Are clinical trials for insomnia recruiting real world patients?

Recent Phase III trials of hypnotic medications that have led to Food and Drug Administration approval have severely restrictive eligibility criteria. One-hundred patients referred for insomnia and who received a hypnotic medication at a large tertiary referral center were identified. Data were extracted to evaluate whether these patients would be eligible to be included in any of the recent Phase III trials. Of the 100 patients identified, only 3 were eligible. Most were excluded due to a prior or concurrent trial of CBT-I. If this criterion were set aside, only 12% were eligible to participate. The remaining top reasons for exclusion were medical comorbidities, daytime napping, and sleep apnea. These findings question the generalizability of the regulatory studies and suggest that future trials should enroll patients with less restrictive criteria to help determine the effectiveness of these medications in real world settings.