Insomnia suffers have reduced work productivity, and higher rates of absenteeism, accidents, and hospitalization, impaired memory function, complaints of daytime fatigue, and lower quality of life ( 3, 9). Researchers propose that insomnia associated with suffering COVID-19 appears to persist over time ( 8). A systematic review including 98 studies with 193,889 Chinese participants suggested that 39.1% presented insomnia during the COVID-19 pandemic and insomnia symptoms did not improve despite control of the disease ( 8). The COVID-19 pandemic is likely to have made insomnia more widespread. Up to one in five people suffer from insomnia or trouble sleeping based on data from the USA ( 5), Nordic countries ( 6) and South Korea ( 7). Insomnia affects a considerable proportion of the general population globally as either a primary or a secondary comorbid condition ( 4). It is predominantly characterized by subjective perceptions of difficulty in initiating and/or maintaining sleep or experiencing non-refreshing and/or non-restorative sleep, often accompanied by reduced daytime performance and cognitive dysfunction ( 1, 3). Insomnia remains the most prevalent sleep complaint and is a major public health concern ( 1, 2). Systematic review registration:, identifier: CRD42022369155. Allowing the engagement of a range of interdisciplinary stakeholders in future updates of CPGs is also warranted. More well-designed studies to provide reliable clinical evidence are therefore urgently needed. The only consensus was that four phytotherapeutics including valerian, chamomile, kava, and aromatherapy were not recommended for insomnia management because of risk profile and/or limited benefits.Ĭonclusions: Existing guidelines are generally limited in providing clear, evidence-informed recommendations for the use of CAM therapies for insomnia management due to a lack of high-quality evidence and multidisciplinary consultation in CPG development. Logically explained graded recommendations supporting the CAM use in the treatment and/or care of insomnia were scarce, with bibliotherapy, Tai Chi, Yoga, and auriculotherapy positively recommended based on little and weak evidence. Recommendations for these modalities were mostly unclear, unambiguous, uncertain, or conflicting. Twenty-two CAM modalities were implicated, involving nutritional or natural products, physical CAM, psychological CAM, homeopathy, aromatherapy, and mindful movements. The reporting rate of eligible CPGs ranged from 42.9 to 97.1%. Results: Seventeen eligible GCPs were included, and 14 were judged to be of moderate to high methodological and reporting quality. The methodological and reporting quality of each included guideline was appraised using the AGREE II instrument and RIGHT statement, respectively. The NCCIH website and six websites of international guideline developing institutions were also retrieved. Methods: Formally published CPGs incorporating CAM recommendations for insomnia management were searched for in seven databases from their inception to January 2023. The quality of the eligible guidelines was appraised to assess the credibility of these recommendations. This systematic review aimed to identify and summarize the CAM recommendations associated with insomnia treatment and care from existing comprehensive clinical practice guidelines (CPGs).
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