Insomnia

Wednesday, May 13, 2026

🔬 Practice-Changing Findings
Evidence from RCTs and meta-analyses published in the last 12 months.

1. Comparative Effectiveness of Brief Behavioral Therapy for Insomnia: A Network Meta-Analysis of Psychological Outcomes.

Clinical therapeutics (2026) - Meta-Analysis

Key Findings

In-person brief behavioral therapy for insomnia significantly reduced depressive symptoms versus sleep education at 1 week post-intervention.
No significant differences were detected between in-person brief behavioral therapy and CBT-I across depression, anxiety, or fatigue outcomes versus each other.
Treatment ranking showed improved anxiety outcomes with in-person brief behavioral therapy, while CBT-I remained most effective for fatigue and comparable for depression.

📋 Practice Implication: Use brief behavioral therapy as a practical behavioral first step when access to full CBT-I is limited, especially when anxiety or depressive symptoms are prominent.

2. The effect of Dual Orexin Receptor Antagonists on sleep: a systematic review and pairwise meta-analysis.

Sleep medicine (2026) - Meta-Analysis

Key Findings

Across 77 trials, dual orexin receptor antagonists increased subjective total sleep time by 18.91 minutes versus placebo.
Sleep quality showed a small improvement, while the risk of treatment-emergent somnolence was increased nearly threefold.
Effects were consistent across treatment durations, and no significant increase was found for insomnia adverse events overall.

📋 Practice Implication: Consider dual orexin receptor antagonists for sleep-maintenance complaints, but counsel patients about next-day somnolence and reassess daytime function after initiation.

3. Management of insomnia symptoms in depressed patients treated with agomelatine, mirtazapine and trazodone: A systematic review and meta-analysis.

Journal of affective disorders (2026) - Meta-Analysis

Key Findings

Mirtazapine significantly increased total sleep time, slow-wave sleep, and sleep efficiency while reducing wake after sleep onset.
Trazodone also improved total sleep time and sleep efficiency, and all three agents improved subjective sleep and depressive symptoms.
Agomelatine was generally well tolerated but did not show a definitive objective sleep improvement, whereas mirtazapine and trazodone increased sedation-related adverse effects.

📋 Practice Implication: When depression and insomnia coexist, choose antidepressants based on the sleep target and adverse-effect tradeoff rather than assuming the class has uniform sleep benefits.

4. Daridorexant and Insomnia in Clinical Practice: A Nominal Group Technique Consensus Study among Italian Sleep and Insomnia Experts.

Current neuropharmacology (2026) - Practice Guideline

Key Findings

Expert consensus identified daridorexant as improving both nighttime symptoms and daytime functioning, with support for long-term use.
The panel recommended cross-tapering when switching from other hypnotics and improving follow-up with sleep diaries plus the Insomnia Severity Index.
Experts considered daridorexant a reasonable option in older adults and several comorbid populations because it may reduce excess sedation.

📋 Practice Implication: If prescribing daridorexant, pair it with a deliberate deprescribing plan for prior hypnotics and track response using structured symptom measures rather than informal follow-up alone.

5. Physical exercise programmes to improve insomnia or poor sleep quality in non-hospitalised elderly people: a systematic review and meta-analysis.

PeerJ (2026) - Meta-Analysis

Key Findings

Exercise programs in older adults improved sleep latency, sleep efficiency, total sleep time, and wake time after sleep onset.
Meta-analysis confirmed statistically significant improvements, with the strongest effects seen for sleep latency and sleep efficiency.
Benefits improved sleep outcomes across aerobic, resistance, tai chi, and aquatic activity programs.

📋 Practice Implication: For community-dwelling older adults, prescribe structured physical activity as a low-risk insomnia intervention before escalating to chronic sedative use.

💡 Summary

Recent insomnia literature continues to favor structured behavioral treatment and newer orexin-based pharmacotherapy, with clinically meaningful gains also seen in selected comorbid and older-adult populations. Meta-analytic evidence suggests brief behavioral therapy can approach CBT-I for mood-related outcomes, while dual orexin receptor antagonists extend subjective sleep time but still require adverse-effect monitoring. Targeted treatment choices also matter in depressed patients and community-dwelling older adults, where efficacy must be balanced against sedation, weight gain, and functional risk.