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.

1
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☢️
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Morphine💊
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95
DangerousModerateSafe

Time to Effect

4-8 weeks

Duration

6-8 weeks

Response Rate

75%

Remission Rate

50%

Number Needed to Treat (NNT)

3

Common Side Effects:

Temporary sleep restriction discomfort: 10%

Annual Cost of Care

Drug Cost

$0

Monitoring

$400

Side Effects

$0

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%
2
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💧
45
DangerousModerateSafe

Time to Effect

immediate

Duration

short-term (2-4 weeks)

Response Rate

65%

Remission Rate

15%

Number Needed to Treat (NNT)

6

Number Needed to Harm (NNH)

20

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
3
Eszopiclone
68% Effectiveness• 85% Confidence• 45% Safety• 48 trials• 16K participants
HIGH EvidenceModerate ValueDose: 1-3 mg at bedtime
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
45
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)

6

Number Needed to Harm (NNH)

18

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
4
Lemborexant
65% Effectiveness• 85% Confidence• 55% Safety• 21 trials• 6K participants
HIGH EvidencePoor 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💧
55
DangerousModerateSafe

Time to Effect

immediate

Duration

long-term

Response Rate

55%

Remission Rate

12%

Number Needed to Treat (NNT)

8

Number Needed to Harm (NNH)

25

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
5
Suvorexant
62% Effectiveness• 85% Confidence• 55% Safety• 39 trials• 9K participants
HIGH EvidencePoor ValueDose: 10-20 mg at bedtime
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
55
DangerousModerateSafe

Time to Effect

immediate

Duration

long-term

Response Rate

50%

Remission Rate

8%

Number Needed to Treat (NNT)

10

Number Needed to Harm (NNH)

28

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
6
Doxepin (low-dose)
60% Effectiveness• 85% Confidence• 60% Safety• 35 trials• 7.5K participants
HIGH EvidenceGood ValueDose: 3-6 mg at bedtime
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

1-2 hours

Duration

long-term

Response Rate

55%

Remission Rate

8%

Number Needed to Treat (NNT)

10

Number Needed to Harm (NNH)

40

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
7
Ramelteon
55% Effectiveness• 80% Confidence• 70% Safety• 49 trials• 10K participants
HIGH EvidenceGood ValueDose: 8 mg at bedtime
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
70
DangerousModerateSafe

Time to Effect

30-60 minutes

Duration

long-term

Response Rate

50%

Remission Rate

8%

Number Needed to Treat (NNT)

12

Number Needed to Harm (NNH)

35

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