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Why therapy comes before medication
In April 2026, the American Academy of Sleep Medicine looked closely at what works best for insomnia: a specific type of therapy called CBT-I, medication, or both together. CBT-I on its own came out ahead. It worked at least as well as combining it with medication, and the improvements lasted longer, without the risks that come with staying on medication long-term. Adding medication on top of CBT-I did help with a couple of specific things, like how long people slept in total, but it didn't make the overall results better.
CBT-I isn't therapy in the way people usually picture it. It's a structured program, usually six to eight sessions, that works on the specific thoughts and habits getting in the way of sleep, like worrying about not being able to fall asleep, or lying awake in bed for long stretches.
That doesn't mean medication doesn't matter. It's still often used alongside or instead of CBT-I; when therapy isn't easy to access, when someone needs relief faster than a multi-week program can give, or when CBT-I alone hasn't fully fixed the problem.
The medications that are approved
Insomnia medications fall into a few genuinely different groups, depending on which part of your body's sleep-and-wake system they work on.
Orexin blockers. These work by turning down orexin, a brain chemical that keeps you alert. Instead of sedating your brain, they calm down an overactive "stay awake" signal. Suvorexant was the first one approved, followed by lemborexant and daridorexant. Daridorexant is the only one of the three that's been specifically studied for whether it makes people groggy the next day.
Z-drugs. Zolpidem, zaleplon, and eszopiclone all work on the same part of the brain as benzodiazepines, but in a more targeted way. That's a big part of why they took over as the go-to sleep medications starting in the 1990s.
Melatonin receptor medication. Ramelteon works on melatonin receptors instead of sedating the brain directly. Unlike everything else on this list, it isn't a controlled substance.
Low-dose doxepin. Approved specifically for insomnia in 2010 under the name Silenor, this is a small dose of an older antidepressant. Here, it's not used to treat depression, it's used for its sedating effect instead.
Benzodiazepines. Older medications like temazepam and triazolam are still approved and still prescribed, but they've mostly been replaced by the options above for everyday use, partly because they carry a higher risk of dependence and next-day grogginess.
What researchers are studying now
One compound worth watching is seltorexant, which works the same way as the orexin medications, but is being studied specifically for people with depression who also have ongoing insomnia. It's now completed Phase 3 trials for this exact use and met all of its main goals, improving both mood and sleep, with side effects similar to placebo. It's still investigational and hasn't been filed with the FDA yet, but if it's eventually approved, it would be the first medication built specifically for this combination rather than treating either condition on its own.
Insomnia and mental health
That connection goes both ways. Chronic insomnia raises the risk of developing depression and anxiety, and having depression or anxiety makes insomnia more likely, to the point where sleep problems are one of the most common symptoms reported alongside both conditions, and one of the last to fully resolve even after mood improves. That's part of why CBT-I's benefits often extend beyond sleep itself, and it's worth mentioning ongoing sleep problems to whoever treats your mental health, even if insomnia doesn't feel like the main issue.
Interesting fact: staying awake for about 17 hours straight slows your reaction time and judgment about as much as having a couple of drinks would, a good reminder of just how much losing sleep really affects you.
How to find an insomnia study
You can search insomnia studies on our platform, filter by location, and see whether you meet the basic criteria before applying. The process usually takes a few minutes, and a coordinator follows up afterward to walk you through next steps.
For example, a Phase 3 trial from Merck is currently recruiting people with opioid use disorder who also have insomnia, to test whether suvorexant helps them sleep better, and a study at Mayo Clinic is comparing CBT-I against a wearable device that uses sound therapy for chronic insomnia.
Common questions
What is insomnia? Insomnia is a common sleep disorder that makes it hard to fall asleep, stay asleep, or get sleep that actually feels restful, even when there's plenty of time for it. It can happen on its own, or alongside other health conditions, and it's often influenced by stress, daily habits, or an irregular sleep schedule.
Is insomnia genetic? Genetics play a real role. Insomnia tends to run in families, and researchers have found specific genes linked to a higher risk. But genetics interact heavily with stress, other health conditions, and sleep habits, so having that genetic risk doesn't mean insomnia is unavoidable or untreatable.
What actually causes insomnia? It's rarely just one thing. Stress, an irregular schedule, another medical or mental health condition, certain medications, and simply spending more time in bed than you actually need for sleep can all play a part, often more than one at once.
How long does it take to treat insomnia? With CBT-I, most people notice real improvement within a few weeks of starting, though getting the full benefit usually takes the whole six-to-eight-session program. Medication can work faster, sometimes within days, but it tends to work best as a short-term bridge or an add-on rather than a long-term fix on its own.