A SMART Approach to Evaluating the Benefits of Common Prescription and OTC Medications for Insomnia

Inclusion Criteria * Adults aged 18-80 years. * Meet DSM-5 criteria for Insomnia Disorder. * Score ≥15 on the Insomnia Severity Index (ISI). * Sleep initiation and/or maintenance complaints: ≥30 minutes in duration, occurring ≥3 nights/week, with a duration of ≥3 months. * Willingness to discontinue use of all sleep-related medications prior to enrollment. * Completion of a 2-week washout period before starting any study medication. * Willingness to provide clinician assent for participation. Exclusion Criteria Patients will be ineligible if they meet any of the following criteria: self-reported daytime napping (≥1 hour per day on ≥3 days per week); a history of suicidal attempts or current ideation, acute or chronic psychiatric or medical condition not controlled by therapy (according to their primary care physician), or current alcohol or drug misuse; or the diagnoses of (or high risk for) other sleep disorders, including circadian rhythm disorders (phase advance or phase delay syndromes), shift work related sleep disorder ("day sleepers" who work \~11pm to 7am) and those with rotating shiftwork schedules. To determine eligibility, all subjects will be screened using a multitier process including: an online screener; an intake interview; a review of the subjects EMR; and, finally, the receipt of the patient's PCP's assent. The following provides additional listing and details (AD) for the Exclusion Criteria: General Considerations * Age \< 18 or \> 80 years old * Inade…