Emotion Regulation and Executive Functions in Insomnia Disorder Comorbid With Mood and Sedative‐Hypnotic Use Disorders: Findings From a Naturalistic Longitudinal Study Employing Daridorexant in the Management of Chronic Insomnia

Insomnia disorder has a considerable effect on mental health, making its effective management crucial in clinical practice. An observational study was conducted on consecutive outpatients with insomnia disorder (DSM-5-TR criteria) attending the Insomnia Clinic of the Psychiatric Unit of the University Hospital of Pisa (Italy). Patients were treated according to insomnia guidelines with DORA Daridorexant. Evaluations were performed at baseline (T0), 1 month (T1) and 3 months (T2). Data collected included clinical assessments of insomnia severity (Insomnia Severity Index [ISI]), depressive and mixed symptoms (Beck Depression Inventory II [BDI-II], Young Mania Rating Scale [YMRS]) and emotional dysregulation (Difficulties in Emotion Regulation Scale [DERS], Frontal Assessment Battery [FAB]). Concurrent pharmacological treatments were collected. The study included 90 patients (mean age 53 ± 13.6 years, n° = 43 females). A significant proportion (63.3%) was comorbid with unipolar or bipolar depression and sedative-hypnotic use disorders. Repeated measures ANOVA analyses revealed a significant improvement for the ISI, DERS and FAB over time, with F-values of 24.23, 15.56 and 21.74 (p < 0.001). Additionally, BDI-II and YMRS scores showed significant decreases during the same period, with F-values of 10.24, 10.33 and 70.00 (p < 0.001). Multiple regression analyses indicated that improvements in depressive symptoms were best predicted by improvement in DERS and ISI, while mixed symptoms were predicted by ISI and FAB improvements. With the caution of a naturalistic design, this study may show that by treating insomnia comorbid to other mental disorders, it may be possible to improve not only insomnia symptoms but also emotion regulation and executive functions.