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Summary: Progress in the field of insomnia since 2017 necessitated this update of the European Insomnia Guideline. Recommendations for the diagnostic procedure for insomnia and its comorbidities are: clinical interview (encompassing sleep and medical history); the use of sleep questionnaires and diaries (and physical examination and additional measures where indicated) (A). Actigraphy is not recommended for the routine evaluation of insomnia (C), but may be useful for differential‐diagnostic purposes (A). Polysomnography should be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep‐related breathing disorders, etc.), treatment‐resistant insomnia (A) and for other indications (B). Cognitive‐behavioural therapy for insomnia is recommended as the first‐line treatment for chronic insomnia in adults of any age (including patients with comorbidities), either applied in‐person or digitally (A). When cognitive‐behavioural therapy for insomnia is not sufficiently effective, a pharmacological intervention can be offered (A). Benzodiazepines (A), benzodiazepine receptor agonists (A), daridorexant (A) and low‐dose sedating antidepressants (B) can be used for the short‐term treatment of insomnia (≤ 4 weeks). Longer‐term treatment with these substances may be initiated in some cases, considering advantages and disadvantages (B). Orexin receptor antagonists can be used for periods of up to 3 months or longer in some cases (A). Prolonged‐release melatonin can be used for up to 3 months in patients ≥ 55 years (B). Antihistaminergic drugs, antipsychotics, fast‐release melatonin, ramelteon and phytotherapeutics are not recommended for insomnia treatment (A). Light therapy and exercise interventions may be useful as adjunct therapies to cognitive‐behavioural therapy for insomnia (B). [ABSTRACT FROM AUTHOR]

Insomnia, the most prevalent sleep disorder worldwide, confers marked risks for both physical and mental health. Furthermore, insomnia is associated with considerable direct and indirect healthcare costs. Recent guidelines in the US and Europe unequivocally conclude that cognitive behavioural therapy for insomnia (CBT‐I) should be the first‐line treatment for the disorder. Current treatment approaches are in stark contrast to these clear recommendations, not least across Europe, where, if any treatment at all is delivered, hypnotic medication still is the dominant therapeutic modality. To address this situation, a Task Force of the European Sleep Research Society and the European Insomnia Network met in May 2018. The Task Force proposed establishing a European CBT‐I Academy that would enable a Europe‐wide system of standardized CBT‐I training and training centre accreditation. This article summarizes the deliberations of the Task Force concerning definition and ingredients of CBT‐I, preconditions for health professionals to teach CBT‐I, the way in which CBT‐I should be taught, who should be taught CBT‐I and to whom CBT‐I should be administered. Furthermore, diverse aspects of CBT‐I care and delivery were discussed and incorporated into a stepped‐care model for insomnia. [ABSTRACT FROM AUTHOR]

Sleep coaching by Holzinger & Klösch™ is a new, Gestalt therapy-based holistic approach to non-pharmacological treatment of non-restorative sleep. It includes psychotherapeutic aspects which enable participants to improve their sleep quality by developing their own coping strategies as a daily routine. Dream work and relaxation techniques are also part of the programme. The aim of this study was to measure the effectiveness of a two-day sleep coaching seminar on sleep quality, daytime sleepiness, and work and life quality in shift workers employed in an Austrian railway company (Österreichische Bundesbahnen, ÖBB). Thirty shift workers (28 male; mean age=24±45.90, age range 24–56 years) answered the same survey before and six months after the seminar (baseline and follow-up) containing items of the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), their chronotype, personality factors, and burnout risk factors. The baseline findings in this group were compared with those of non-completers (who did not take the follow-up survey) (N=154) to see if the two groups differed significantly enough to create a bias among completers (who took the follow-up survey as well). Groups differed significantly in burnout levels as well as sleep duration, but not in the distribution of critical PSQI and ESS values. The two-day sleep coaching seminar resulted in a significant improvement in total PSQI score and subjective sleep quality and in a significant reduction in diurnal fatigue, sleep latency, and daytime sleepiness. Nevertheless, more research with a larger sample and a longitudinal design is needed to establish the long-term effects of sleep coaching. [ABSTRACT FROM AUTHOR]

The main goal of the present study was to explore electrophysiological differences between lucid and nonlucid dreams in REM sleep. Seven men and four women experienced in lucid dreaming underwent polysomnographic recordings in the sleep laboratory on two consecutive nights. EEG signals were subjected to spectral analysis to obtain five different frequency bands between 1 and 20 Hz. Lucidity was determined by both subjective dream reports and eye-movement signals made by the subjects in response to light stimuli indicating a REM period. The main discrimination factor between lucid and nonlucid dreaming was found in the beta-1 frequency band (13–19 Hz), which in lucid dreaming was increased in both parietal regions. The ratio of frontal to parietal beta-1 activity was 1 to 1.16 in nonlucid and 1 to 1.77 in lucid dreaming. A tendency towards the greatest increase was observed in the left parietal lobe (P3), an area of the brain considered to be related to semantic understanding and self-awareness. [ABSTRACT FROM AUTHOR]

Restless legs syndrome (RLS) has been associated with anxiety, depression, insomnia, lifestyle factors and infections. We aimed to study the prevalence of symptoms of RLS during the COVID-19 pandemic versus pre-pandemic. We hypothesized that pre-existing RLS symptoms worsened and pandemic-related factors may have triggered new symptoms of RLS. Adults (≥18 years) from fifteen countries across four continents participated in an online survey between May and August 2020. The harmonized questionnaire included a validated single question on RLS with response alternatives from 1 to 5 on a scale from never to every/almost every evening or night. Other measures were the Insomnia Severity Index (ISI), measures of symptoms of anxiety (GAD-2) and depression (PHQ-2), and questions on different pandemic-related factors. Altogether, 17 846 subjects (63.8 % women) were included in the final analyses. The mean age was 41.4 years (SD 16.1). During the pandemic, symptoms of RLS (≥3 evenings/nights per week) were more common 9.1 % (95 % CI 8.7–10.1) compared to 5.4 % (95 % CI 4.9–6.0) before the pandemic (P < 0.0001). Alltogether 1.3 % (95 % CI 1.1–1.6) respondents had new-onset symptoms (≥3 evenings/nights per week). Moderate-severe insomnia was strongly associated with RLS symptoms. The occurrences of new-onset RLS symptoms were 5.6 % (95 % CI 0.9–13.0) for participants reporting COVID-19 and 1.1 % (95 % CI 0.7–1.5) for non-COVID-19 participants. In the fully adjusted logistic regression model, the occurrence of new-onset RLS symptoms was associated with younger age, social restrictions and insomnia severity. In a similar analysis, RLS symptoms (≥3 evenings/nights per week) were associated with lower education, financial hardship, sleep apnea symptoms, use of hypnotics, insomnia severity, symptoms of depression and possible post-traumatic stress disorder. Our findings indicate that RLS symptoms were more common during the pandemic than before. Usually, the prevalence of RLS increases with age. However, during the pandemic, new-onset symptoms of RLS were more common in younger age groups. This may be due to the pandemic-related factors being more pronounced in the younger compared to the older. The association between insomnia, psychiatric symptoms and RLS warrants clinical attention. • Restless legs symptoms were more prevalent during the COVID-19 pandemic than before. • Insomnia and psychiatric symptoms were associated with RLS symptoms. • New-onset RLS symptoms were more common among younger subjects. [ABSTRACT FROM AUTHOR]