Delphi consensus recommendations for the management of chronic insomnia in Canada

Charles M Morin; Atul Khullar; Rebecca Robillard; Alex Desautels; Michael S B Mak; Thien Thanh Dang-Vu; Walter Chow; Jeff Habert; Serge Lessard; Lemore Alima; Najib T Ayas; James MacFarlane; Tetyana Kendzerska; Elliott K Lee; Colleen E Carney

doi:10.1016/j.sleep.2024.09.038

Delphi consensus recommendations for the management of chronic insomnia in Canada

Sleep Med. 2024 Oct 5:124:598-605. doi: 10.1016/j.sleep.2024.09.038. Online ahead of print.

Authors

Affiliations

¹ École de Psychologie and Centre de recherche CERVO/Brain Research Center, Université Laval, QC, Canada. Electronic address: cmorin@psy.ulaval.ca.
² Department of Psychiatry, University of Alberta, AB, Canada.
³ School of Psychology, University of Ottawa, ON, Canada.
⁴ Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, QC, Canada; Department of Neurosciences, Université de Montréal, QC, Canada.
⁵ University of Toronto, ON, Canada; Centre for Addiction & Mental Health, ON, Canada.
⁶ Department of Health, Kinesiology, and Applied Physiology, Concordia University, QC, Canada; Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), QC, Canada.
⁷ Victoria, BC, Canada.
⁸ Department of Family and Community Medicine, University of Toronto, ON, Canada.
⁹ Department of Psychiatry, University of Ottawa, ON, Canada.
¹⁰ Edmonton, AB, Canada.
¹¹ Department of Medicine, University of British Columbia, BC, Canada.
¹² Department of Psychiatry, University of Toronto, ON, Canada.
¹³ Department of Medicine, University of Ottawa, ON, Canada; Ottawa Hospital Research Institute, ON, Canada.
¹⁴ Sleep Disorders Clinic, Royal Ottawa Mental Health Centre, ON, Canada.
¹⁵ Department of Psychology, Toronto Metropolitan University, ON, Canada.

PMID: 39481275
DOI: 10.1016/j.sleep.2024.09.038

Abstract

Objective: The lack of current Canadian practice guidelines for the management of insomnia poses a challenge for healthcare providers (HCP) in selecting the appropriate treatment options. This study aimed to establish expert consensus recommendations for the management of chronic insomnia in Canada.

Composition of the committee: Sixteen multidisciplinary experts in sleep medicine and insomnia across Canada developed consensus recommendations based on their knowledge of the literature and their practical experience.

Methods: The consensus recommendations were developed through a Delphi method. Consensus was reached if at least 75 % of the voting participants "agreed" or "strongly agreed" with the corresponding statements. The quality of supporting evidence was rated using a GRADE rating system.

Report: Among 37 recommendations that reached consensus for the management of chronic insomnia, the experts recommend and agree that.

Conclusion: These consensus recommendations highlight the need to increase awareness, capacity for, and access to CBT-I; integrate newly approved pharmacotherapy; reduce both self-medication and medications with limited evidence or low risk/benefit ratio.

Keywords: Canadian practice; Chronic insomnia management; Consensus recommendations; Family practice/general practice/primary care.