Condition

Insomnia

Chronic difficulty falling or staying asleep

852M

People Affected

100

Active Trials

170.4M

New Cases/Year

500

Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

78% Effectiveness• 95% Confidence• 95% Safety• 311 trials• 25K participants

HIGH EvidenceExcellent ValueDose: 60 minutes per session, 1 session weekly

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Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

4-8 weeks

Duration

6-8 weeks

Response Rate

75%

Remission Rate

50%

Number Needed to Treat (NNT)

Common Side Effects:

Temporary sleep restriction discomfort: 10%

Annual Cost of Care

Drug Cost

Monitoring

$400

Side Effects

Total Annual

$400

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.2

Cost per Remission

$3,000

Cost per Responder

$2,000

Treatment Outcomes

Primary Outcomes

Insomnia Severity Index (ISI) scoreISI score: 19/28 (moderate insomnia)

-42% (-8 points)

Sleep Onset Latency (SOL)75 minutes

-40% (-30 minutes)

Wake After Sleep Onset (WASO)80 minutes

-44% (-35 minutes)

Sleep Efficiency (SE)65%

+23% (+15 percentage points)

Secondary Benefits

Daytime Fatigue (Fatigue Severity Scale - FSS)FSS score: 45/63 (significant fatigue)

-22% (-10 points)

Quality of Life (SF-36 Mental Health component)SF-36 Mental Health score: 55/100

+15% (+8 points)

Depressive Symptoms (Patient Health Questionnaire-9 - PHQ-9)PHQ-9 score: 12/27 (moderate depression)

-33% (-4 points)

Common Side Effects

Temporary sleep restriction discomfort

+10%

Zolpidem

70% Effectiveness• 90% Confidence• 45% Safety• 80 trials• 35K participants

HIGH EvidenceModerate ValueDose: 5-10 mg at bedtime

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Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

immediate

Duration

short-term (2-4 weeks)

Response Rate

65%

Remission Rate

15%

Number Needed to Treat (NNT)

Number Needed to Harm (NNH)

Common Side Effects:

Drowsiness: 20%

Dizziness: 10%

Headache: 8%

Nausea: 6%

Amnesia: 3%

Complex sleep behaviors: 1%

Annual Cost of Care

Drug Cost

$50

Monitoring

$150

Side Effects

$50

Total Annual

$250

Cost-Effectiveness

MODERATE

QALYs Gained

0.08

ICER

$90,000/QALY

Cost per Remission

$1,667

Cost per Responder

$385

Treatment Outcomes

Primary Outcomes

Sleep Latency (Time to fall asleep)60 minutes

-30% (-18 minutes)

Wake After Sleep Onset (WASO)80 minutes

-31.3% (-25 minutes)

Total Sleep Time (TST)300 minutes (5 hours)

+15% (+45 minutes)

Number of Nocturnal Awakenings5 awakenings

-30% (-1.5 awakenings)

Subjective Sleep Quality (0-10 scale, 10=excellent)4/10

+50% (+2 points)

Secondary Benefits

Daytime Sleepiness (Epworth Sleepiness Scale: 0-24, higher is worse)14/24

-21.4% (-3 points)

Health-Related Quality of Life (Generic Scale: e.g., SF-36 MCS, 0-100, higher is better)40/100

+12.5% (+5 points)

Daytime Concentration (Subjective Scale: 0-10, 10=excellent)6/10

+16.7% (+1 point)

Common Side Effects

Drowsiness

+20%

Dizziness

+10%

Headache

+8%

Clinical Trial Phases:

Phase 4

Eszopiclone

68% Effectiveness• 85% Confidence• 45% Safety• 48 trials• 16K participants

HIGH EvidenceModerate ValueDose: 1-3 mg at bedtime

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

immediate

Duration

short-term (2-4 weeks), approved for longer

Response Rate

60%

Remission Rate

12%

Number Needed to Treat (NNT)

Number Needed to Harm (NNH)

Common Side Effects:

Unpleasant taste: 25%

Headache: 13%

Drowsiness: 12%

Dizziness: 7%

Annual Cost of Care

Drug Cost

$100

Monitoring

$150

Side Effects

$50

Total Annual

$300

Cost-Effectiveness

MODERATE

QALYs Gained

0.08

ICER

$100,000/QALY

Cost per Remission

$2,500

Cost per Responder

$500

Treatment Outcomes

Primary Outcomes

Sleep Latency (Time to Persistent Sleep)70 minutes

-40% (-28 minutes)

Wake After Sleep Onset (WASO)80 minutes

-30% (-24 minutes)

Total Sleep Time (TST)360 minutes (6 hours)

+12.5% (+45 minutes)

Number of Awakenings6 awakenings

-25% (-1.5 awakenings)

Secondary Benefits

Patient-Reported Sleep Quality (0-10 scale)4/10 points

+62.5% (+2.5 points)

Insomnia Severity Index (ISI) Score21/28 points

-33.33% (-7 points)

Daytime Alertness (Patient-rated 0-10 scale)6/10 points

+25% (+1.5 points)

Common Side Effects

Unpleasant taste

+25%

Headache

+13%

Drowsiness

+12%

Clinical Trial Phases:

Phase 4

Lemborexant

65% Effectiveness• 85% Confidence• 55% Safety• 21 trials• 6K participants

HIGH EvidencePoor ValueDose: 5-10 mg at bedtime

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

immediate

Duration

long-term

Response Rate

55%

Remission Rate

12%

Number Needed to Treat (NNT)

Number Needed to Harm (NNH)

Common Side Effects:

