Increasing brain activity to induce insomnia using auditory tones and light-frequency stimulation in an auditory-sound-aligned headband

New treatments are arriving for insomnia, which is great news for Miranda. The emergence of a class of pharmaceuticals that induce sleep through a different brain pathway from existing drugs is a welcome development and shows the potential for sleep aids. There are a range of options available for those struggling with sleep.

Some studies suggest that insomnia can stem from a high level of underlying brain activity during sleep. There is a question of whether this activity could be reduced to treat insomnia according to Ruth Benca. Companies and academic research groups are beginning to test this proposition with wearable devices that use auditory tones or mild electrical stimulation to increase slow-wave activity in the brain. Some devices already on the market, and evidence suggests that they can increase the duration of sleep. The researchers at Elemind Technologies in Cambridge, Massachusetts, found that listening to noise in sync with brain-wave rhythms in a headband was enough to allow people to sleep for less than 30 minutes.

A comparison of online and in-person cannabinoids for treating insomnia, and how it may affect the effects of the neurotransmitter Orexin

Uptake among physicians has been slow so far, Krystal says. He thinks that once practitioners catch on, they will see a therapist if digital care doesn’t work out.

The Cleveland Clinic in Ohio and the US Department of Veterans Affairs are examples of companies that are creating or developing digital platforms for the delivery of CBT-I. SleepioRx has been evaluated in more than two dozen trials and has shown efficacy that is as high as 76%. This includes helping people to fall asleep faster, sleep better throughout the night and feel better the next day. The FDA cleared the programme developed by Big Health in San Francisco, California in August. A 2024 meta-analysis of 15 studies that compare in-person and electronically delivered CBT-I concluded that the two approaches were equally effective12.

When he was studying narcolepsy he inadvertently helped to pave the way for the latest methods of treating insomnia, a chronic disorder that affects sleep and wakes people up suddenly. The primary role of the neurotransmitter Orexin is thought to be the regulation of appetite, but it was discovered that dogs have a genetic mistake that causes them to lack one of the tworeceptors. Mignot then found that people with narcolepsy lack orexin, confirming the chemical’s main job: promoting wakefulness. People with insomnia would become ‘narcoleptic for one night’ if drugs could be made to prevent Orexin from binding to its receptors.

Yet, scientifically, little is known about which cannabinoids — if any — promote sleep, and what a safe and effective dose is. Many people around the world are most likely to be using cannabinoids for insomnia, but we don’t have good-quality evidence to back that up.

There are more than one drug in the clinical pipeline. The drug Seltorexant is being developed by Johnson & Johnson, for people with both insomnia and major depression. Around 70% of people with depression have insomnia, so having a medication that treats both of those disorders “has the potential to fill an important gap”, says Krystal, who has consulted for Johnson & Johnson on the drug. In a phase III trial6, people who took the drug had better moods, but it was not an effect on sleep that mattered. Seltorexant might have an antidepressant effect because it is designed to block only one of the two types of orexin receptor, Krystal adds, whereas other DORA drugs block both receptor types.

DORA drugs’ high cost keeps them out of reach for many people who could benefit from them, according to Buysse. “There are many patients I would like to prescribe these drugs for, but I know in order for them to get one of these medications we’ll have to go through trials of several other drugs before the request will be considered,” Buysse says. DORA drugs are also available only in a few countries, so far.

The Search for a good sleep aid in the U.S. is an ongoing challenge for doctors and health care workers in the 21st century

The journey to find a good sleep aid began after this. The first medication I tried was 50 milligrams of an antihistamine called hydroxyzine, prescribed to me after a five-minute telehealth appointment. It effectively knocked me out, but it left me feeling so groggy the next morning that I struggled to get out of bed. I stopped taking it.

Even if you are a supporter of CBT-I, it doesn’t work for everyone. Miranda has tried it and has received conventional talking therapy for over a decade, with limited success. She says it helps so much.

Cognitive behavioural therapy for insomnia is usually first treatment. A talking therapy focuses on establishing healthy sleep behaviours and addressing thoughts that can interfere with sleep. All health care insurance plans in the U.S. don’t cover CBT-I. Waiting times can be long in public health-care systems in the United Kingdom and parts of Europe. A limited availability of therapists is the reason behind this, according to Andrew Krystal. “We keep hiring new people, but almost immediately their schedules are completely filled and the wait list is a year.”

I held out hope that my health-insurance company, one of the largest in the United States, would eventually agree to cover Belsomra. I was forced to try the cheaper generic Z-drugs and benzodiazepines after the company sent me a rejection notice with a list of them. We tried to make a case that none of the prescriptions were suitable. In late March, we received good news: the insurance company agreed to pay for Belsomra for the next year. My pharmacy said that the $150 per month for a month’s supply of the drug is normal for this medication, so even with that coverage, I have to pay it. So, until a generic DORA drug comes out, this particular sleep solution will unfortunately be available only for those who have enough extra income to be able to pay for the privilege.

This should not be the case. Medical professionals should be in charge of what care their patients need, rather than insurance companies that want to make as much money as possible off of their clients. However, until the system changes, millions of people will continue to take the same tortuous path that I have been forced onto, and resort to medications that might have harmful long-term effects while the most advanced therapies remain tantalizingly out of financial reach.

I woke up and realized that buspirone had a side effect on sleep. Thankfully, my PA didn’t need a dimer

Last year, my struggle to sleep markedly worsened. It seemed stress was still in high demand. My identity is wrapped up in my job as a science journalist, but as the media industry continues to collapse in on itself, it is becoming more and more difficult to make ends meet. I was at night trying to picture a viable future in my chosen career. Layered on top of that were the stressors of the 2024 US presidential election and interpersonal drama with my increasingly conservative father.

I agreed to give it more time. I woke up one night from a nightmare and felt something crawling through my hair. I saw a light that looked like someone was standing over me taking a photograph. I realized that these were hallucinatings from the transition from sleep to wakefulness. Nothing like this had ever happened to me before, and the vividness of the experience was extremely disconcerting. The next day, I learnt that disturbed sleep is a side effect of buspirone. My PA agreed that I should stop the drug.

It took me almost a month to receive the prescription and my insurance didn’t cover it. There are no generic DORA drugs. I was going to pay US$500 for 30 tablets of Belsomra. But, I was desperate to get some sleep and my pharmacist was able to find a coupon that knocked $150 off the bill. I paid it up after I sucked it up.