About one in nine adults experiences chronic insomnia, a condition that reaches well beyond disrupted sleep at night. Many individuals continue to struggle during the day with persistent drowsiness, slowed thinking, memory problems, and irritability. When insomnia is left untreated, it is also linked to increased long-term health risks, including diabetes and cardiovascular disease. Despite the wide range of available treatments, from prescription medications to behavioural interventions, clinicians still face a central challenge: accurately determining how effective a given treatment is for a particular patient, especially in terms of how that patient functions during waking hours.
A new study from the University of Maryland School of Medicine suggests that smartphone-based, real-time assessments provide a more precise way to evaluate the effectiveness of insomnia treatments. Rather than relying solely on traditional questionnaires that ask patients to summarise their symptoms after the fact, the researchers used a method that captured experiences as they occurred throughout the day. This approach allowed the study team to detect changes in key daytime symptoms of insomnia, including fatigue, cognitive functioning, and mood, with greater sensitivity than conventional recall-based tools. The findings were published in JAMA Network Open.
The study was designed as a randomised clinical trial involving 40 older adults aged between 60 and 85, all of whom met criteria for chronic insomnia. Participants were randomly assigned to receive either the sleep medication suvorexant or a placebo for 16 consecutive nights. Throughout the study period, participants used a smartphone app to report their daytime symptoms in real time, completing brief assessments four times per day. In parallel, they also completed standard questionnaires evaluating sleep quality and daytime functioning before and after the treatment phase, enabling a direct comparison between traditional and real-time measurement methods.
When the results were analysed, essential differences emerged between the two assessment approaches. Conventional questionnaires identified an overall improvement in insomnia severity in the treatment group compared with the placebo group, but they failed to detect meaningful differences in daytime symptoms. By contrast, the smartphone-based method, known as ecological momentary assessment, revealed subtle but clinically relevant patterns across the day. Participants taking suvorexant reported greater fatigue in the morning but less fatigue in the afternoon and evening compared with those taking a placebo. A similar pattern was seen for cognition, with reduced alertness earlier in the day that normalised as the day progressed. These time-specific effects would likely have gone unnoticed using retrospective questionnaires alone.
Mood changes were also examined. Although participants in the suvorexant group reported slightly worse mood ratings at each of the four daily assessment points compared with the placebo group, these differences were not statistically significant. Importantly, participants reported high satisfaction with the smartphone-based assessments. The completion rate exceeded 93 per cent across all surveys, demonstrating that frequent, real-time symptom tracking was both feasible and well accepted, even among older adults.
“Daytime symptoms such as fatigue, cognitive impairment, and mood disturbances are core features of insomnia,” said Emerson M. Wickwire, the study’s corresponding author and section chief of sleep medicine at the University of Maryland Medical Center. He emphasised that improving sleep alone does not fully address the condition from the patient’s perspective, noting that retrospective questionnaires often miss subtle but meaningful changes in daily functioning that matter most to those living with insomnia.
As the first randomised controlled trial to incorporate smartphone-based ecological momentary assessment as an outcome measure in a sleep-focused study, this research highlights the potential of digital tools to reshape insomnia research and care. According to Mark T. Gladwin, Dean of the University of Maryland School of Medicine, real-time smartphone assessments offer valuable insights that could improve how treatments are evaluated, personalised, and ultimately delivered, benefiting millions of people affected by sleep disorders.
More information: Emerson M. Wickwire et al, Smartphone-Based Real-Time Assessment of Daytime Insomnia Symptoms With Suvorexant, JAMA Network Open. DOI: 10.1001/jamanetworkopen.2025.50186
Journal information: JAMA Network Open Provided by University of Maryland School of Medicine
