SLEEP–ENDO™: A stepped-care protocol for insomnia in endometriosis

Sleep disturbance is very common in people with endometriosis, and insomnia is closely linked with pain, mood and fatigue. SLEEP–ENDO™ is an author-developed stepped-care protocol that organises the management of insomnia in endometriosis into six steps: (0) recognise and characterise, (1) remove modifiable drivers, (2) deliver CBT-I as the core treatment, (3) address arousal and the pain–sleep loop, (4) consider short-term pharmacological options only if CBT-I is insufficient, (5) review and maintain. The core treatment follows the European Insomnia Guideline 2023, which recommends CBT-I as first-line treatment for chronic insomnia, including insomnia with comorbid conditions. Practical sheets translate the core components into working rules adapted to night pain, hormone-suppressing therapy and flares. In the literature searched for this protocol (November 2026), no completed randomised trial of CBT-I for insomnia specifically in endometriosis was identified, so the adaptations are extrapolations.