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Insomnische Störungen

Herausforderungen und offene Fragen

Insomnia disorders

Challenges and open questions

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Zusammenfassung

Aktuell gebräuchliche diagnostische Systeme wie ICD-10 oder DSM-IV werden der Komplexität und Heterogenität insomnischer Störungen nicht gerecht. Mit dem ICSD-2 und den Research Diagnostic Criteria (RDC) wurden bereits Fortschritte erreicht. Im DSM-V wird eine neue übergreifende Kategorie „insomnia disorder“ etabliert werden. Hinsichtlich Ätiologie und Pathophysiologie dominiert aktuell das sog. Hyperarousal-Modell, das allerdings auch Schwachstellen aufweist, sodass weitergehende klinische Forschung zu seiner Bestätigung aussteht. Zudem ist die Etablierung valider Tiermodelle notwendig, um die grundlegenden Mechanismen gestörten Schlafs bei der Insomnie besser zu verstehen. Hinsichtlich der pharmakologischen Therapie muss ein Innovationsstau, zumindest in Europa konstatiert werden. Die kognitiv-verhaltenstherapeutische Behandlung der Insomnien (KVT-I), die durch viele Evidenzen sowohl kurz- als auch langfristig wirksam ist, sollte als „First-line“-Behandlung akzeptiert werden. Leider besteht jedoch nur für eine Minderheit von Betroffenen aufgrund mangelnder Ressourcen eine gute Zugangsmöglichkeit zu dieser Behandlungsform. Sog. Stepped-care-Modelle schlagen zur Lösung dieses Versorgungsproblems Selbsthilfeprogramme, internetbasierte Ansätze, gemeindezentrierte Aktivitäten und erst zuletzt Fachärzte und Schlafspezialisten als Behandlungsoptionen vor.

Abstract

Current diagnostic concepts, i.e. ICD-10 or DSM IV, do not fully encompass the complexity and heterogeneity of insomnia disorders. Advances have been made with ICSD-2 and the Research Diagnostic Criteria (RDC). Further progress will be made with the DSM V, which will encompass a main diagnostic category of “insomnia disorder”. Concerning etiological and pathophysiological assumptions, the hyperarousal model has gained wide-spread attention. Nevertheless, many of its tenets have only been confirmed by single studies, so further clinical research will be necessary to fully support the model. Additionally, animal models of insomnia are needed to advance the understanding of basic mechanisms involved in insomnia. With respect to treatment, there is a lack of new developments in the field of hypnotics for Europe. Concerning cognitive behavioral therapy of insomnia (CBT-I), much empirical evidence underlines that this type of treatment should be the first line treatment for insomnia. Unfortunately, only a minority of patients seem to have access to the benefits of this treatment due to a lack of resources. Stepped-care models for insomnia suggest self-help programs, internet-based approaches, community-centered activities (specially trained nurses) and as a last resort medical specialists and sleep experts to treat insomnia.

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  1. Abteilung für Psychiatrie und Psychotherapie, Universitätsklinik Freiburg, Hauptstr. 5, 79104, Freiburg, Deutschland

    C. Baglioni, K. Spiegelhalder, C. Nissen, V. Hirscher, L. Frase, B. Feige, T. Unbehaun &  D. Riemann

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  1. C. Baglioni
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  2. K. Spiegelhalder
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Correspondence to D. Riemann.

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Baglioni, C., Spiegelhalder, K., Nissen, C. et al. Insomnische Störungen. Somnologie 17, 6–14 (2013). https://doi.org/10.1007/s11818-013-0602-4

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