Sleep medicine · Insomnia · 2026
Insomnia treatment,
what actually works.
Chronic insomnia is common, treatable and often treated the wrong way, with years of sleeping pills or sleep-hygiene tips alone. Guidelines in the US, Europe and China agree on the first step: cognitive behavioural therapy for insomnia (CBT-I). This guide explains it, when medication fits, what acupuncture can and can't do, and how a trip to China can start proper treatment.
Quick answer
What is the best treatment for chronic insomnia?
Cognitive behavioural therapy for insomnia (CBT-I) is the recommended first-line treatment for chronic insomnia in adults, according to the American College of Physicians (2016), the AASM (2021), the European Insomnia Guideline (2023) and the 2025 Chinese guideline. It combines sleep restriction, stimulus control, work on unhelpful thoughts about sleep and relaxation, delivered in person or digitally. Medication can be added if CBT-I is not enough, mostly for the short term. Chronic insomnia means trouble sleeping at least three nights a week for at least three months.
15.0%
Insomnia in China
Pooled prevalence, 17 studies, 115,988 people
Cao et al., PLoS One 2017
≥3 × 3
Definition of chronic
At least 3 nights a week, for at least 3 months
European Insomnia Guideline 2023
−19 min
Time to fall asleep
With CBT-I vs inactive control; night-time waking −26 min
Trauer et al., Ann Intern Med 2015
+9.9%
Sleep efficiency
CBT-I, 20 randomised trials, 1,162 people
Trauer et al., Ann Intern Med 2015
4
Guidelines: CBT-I first
ACP 2016 · AASM 2021 · Europe 2023 · China 2025
See references
2025
Orexin drugs approved in China
Lemborexant (May) and daridorexant (June)
Eisai; Idorsia
The steps
How insomnia is treated, in order.
1 · Find the cause
A sleep physician looks for what drives or mimics insomnia: sleep apnoea, restless legs, depression or anxiety, pain, thyroid disease, medicines, caffeine and alcohol. A sleep diary and questionnaires come first; an overnight study only if apnoea or another sleep disorder is suspected.
1–2 visits
2 · CBT-I
Usually 4–8 sessions, in person, by video or through a digital programme. Sleep restriction and stimulus control do most of the work. Results tend to last after treatment ends.
Strong recommendation
3 · Medication, if needed
When CBT-I is not enough or not available. European guidance supports short-term use (up to about 4 weeks) of most hypnotics, and up to 3 months or longer for orexin receptor antagonists in some cases.
Shared decision
4 · Adjuncts
Light therapy and exercise may help alongside CBT-I. Acupuncture has some positive trials, including a 2022 study in people with depression, but guidelines do not yet recommend it.
Lower certainty
Not sure which step you're at?
Describe your sleep and what you've already tried. A sleep coordinator will tell you what should come next, free. The chat needs no sign-up.
Guidelines
What the major guidelines agree on
The American, European and Chinese recommendations line up closely. All put CBT-I first. All treat medication as an add-on, mostly for the short term. All advise against relying on sleep-hygiene advice alone. They differ mainly on individual drugs, partly because which drugs are available differs by country.
| Guideline | First-line | Medication | Notable 'don'ts' |
|---|---|---|---|
| ACP 2016 (US) | CBT-I for all adults (strong) | Shared decision on short-term use if CBT-I fails (weak) | — |
| AASM 2021 & 2017 (US) | Multicomponent CBT-I (strong) | Weak suggestions for specific drugs, e.g. zolpidem, eszopiclone, doxepin, suvorexant | Suggests against melatonin, trazodone, diphenhydramine, valerian; sleep hygiene alone |
| European 2023 | CBT-I, in person or digital (grade A) | Short term (≤4 weeks) for most; orexin antagonists up to 3 months or longer | Antihistamines, antipsychotics, fast-release melatonin, ramelteon, herbal remedies |
| China 2025 | CBT-I first-line, including digital CBT-I | Hypnotics not recommended long term | — |
Simplified. The 2025 Chinese guideline's first-line position is reported from a published summary (Front Psychiatry 2025); the guideline itself is in Chinese.
Insomnia, or something else?
Snoring, gasping or heavy daytime sleepiness can mean sleep apnoea, which needs a sleep study rather than insomnia care alone. Ask us which test fits.
For international patients
What a trip to China can and can't do
A holiday on its own does not cure chronic insomnia. Better sleep on a good trip often fades once you're home. What a trip can do is get you a thorough assessment quickly: a sleep physician, sleep apnoea screening, and an overnight study if needed. It can also start CBT-I in person, which you then continue by video or digitally after you return.
Chinese hospital sleep centres can also offer acupuncture and TCM alongside standard care, and the two newest insomnia drugs, lemborexant and daridorexant, were approved in China in 2025. Our sleep wellness tours build the assessment and first sessions into a slow-paced itinerary.
Sleep centres
Where we arrange
sleep assessment.
Shanghai Mental Health Center 上海市精神卫生中心
Sleep-disorder ward combining polysomnography, a sleep-disorder clinic and inpatient care
Huashan Hospital, Fudan University 复旦大学附属华山医院
Neurology sleep centre with 9 polysomnography rooms and a sleep-breathing clinic
Shanghai Sixth People's Hospital 上海市第六人民医院
Home of the Shanghai Key Laboratory of Sleep Disordered Breathing (sleep apnoea)
Hangzhou Seventh People's Hospital 杭州市第七人民医院
Zhejiang University-affiliated mental health centre; Hangzhou Sleep Disorder Diagnosis and Treatment Center
West China Hospital, Sichuan University 四川大学华西医院
Sleep Medicine Center with 16 polysomnography rooms; treats insomnia, sleep apnoea and circadian disorders
Guangdong Provincial Hospital of Chinese Medicine 广东省中医院
TCM hospital with a sleep medicine centre; runs insomnia trials using polysomnography
FAQ
Insomnia — answered.
