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Peer-reviewedCC BY 4.0Frontiers in Psychiatry

Comprehensive management of chronic insomnia in Spain: a multidisciplinary modified RAND/UCLA consensus with recommendations on daridorexant

  • Ainhoa Álvarez-Ruiz-Larrinaga1,2
  • Lorenzo Armenteros3,4
  • Carmen Bellido5,6
  • Laura Lillo Triguero7,8
  • José Martínez-Raga9
  • Julio Pascual10
  • Luis San11
11 affiliations
  1. 1Neuroscience, Sleep Disorders, Bioaraba Health Research Institute
  2. 2Osakidetza Basque Health Service, Araba University Hospital
  3. 3Primary Care, Centro de Salud Islas Canarias
  4. 4Spanish Society of General and Family Physicians (SEMG)
  5. 5Occupational Risk Prevention Department. General University Hospital of Castellón
  6. 6Spanish Association of Occupational Medicine
  7. 7Codirector of Sleep Unit, Neurology Service, Ruber International Hospital
  8. 8Neurology Service, Getafe University Hospital
  9. 9Service of Psychiatry And Mental Health, University Hospital Doctor Peset
  10. 10Service of Neurology, University Hospital Marqués de Valdecilla, Universidad de Cantabria and IDIVAL
  11. 11Senior Psychiatrist, Miembro del CIBERSAM, Colegio de Psiquiatras Eméritos de la Sociedad Española de Psiquiatría y Salud Mental
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Abstract

Introduction: Chronic insomnia is a prevalent 24-hour disorder with significant daytime impact. Its management is frequently complicated by conceptual barriers, limited use of standardised diagnostic tools and prolonged benzodiazepine use, while insomnia is often overlooked or inadequately coded as an independent disorder. These challenges highlight the need for improved recognition and clearer therapeutic pathways. Dual orexin receptor antagonists (DORAs), particularly daridorexant, offer a new pharmacological option targeting wake-promoting pathways, yet practical guidance on their clinical use remains limited.

Method: A multidisciplinary panel of seven experts conducted a national consensus using the RAND/UCLA Appropriateness Method. Seventy-four statements addressing the nature, diagnosis and treatment of chronic insomnia, including the clinical use of daridorexant, were evaluated across two rating rounds and a structured discussion. Consensus was reached on 36 statements in round one; one statement was removed; and the remaining 37 achieved consensus in round two.

Results: Experts agreed that chronic insomnia is a distinct disorder, with hyperarousal as a central mechanism, and emphasised the importance of targeting daytime functioning and preserving sleep architecture. Daridorexant was considered appropriate across heterogeneous clinical profiles, supported by evidence demonstrating improvements in nocturnal sleep, daytime functioning and sleep architecture, along with favourable tolerability and low abuse potential.

Conclusions: This consensus supports a pragmatic and patient-centred approach to chronic insomnia management, integrating current evidence with expert clinical experience. The recommendations may help guide decision-making in routine practice, including the use of daridorexant when pharmacological treatment is considered appropriate.

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Cite

BibTeXRIS
BibTeX
@article{alvarezruizlarrinaga2026comprehensive,
  title = {{Comprehensive management of chronic insomnia in Spain: a multidisciplinary modified RAND/UCLA consensus with recommendations on daridorexant}},
  author = {Ainhoa Álvarez-Ruiz-Larrinaga and Lorenzo Armenteros and Carmen Bellido and Laura Lillo Triguero and José Martínez-Raga and Julio Pascual and Luis San},
  journal = {Frontiers in Psychiatry},
  year = {2026},
  month = oct,
  doi = {10.3389/fpsyt.2026.1927424},
  url = {https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1927424/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Comprehensive management of chronic insomnia in Spain: a multidisciplinary modified RAND/UCLA consensus with recommendations on daridorexant
AU  - Ainhoa Álvarez-Ruiz-Larrinaga
AU  - Lorenzo Armenteros
AU  - Carmen Bellido
AU  - Laura Lillo Triguero
AU  - José Martínez-Raga
AU  - Julio Pascual
AU  - Luis San
PY  - 2026
DA  - 2026/10/13
JO  - Frontiers in Psychiatry
DO  - 10.3389/fpsyt.2026.1927424
UR  - https://www.frontiersin.org/articles/10.3389/fpsyt.2026.1927424/full
AB  - Introduction: Chronic insomnia is a prevalent 24-hour disorder with significant daytime impact. Its management is frequently complicated by conceptual barriers, limited use of standardised diagnostic tools and prolonged benzodiazepine use, while insomnia is often overlooked or inadequately coded as an independent disorder. These challenges highlight the need for improved recognition and clearer therapeutic pathways. Dual orexin receptor antagonists (DORAs), particularly daridorexant, offer a new pharmacological option targeting wake-promoting pathways, yet practical guidance on their clinical use remains limited.  Method: A multidisciplinary panel of seven experts conducted a national consensus using the RAND/UCLA Appropriateness Method. Seventy-four statements addressing the nature, diagnosis and treatment of chronic insomnia, including the clinical use of daridorexant, were evaluated across two rating rounds and a structured discussion. Consensus was reached on 36 statements in round one; one statement was removed; and the remaining 37 achieved consensus in round two.  Results: Experts agreed that chronic insomnia is a distinct disorder, with hyperarousal as a central mechanism, and emphasised the importance of targeting daytime functioning and preserving sleep architecture. Daridorexant was considered appropriate across heterogeneous clinical profiles, supported by evidence demonstrating improvements in nocturnal sleep, daytime functioning and sleep architecture, along with favourable tolerability and low abuse potential.  Conclusions: This consensus supports a pragmatic and patient-centred approach to chronic insomnia management, integrating current evidence with expert clinical experience. The recommendations may help guide decision-making in routine practice, including the use of daridorexant when pharmacological treatment is considered appropriate.
SN  - 1664-0640
ER  -