Abstract
Insomnia is defined as difficulties of initiating and maintaining sleep, early awakening and poor subjective sleep quality despite adequate opportunity and circumstances for sleep with impairment of daytime performance. These components of insomnia – namely persistent sleep difficulties despite of adequate sleep opportunity resulting in daytime dysfunction - appear secondary or co-morbid to neurological diseases. Comorbid insomnia originates from neurodegenerative, inflammatory, traumatic or ischemic changes in sleep regulating brainstem and hypothalamic nuclei with consecutive changes of neurotransmitters. Symptoms of neurological disorders (i.e motor deficits), co-morbidities (i.e. pain, depression, anxiety) and some disease-specific pharmaceuticals may cause insomnia and/or other sleep problems.This guideline focuses on insomnias in headaches, neurodegenerative movement disorders, multiple sclerosis, traumatic brain injury, epilepsies, stroke, neuromuscular disease and dementia.The most important new recommendations are: Cognitive behavioral therapy (CBTi) is recommended to treat acute and chronic insomnia in headache patients. Insomnia is one of the most frequent sleep complaints in neurodegenerative movement disorders. Patients may benefit from CBTi, antidepressants (trazodone, doxepin), melatonin and gaba-agonists. Insomnia is a frequent precursor of MS symptoms by up to 10 years. CBTi is recommended in patients with MS, traumatic brain injury and. Melatonin may improve insomnia symptoms in children with epilepsies. Patients with insomnia after stroke can be treated with benzodiazepine receptor agonists and sedating antidepressants. For patients with dementia suffering from insomnia trazodone, light therapy and physical exercise are recommended.
Highlights
Insomnias with difficulties of initiating and maintaining sleep, excessive daytime sleepiness, motor disorders during sleep and parasomnias, early awakening and impaired sleep quality frequently accompany neurological diseases as secondary or comorbid conditions
This guideline focuses on insomnias in headaches, neurodegenerative movement disorders, multiple sclerosis, traumatic brain injury, epilepsies, stroke, neuromuscular disease and dementia
The ICD 11 contains a special chapter on sleep disorders, in which insomnia disorder is differentiated into short-term, chronic and unspecified insomnia disorders
Summary
Insomnias with difficulties of initiating and maintaining sleep, excessive daytime sleepiness, motor disorders during sleep and parasomnias, early awakening and impaired sleep quality frequently accompany neurological diseases as secondary or comorbid conditions. Classification and definitions The ICD 10/11, ICSD 3 and DSM V differentiate as “transient” or “chronic” insomnia. The ICD 11 contains a special chapter on sleep disorders, in which insomnia disorder is differentiated into short-term, chronic and unspecified insomnia disorders. Chronic insomnia disorder is defined by the following diagnostic criteria (ICD 10): A. B. The sleep disorder causes significant clinical suffering or impairment in social-, educational- and professional life or other important domains. C. The sleep disturbance and associated daytime symptoms occur at least three times per week. D. The sleep disturbance and associated daytime symptoms have been present for at least 3 months
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