Sleep–wake reference expansion — October 3, 2026

Scope

Focused source verification for the requested sleep–wake visualization expansion. Ten medication records are added to the existing six entries: low-dose doxepin, suvorexant, ramelteon, zolpidem immediate release, eszopiclone, zaleplon, temazepam, triazolam, trazodone and mirtazapine. The reference now has 13 insomnia options including CBT-I and three narcolepsy type 1 entries. This is historical baseline context, not new October trial news, a full sleep-topic review or a 28-topic monitoring run. Other conditions and the earlier six records retain their original verification dates.

Evidence integrity

Doxepin uses primary Table 2 raw night-29 PSG wake-after-sleep-onset means: 40.7 minutes for 6 mg versus 60.5 for placebo; no 95% interval is inferred from the reported SDs. There were 229 randomized participants and 221 treated/analyzed. DREAMING uses its adjusted week-six ISI effect −6.0 (95% CI −9.0 to −3.0), separately from raw group means 10.2/15.8; no significant ISI advantage from week 12 onward. It randomized 80 across three arms, including 27 each mirtazapine and placebo. MIRAGE tolerability has separate analysis denominators. Existing plotted results remain unchanged.

Approved indications and off-label insomnia use are separate from dated recommendations. AASM 2017 and VA/DoD 2025 differ for benzodiazepines and ramelteon. Safety rates stay within their selected trials, with dose, follow-up and denominators. Brand/formulation distinctions and label revision versus online posting dates are retained. No numerical efficacy plot is invented for labels with qualitative results only.

Sources

Low-dose doxepin · Silenor: Silenor U.S. prescribing information, revised December 2022 · Krystal et al., five-week doxepin trial, October 2011; Tables 1–3 · AASM adult insomnia pharmacologic guideline, February 2017 · VA/DoD chronic insomnia and OSA guideline, January 2025
Ramelteon · Rozerem: Rozerem U.S. prescribing information, revised April 2026 · Mayer et al., six-month ramelteon trial, March 2009 · AASM adult insomnia pharmacologic guideline, February 2017 · VA/DoD chronic insomnia and OSA guideline, January 2025
Suvorexant · Belsomra: Belsomra U.S. prescribing information, revised March 2025 · Herring et al., two three-month suvorexant trials, 2016 · AASM adult insomnia pharmacologic guideline, February 2017 · VA/DoD chronic insomnia and OSA guideline, January 2025
Trazodone · off-label for insomnia: Trazodone U.S. prescribing information, revised March 2026 · Roth et al., trazodone sleep and next-day function trial, May 2011 · AASM adult insomnia pharmacologic guideline, February 2017 · VA/DoD chronic insomnia and OSA guideline, January 2025
Mirtazapine · off-label for insomnia: DREAMING mirtazapine trial, 2025; primary Table 1 · MIRAGE mirtazapine trial, March 26, 2025; Tables 2–3 · Remeron U.S. prescribing information, revised November 2021 · VA/DoD chronic insomnia and OSA guideline, January 2025
Zolpidem · Ambien (immediate release): Ambien immediate-release U.S. prescribing information; revised February 2022, posted April 2025 · FDA Z-drug complex sleep behavior boxed warning, April 30, 2019 · AASM pharmacologic insomnia guideline (2017) · VA/DoD chronic insomnia guideline (2025), recommendations 8–10
Eszopiclone · Lunesta: Lunesta U.S. prescribing information, revised July 2023 · Krystal et al., six-month randomized eszopiclone trial, Sleep (November 2003) · FDA Z-drug complex sleep behavior boxed warning, April 30, 2019 · AASM pharmacologic insomnia guideline (2017) · VA/DoD chronic insomnia guideline (2025), recommendations 8–10
Zaleplon · Sonata / generics: Zaleplon generic U.S. prescribing information; DailyMed posting October 8, 2025 · FDA Z-drug complex sleep behavior boxed warning, April 30, 2019 · AASM pharmacologic insomnia guideline (2017) · VA/DoD chronic insomnia guideline (2025), recommendations 8–10
Temazepam · Restoril: Restoril U.S. prescribing information; DailyMed updated June 9, 2026 · FDA benzodiazepine class boxed warning, September 23, 2020 · AASM pharmacologic insomnia guideline (2017) · VA/DoD chronic insomnia guideline (2025), recommendations 8–10
Triazolam · Halcion: Halcion U.S. prescribing information, revised July 2026 · FDA benzodiazepine class boxed warning, September 23, 2020 · AASM pharmacologic insomnia guideline (2017) · VA/DoD chronic insomnia guideline (2025), recommendations 8–10

Coverage for every active topic

Topic	Coverage in this focused addition
whole_body_mri	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
galleri	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
glp1	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
muscle	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
longevity	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
localized_fat	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
cardiovascular	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
alzheimers	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
psychedelics	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
ssri_antidepressants	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
cancer_vaccines	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
autoimmune	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
sleep	Established-insomnia label/guideline and selected primary-trial baseline only; existing NT1, apnea, RLS, circadian, digital-therapy and informal-source coverage not refreshed.
liver	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
kidney	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
joint_preservation	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
pain	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
hearing_vision	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
hair_loss	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
skin_aging	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
facial_volume	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
scars	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
pigmentation	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
acne_rosacea	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
dental	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
allergy_airway	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
infectious_disease	Not rechecked in this focused baseline addition; prior dates and gaps preserved.
genetic_screening	Not rechecked in this focused baseline addition; prior dates and gaps preserved.

Gaps and state

No worldwide sleep registry sweep, rumor discovery or new safety surveillance review was performed. Existing gaps remain for the next scheduled check. Canonical notes and sources were read back before focused reference metadata was saved. Global run date, full-topic successful-check timestamps, seen-news events and historical results are preserved. No fresh medical-news alert or new future milestone is created for this historical baseline. Public export and website publication are handled separately after release validation.