Insomnische Störungen - Herausforderungen und offene Fragen (In press.)

Current diagnostic conceptualizations of insomnia, i.e. ICD-10 or DSM IV do not fully encompass the complexity and heterogeneity of the phenomenon. Advances have been made with ICSD-2 and the RDC (Research Diagnostic Criteria). Further progress will be made through 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), manifold empirical evidence under-lines that this type of treatment should be the first line treatment for insomnia. Unfortu-nately, only a minority of patients seems to have access to the benefits of this treatment due to a lack of ressources. Stepped-care models for insomnia suggest self-help pro-grams, internet-based approaches, community-centered activities (specially trained nurses) and as a last resort medical specialists and sleep experts to treat insomnia