Insomnia: Definition and prevalence
Insomnia disorder is defined by a persistent reduction in reported sleep quantity or quality, accompanied by perceived daytime impairments. Approximately 5–10% of the general population meet
diagnostic criteria for insomnia disorder. The prevalence is higher among patients with comorbid conditions in various medical settings, often around 30%.
Guideline
The SLEEPexpert treatment program is based on
Cognitive Behavioral Therapy for Insomnia (CBT‑I). The effectiveness of CBT‑I is well established. According to current treatment guidelines, CBT‑I is the first-line therapy for insomnia
(Riemann et al. 2023).
CBT‑I improves mental health
CBT‑I is also effective in patients with comorbid conditions and has the potential to improve not only sleep quality but also other mental health outcomes
(Hertenstein et al., 2022).
The know-do gap
CBT‑I is the treatment of choice according to international guidelines. However, a significant gap remains between the clear recommendation and poor implementation in clinical practice
(Schneider et al., 2023).
Overmedication
As part of the SLEEPexpert program, continuous assessment and—if clinically possible—reduction and discontinuation of sedative and sleep-inducing medication is intended. The program aims to help reduce a widespread overmedication in clinical settings.
Development of the treatment program
SLEEPexpert was developed in collaboration with patients and health care teams. CBT‑I was adapted to the needs of patients and health care providers in routine clinical settings. The program aims to empower patients to take care of their own sleep health and to enable teams to systematically support this process.
Based on core principles of sleep-wake regulation and key mechanisms of CBT‑I, two essential treatment elements were defined:
restriction of time in bed (sleep pressure) and adjustment to the individual rhythm (
circadian rhythm).
Using qualitative and quantitative analyses of interviews with patients, psychologists, physicians, and the nursing team, SLEEPexpert was developed through an iterative process.
The name SLEEPexpert emphasizes the idea that both patients and the treatment team become sleep experts and actively contribute to improving sleep quality.
An evaluation of the program shows that implementation in routine clinical care is feasible for inpatients with acute psychiatric disorders
(Schneider et al. 2020). Surveys of patients and healthcare teams indicated a preference for non-pharmacological treatment of insomnia. Many patients were able to adhere to the reduced time in bed, increase their sleep quality despite spending less time in bed, and reported a reduction in the severity of insomnia symptoms. The evaluation shows that SLEEPexpert can be implemented even in complex medical settings.
Current activities include implementations in a wider range of settings, an
Investigator Initiated Clinical Trial (IICT) funded by the Swiss National Science Foundation (SNSF) as well as an
adaptation for adolescents with support of Health Promotion Switzerland.
