment. Expert guidelines indicate cognitive-behavioral therapy for insomnia (CBT-I) as first line treatment. They neglect, however, the reality of major health care providers. The role of combined therapy, CBT-I plus pharmacological treatment, should more extensively evaluated. CONCLUSION: While insomnia disorder might affect large proportions of the population, there are a number of significant gaps in the epidemiological/clinical/research studies carried out to date. In particular, the identification of different insomnia phenotypes could allow more cost-effective and efficient therapies