Expert opinion survey on the pharmacological treatment of insomnia in Japan (2025)
Hiromi Tagata, Saki Hattori, Hitoshi Sakurai, Hideaki Tani, Yasushi Kawamata, Asuka Katsuki, Hiroyuki Muraoka, Shinichiro Ochi, Kyosuke Sawada, Akira Nishi, Toshiaki Kikuchi, Yoshiteru Takekita, Hajime Baba, Masaki Kato, Koichiro Watanabe, Ken Inada, Norio Yasui-Furukori, Junichi IgaBackground
Rapidly evolving insomnia management with orexin receptor antagonists (ORAs) has outpaced current clinical guidelines.
Objectives
This study aimed to provide a practical expert opinion reflecting specialists’ collective experience to bridge the gap between existing recommendations and contemporary clinical practice in Japan.
Design
Cross-sectional web-based survey.
Methods
A web-based questionnaire survey conducted in late 2025 targeted board-certified experts in clinical neuropsychopharmacology. Experts rated treatment options for 17 clinical scenarios using a nine-point Likert scale. Treatments were categorized as first-, second-, or third-line based on the 95% confidence interval (CI), with “treatments of choice” defined by ≥50% of respondents assigning the highest score.
Results
A total of 152 responses were analyzed (response rate: 43.4%). ORAs occupied central positions across nearly all scenarios. Lemborexant was the treatment of choice for both sleep initiation and maintenance, while suvorexant and daridorexant were also first-line options. When ORA monotherapy was insufficient, switching to another ORA was the preferred strategy. In contrast, most benzodiazepine receptor agonists were relegated to lower-line treatments, with eszopiclone remaining a notable exception as a second-line option. Regarding treatment duration, experts showed an increased tendency for continuing pharmacotherapy, particularly when clinical stability was incomplete or relapse risk was high.
Conclusions
This opinion survey demonstrates a clear shift toward ORA-based strategies in Japan and a growing acceptance of ORA continuation based on clinical stability. While representing a lower evidence level than formal guidelines, these practice-based insights offer a valuable reference for pharmacological decision-making in real-world scenarios where high-level evidence is limited.