Daytime well-being has become a key criterion for evaluating the treatment of insomnia

A randomized clinical trial involved 40 elderly people aged 60 to 85 years with chronic insomnia. The participants were randomly assigned to two groups: one received the drug suvorexant, the other received a placebo for 16 nights. Throughout the study, all participants used a mobile app in which they recorded their well—being four times a day – fatigue levels, cognitive activity, and mood. In parallel, they filled out standard questionnaires before and after the course of treatment.

The results showed a significant difference between the assessment methods. Traditional questionnaires recorded an overall decrease in the severity of insomnia, but did not reveal significant differences in daytime symptoms between the groups. At the same time, a smartphone assessment known as an environmental instant assessment (EMA) has revealed more subtle and clinically important effects.

Thus, patients taking suvorexant had increased morning fatigue, but in the afternoon and evening, the level of fatigue decreased compared with the placebo group. A similar dynamic was observed in the cognitive sphere: a decrease in clarity of thinking in the morning was followed by normalization of indicators during the day. The mood of the participants who took the drug was slightly worse at all stages of the day, but these differences did not reach statistical significance.

It is important that the participants accepted the digital format of observations well: the application turned out to be convenient, and the questionnaire completion rate was more than 93 percent, which indicates a high level of engagement and practical applicability of the method.

According to study leader Emerson Wickwire, daytime symptoms—fatigue, cognitive impairment, and mood changes—are key manifestations of insomnia. They are the ones that have the greatest impact on the quality of life of patients, and it is their improvement that should be the central goal of therapy.

The study was the first randomized clinical trial in the field of sleep medicine, where the smartphone EMA was used as the main tool for evaluating the effectiveness of treatment. The authors believe that the combination of digital tools with traditional methods can radically change the approach to evaluating therapy not only for insomnia, but also for other sleep disorders.

In the future, such technologies can help doctors choose treatment more precisely, take into account individual patient reactions and focus not only on the amount of sleep, but also on how fully a person is able to function during the day.