The sleep of Israelis has become more fragile than ever in recent years. Since the outbreak of the war, at least half of Israelis report sleep disturbances and insomnia, and data from the Central Bureau of Statistics show that this is no longer a marginal medical problem – but a broad social phenomenon, with health, mental, and economic consequences.
Against the backdrop of these worrying data, the Israeli Sleep Research Society and the Institute for Medical Quality of the Israel Medical Association recently published a first-of-its-kind position paper in Israel. Its aim: To provide therapists and community doctors with updated, evidence-based tools for diagnosing and treating sleep disorders – especially chronic insomnia.
Dr. Joel Reiter, Director of the Sleep Laboratory at Hadassah Ein Kerem, Chairman of the Israeli Sleep Research Society, and one of the authors of the document, explains what has changed – and why it matters to anyone still counting sheep.
Sleep Disorders Are Much More Than “Another Night Without Falling Asleep”
Sleep disorders are not limited to occasional difficulty falling asleep. They are ongoing symptoms of difficulty falling asleep, maintaining sleep continuity, or waking up too early, accompanied by fatigue, decreased concentration, and impaired daily functioning – to the point of affecting work, studies, and personal relationships.
According to the international classification of sleep disorders (ICSD-3), insomnia is defined as chronic when complaints occur at least three nights a week, persist for more than three months, and are not better explained by another physical, neurological, or psychiatric condition. The diagnosis also relies on subjective distress: Worry about the upcoming night, cognitive “background noise” in bed, and the perception of sleep as a continuous failure.
Central Bureau of Statistics (CBS) data indicate that about 50% of Israelis sleep less than seven hours per night. The position paper states that chronic insomnia affects a significant percentage of the adult population, with a sharp increase among those aged 60–70. Prevalence is higher among women and people with underlying conditions – cardiopulmonary diseases, diabetes, chronic kidney disease, and mental disorders such as anxiety and post-traumatic stress disorder.
The consequences go far beyond feelings of fatigue: Increased risk of workplace and road accidents, cognitive and emotional impairment, worsening of depression and existing chronic illnesses. Despite this, many do not seek formal diagnosis and do not receive evidence-based treatment – making insomnia one of the most common and undertreated disorders in the healthcare system.
The New Guidelines: Fewer Sleep Labs, More Family Doctors
Until now, many patients with complaints of insomnia were quickly referred to sleep lab monitoring – sometimes after long waits and a cumbersome process. The new guidelines change direction: In most cases, the family doctor can diagnose chronic insomnia already in the clinic, based on clear clinical symptoms – without electrodes, without a night away from home, and without unnecessary tests.
The sleep laboratory retains an important role, but a more focused one – mainly in cases where there is suspicion of specific disorders such as sleep apnea, periodic limb movements, or other neurological disorders.
Treatment of Choice: Psychologist Before Pills
The diagnostic revolution is accompanied by a treatment revolution. The first and most important recommendation is dedicated cognitive behavioral therapy for insomnia (CBT-I). This is a short and focused therapy that teaches the brain and body to “relearn” how to sleep: Limiting time in bed, changing harmful habits, relaxation techniques, and debunking myths that increase anxiety around sleep.
The challenge in Israel is a severe shortage of qualified therapists, leading to long waiting lists. To address this gap, specialized training courses are currently being launched. The only course recognized by both the Israeli and European Sleep Research Societies is held alternately at Tel Aviv University and the University of Haifa.
Even in the pharmacological field, the guidelines signal a dramatic change. Older benzodiazepine medications, such as Bondormin, are no longer first-line treatments. Despite their effectiveness in inducing sleep, they can cause dependence, drowsiness, falls, and a “hangover” feeling the next day, and even disrupt sleep architecture at the expense of deep and REM (dream) sleep.
Instead, orexin receptor antagonists (DORA) are presented for the first time. These drugs work in the opposite approach: They do not “push” sleep but inhibit wakefulness mechanisms in the brain. Studies show a milder side effect profile, no addiction, and good effect throughout most of the night, with minimal impact on sleep stages. A rare but unique side effect is particularly vivid and tangible dreams.
The message to patients is clear. Those suffering from sleep disorders do not have to continue suffering in silence. The new guidelines emphasize the importance of community diagnosis, behavioral treatment as the first line, and informed, updated use of medications. It is advisable to ensure that the family doctor is familiar with the guidelines, understand when a sleep lab is necessary, and choose evidence-based treatment together – instead of continuing to spend sleepless nights.