Circadian Misalignment as a Determinant of Insomnia Severity: Possible Implications in Sleep Medicine Clinical Practice

Abstract

In this letter to the editor, we comment on the recently published study from Scott et al. (2025), which highlights circadian misalignment as a possible determinant of insomnia severity. Considering the robust methodology of this study and in light of recent research aiming at optimizing melatonin treatment schedules, our letter explores why these findings may pave the way towards an extension of current recommendations for melatonin administration in insomnia, while encouraging the quantification of circadian misalignment during sleep medicine clinical practice. Finally, possible methodologies to routinely assess circadian misalignment in insomnia patients are discussed.