These guidelines include practice parameter papersx and also include areas with limited evidence in order to provide a comprehensive practice guideline. Clinical guidelines provide clinicians with a working overview for disease or disorder evaluation and management. Use of Practice Parameters and Clinical GuidelinesĪASM practice parameter papers are based on evidence-based review and grading of literature, often addressing a specific issue or topic. If consensus was not evident after the second vote, the process was repeated until consensus was attained to include or exclude a recommendation. If consensus was not evident after the first vote, the consensus recommendations were discussed again, amended as appropriate, and a second anonymous vote was conducted. Consensus was defined when all experts rated a recommendation 8 or 9. To minimize individual expert bias, the group anonymously voted and rated consensus recommendations from 1: strongly disagree to 9: strongly agree. Recommendations were generated by panel members and discussed by all. Using a face-to-face meeting, voting surveys, and frequent teleconference discussions, the expert panel identified consensus areas and recommendations for those areas not covered by AASM practice parameters. In addition to using all AASM practice parameters and AASM Sleep publications through July 2007, the expert panel reviewed other relevant source articles from a Medline search (1999 to October 2006 all adult ages including seniors “insomnia and” key words relating to evaluation, testing, and treatments. An expert insomnia panel was assembled by the AASM to author this clinical guideline. Consensus-based recommendations reflect the shared judgment of the committee members and reviewers, based on the literature and common clinical practice of topic experts, and were developed using a modified nominal group technique. The purpose of this clinical guideline is to provide clinicians with a framework for the assessment and management of chronic adult insomnia, using existing evidence-based insomnia practice parameters where available, and consensus-based recommendations to bridge areas where such parameters do not exist.Ĭonsensus-based recommendations were developed for this clinical guideline to address important areas of clinical practice that had not been the subject of a previous AASM practice parameter, or where the available empirical data was limited or inconclusive. Because insomnia may present with a variety of specific complaints and contributing factors, the time required for evaluation and management of chronic insomnia can be demanding for clinicians. In this guideline, an insomnia disorder is defined as a subjective report of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep, and that results in some form of daytime impairment. “Insomnia” has been used in different contexts to refer to either a symptom or a specific disorder. Consistent risk factors for insomnia include increasing age, female sex, comorbid (medical, psychiatric, sleep, and substance use) disorders, shift work, and possibly unemployment and lower socioeconomic status. Insomnia symptoms occur in approximately 33% to 50% of the adult population insomnia symptoms with distress or impairment (general insomnia disorder) in 10% to 15%. Unless otherwise stated, “insomnia” refers to chronic insomnia, which is present for at least a month, as opposed to acute or transient insomnia, which may last days to weeks. The purpose of this clinical guideline is to provide clinicians with a practical framework for the assessment and disease management of chronic adult insomnia, using existing evidence-based insomnia practice parameters where available, and consensus-based recommendations to bridge areas where such parameters do not exist. 1 Insomnia may present with a variety of specific complaints and etiologies, making the evaluation and management of chronic insomnia demanding on a clinician's time. Insomnia is defined as the subjective perception of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep, and that results in some form of daytime impairment. Insomnia is the most prevalent sleep disorder in the general population, and is commonly encountered in medical practices.
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