- What counts as chronic insomnia?
- Difficulty falling asleep, staying asleep or waking too early, with daytime effects, on at least three nights a week for at least three months, despite adequate opportunity to sleep. Shorter episodes are common after stress or travel and often resolve on their own.
- Is CBT-I better than sleeping pills?
- For chronic insomnia, guidelines prefer CBT-I as the first treatment because its benefits tend to last after treatment ends and it has no drug side effects. In a meta-analysis of 20 trials, CBT-I shortened the time to fall asleep by about 19 minutes and night-time waking by about 26 minutes. Medication can help in the short term and can be combined with CBT-I.
- Does sleep hygiene work?
- Sleep hygiene (regular hours, less caffeine, a dark quiet bedroom) is sensible, but the AASM suggests against using it as the only treatment for chronic insomnia. On its own, it is usually not enough.
- Is melatonin good for insomnia?
- For chronic insomnia, the AASM 2017 guideline suggests against melatonin, and the European 2023 guideline does not recommend fast-release melatonin. Europe allows prolonged-release melatonin for up to 3 months in people aged 55 and over. Melatonin is useful for jet lag, which is a different problem.
- Which new insomnia drugs are available in China?
- Two orexin receptor antagonists were approved in mainland China in 2025: lemborexant (Dayvigo, approved 27 May 2025) and daridorexant (Quviviq, approved June 2025). They work by blocking wake-promoting orexin signals, rather than by sedating the brain the way benzodiazepines do.
- Can acupuncture cure insomnia?
- The evidence is mixed. A 2012 Cochrane review found trials too low in quality to support or refute it. Later trials were better designed, including a 2022 study of 270 people with depression in which electroacupuncture improved sleep scores more than sham. Guidelines do not currently recommend acupuncture as a standard treatment. It is reasonable as an add-on if you want to try it.
- How common is insomnia in China?
- A meta-analysis of 17 studies covering 115,988 people estimated that 15.0% of China's general population has insomnia. That figure is lower than in Western countries and similar to other Asian countries.
- Could my insomnia actually be sleep apnoea?
- Sometimes. Loud snoring, gasping, morning headaches or heavy daytime sleepiness suggest sleep apnoea, which needs a sleep study and different treatment. Globally an estimated 936 million adults aged 30–69 have sleep apnoea, more in China than in any other country.
Related guides
CBT-I explained
The first-line treatment: components, results, in person or digital.
Read the guideSleeping pills & new drugs
What guidelines allow, for how long — and orexin drugs now approved in China.
Read the guideAcupuncture & TCM for insomnia
What the trials show, honestly graded.
Read the guideJet lag & sleep in China
Light, timing and melatonin for long-haul flights.
Read the guideSleep wellness tours
Six slow-travel routes with sleep care built in.
Read the guideSleep apnoea & sleep studies
Polysomnography, CPAP and surgical options.
Read the guideSources
References
- Qaseem A, Kansagara D, Forciea MA, et al. Management of chronic insomnia disorder in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016;165(2):125–133.
- Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an AASM clinical practice guideline. J Clin Sleep Med. 2021;17(2):255–262.
- Sateia MJ, Buysse DJ, Krystal AD, et al. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an AASM clinical practice guideline. J Clin Sleep Med. 2017;13(2):307–349.
- Riemann D, Espie CA, Altena E, et al. The European Insomnia Guideline: an update on the diagnosis and treatment of insomnia 2023. J Sleep Res. 2023;32(6):e14035.
- Chinese Sleep Research Society. 失眠症诊断和治疗指南(2025版) [Guidelines for the diagnosis and treatment of insomnia disorder, 2025 edition]. Zhonghua Yi Xue Za Zhi. 2025;105(34):2960–2981.
- Yan P, Feng S, Ma M, et al. Front Psychiatry. 2025;16:1688561 — summarises the 2025 Chinese guideline: CBT-I offered first-line; hypnotics not recommended long term.
- Trauer JM, Qian MY, Doyle JS, et al. Cognitive behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Ann Intern Med. 2015;163(3):191–204.
- Cao XL, Wang SB, Zhong BL, et al. The prevalence of insomnia in the general population in China: a meta-analysis. PLoS One. 2017;12(2):e0170772.
- Cheuk DK, Yeung WF, Chung KF, Wong V. Acupuncture for insomnia. Cochrane Database Syst Rev. 2012;(9):CD005472.
- Yin X, Li W, Liang T, et al. Effect of electroacupuncture on insomnia in patients with depression: a randomized clinical trial. JAMA Netw Open. 2022;5(7):e2220563.
- Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respir Med. 2019;7(8):687–698.
- Eisai. DAYVIGO (lemborexant) approved in China on 27 May 2025 and launched 18 August 2025 as the first orexin receptor antagonist launched in China (company press releases).
- Idorsia. QUVIVIQ (daridorexant) receives NMPA approval in China for adult insomnia (media release, 23 June 2025).
Tell us how you sleep
and get a written plan.
Share a two-week sleep diary (or a short description), your medicines and any sleep-study results. A sleep physician will say what to assess and which treatment to start, at home, by video or on a sleep wellness trip.
This page is for general education only and is not medical advice. Insomnia can be a symptom of other conditions — sleep apnoea, depression, anxiety, pain, thyroid disease or medication side effects — that need their own treatment. Do not stop or change sleeping medication without talking to your doctor. Seek urgent help if you have thoughts of self-harm, or if sleepiness affects your driving.
Published 5 October 2026 · Figures checked against the cited sources by the PandaTouring Care editorial team · Editorial policy