Somnolence: 13%

Headache: 6%

Dizziness: 3%

Annual Cost of Care

Drug Cost

$2,000

Monitoring

$150

Side Effects

$50

Total Annual

$2,200

Cost-Effectiveness

POOR

QALYs Gained

0.12

ICER

$180,000/QALY

Cost per Remission

$18,333

Cost per Responder

$4,000

Treatment Outcomes

Primary Outcomes

Latency to Persistent Sleep (LPS)80 minutes

-31.3% (-25 minutes)

Wake After Sleep Onset (WASO)100 minutes

-30% (-30 minutes)

Total Sleep Time (TST)330 minutes

+13.6% (+45 minutes)

Patient-Reported Sleep Onset Latency (PSOL)65 minutes

-27.7% (-18 minutes)

Patient-Reported Wake After Sleep Onset (pWASO)90 minutes

-24.4% (-22 minutes)

Secondary Benefits

Daytime Impairment SeverityDaytime Impairment Severity (0-10 scale): 7.5

-26.7% (-2.0 points)

Health-Related Quality of LifeHealth-Related Quality of Life (0-100 scale): 55

+14.5% (+8 points)

Insomnia Severity Index (ISI) Total ScoreISI score (0-28): 19

-36.8% (-7 points)

Common Side Effects

Somnolence

+13%

Headache

+6%

Dizziness

+3%

Clinical Trial Phases:

Phase 4

Suvorexant

62% Effectiveness• 85% Confidence• 55% Safety• 39 trials• 9K participants

HIGH EvidencePoor ValueDose: 10-20 mg at bedtime

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

immediate

Duration

long-term

Response Rate

50%

Remission Rate

Number Needed to Treat (NNT)

Number Needed to Harm (NNH)

Common Side Effects:

Somnolence: 10%

Headache: 7%

Dizziness: 4%

Annual Cost of Care

Drug Cost

$2,000

Monitoring

$150

Side Effects

$50

Total Annual

$2,200

Cost-Effectiveness

POOR

QALYs Gained

0.1

ICER

$200,000/QALY

Cost per Remission

$27,500

Cost per Responder

$4,400

Treatment Outcomes

Primary Outcomes

Latency to Persistent Sleep (LPS) - PSG68 minutes

-26.5% (-18 minutes)

Wake After Sleep Onset (WASO) - PSG115 minutes

-21.7% (-25 minutes)

Total Sleep Time (TST) - PSG320 minutes

+9.4% (+30 minutes)

Secondary Benefits

Subjective Total Sleep Time (sTST)360 minutes

+11.1% (+40 minutes)

Sleep Quality - PSQIPSQI score: 14/21

-28.6% (-4 points)

Daytime Alertness - KSSKSS score: 7/9

-21.4% (-1.5 points)

Common Side Effects

Somnolence

+10%

Headache

+7%

Dizziness

+4%

Clinical Trial Phases:

Phase 4

Doxepin (low-dose)

60% Effectiveness• 85% Confidence• 60% Safety• 35 trials• 7.5K participants

HIGH EvidenceGood ValueDose: 3-6 mg at bedtime

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

1-2 hours

Duration

long-term

Response Rate

55%

Remission Rate

Number Needed to Treat (NNT)

Number Needed to Harm (NNH)

Common Side Effects:

Somnolence: 5%

Nausea: 2%

Dizziness: 2%

Annual Cost of Care

Drug Cost

$75

Monitoring

$150

Side Effects

$20

Total Annual

$245

Cost-Effectiveness

GOOD

QALYs Gained

0.1

ICER

$60,000/QALY

Cost per Remission

$3,062

Cost per Responder

$445

Treatment Outcomes

Efficacy Outcomes

Overall Effectiveness

+60%

Response Rate

+55%

Remission Rate

+8%

Common Side Effects

Somnolence

+5%

Nausea

+2%

Dizziness

+2%

Clinical Trial Phases:

Phase 4

Ramelteon

55% Effectiveness• 80% Confidence• 70% Safety• 49 trials• 10K participants

HIGH EvidenceGood ValueDose: 8 mg at bedtime

Find Trials

Comparative Safety Scale(Higher is safer)

Cyanide☠️

Meth💀

Cigarettes🚬

Chemo☢️

Alcohol🍺

Morphine💊

Antibiotics💉

Tylenol💊

Exercise🏃

Water💧

DangerousModerateSafe

Time to Effect

30-60 minutes

Duration

long-term

Response Rate

50%

Remission Rate

Number Needed to Treat (NNT)

Number Needed to Harm (NNH)

Common Side Effects:

Somnolence: 5%

Dizziness: 4%

Nausea: 3%

Annual Cost of Care

Drug Cost

$100

Monitoring

$150

Side Effects

$20

Total Annual

$270

Cost-Effectiveness

GOOD

QALYs Gained

0.09

ICER

$75,000/QALY

Cost per Remission

$3,375

Cost per Responder

$540

Treatment Outcomes

Primary Outcomes

Latency to Persistent Sleep (LPS)75 minutes

-13.33% (-10 minutes)

Subjective Sleep Latency (sSL)60 minutes

-20% (-12 minutes)

Total Sleep Time (TST)330 minutes

+3.03% (+10 minutes)

Wake After Sleep Onset (WASO)70 minutes

-10% (-7 minutes)

Secondary Benefits

Pittsburgh Sleep Quality Index (PSQI) Score12/21 points

-20.83% (-2.5 points)

Epworth Sleepiness Scale (ESS) Score12/24 points

-12.5% (-1.5 points)

Sleep Efficiency (SE)75%

+4% (+3 percentage points)

Common Side Effects

Somnolence

+5%

Dizziness

+4%

Nausea

+3%

Clinical Trial Phases:

Phase 4