Management of adult insomnia in Australia: a joint position statement of the Australasian Sleep Association, Sleep Health Foundation, Royal Australian College of General Practitioners, Australian Psychological Society, Pharmaceutical Society of Australia, and Australian Primary Health Care Nurses Association.

Abstract

This joint position statement of Australian sleep and primary care organizations provides information to healthcare providers on the management of adults with insomnia symptoms in Australia. Perspectives of sleep researchers, psychologists, sleep physicians, general practitioners, pharmacists, nurses, advocacy and implementation experts, and people with lived experience of insomnia are represented. Insomnia may present as an acute disorder (lasting up to 3 months) or a chronic disorder (lasting for 3 months or longer). Untreated insomnia is associated with lowered mood, daytime function, productivity, and quality of life. Insomnia assessment and diagnosis is based on self-reported symptoms. Insomnia occurring in the context of other conditions should be considered a "comorbid condition" that requires concurrent and targeted assessment and management. Recommendations about healthy sleep practices (sleep hygiene) are not an adequate stand-alone treatment for chronic insomnia. Multi-component Cognitive Behavioral Therapy for insomnia (CBTi) is the recommended "first-line" treatment for insomnia. There is evidence that CBTi is effective in a range of settings, in the presence of comorbid conditions, and when delivered in different modalities (e.g. individual sessions, group settings, tele-health, self-guided digital programs). Other evidence-based psychological and behavioral therapies may be appropriate for specific presentations, and in people that do not respond to CBTi. Medicines used for insomnia management are not recommended as the "first-line" treatment for insomnia but may be appropriate in conjunction with CBTi or as second-line treatment if CBTi is not effective or appropriate. Sleep medications may be considered in people with acute insomnia that is caused by a clear precipitant (e.g. bereavement, medical crisis, psychosocial stressors) and resulting in significant distress and/or functional impairment. If used, specific benzodiazepines and "z-drugs" may be indicated for up to 2-4 weeks of use at the lowest effective dose, melatonin may be used for up to 13 weeks, and dual orexin receptor antagonists are generally only recommended for chronic insomnia. Sedating antihistamines, antidepressants, antipsychotics, cannabinoids, and complementary medications are not recommended. Collaboration between people with insomnia and a range of clinicians is important for the management of insomnia and associated sleep, mental, and physical health conditions. Collaboration between sleep and primary care organizations has led to the development and implementation of healthcare provider education programs on insomnia assessment and management.