Abstract : <p>There have been no naturalistic reports in Japan clarifying the effect of switched to emborexant on insomnia disorder. This study aimed to investigate the difference in treatment continuation between the recently started group and switched group in clinical setting. Insomnia was assessed using the Athens Insomnia Scale (AIS). Efficacy outcome assessment was the Clinical Global Impressions-Improvement scale (CGI-I). 77 patients had recently started lemborexant and 73 patients switched from benzodiazepine hypnotic monotherapy to lemborexant. The mean AIS total score of the recently started group and switched group were a significantly improved (7.7 &plusmn; 4.1 to 3.7 &plusmn; 3.4; 5.7 &plusmn; 3.3 to 3.9 &plusmn; 3.3) (p &lt; 0.05). There was no significant difference in the mean CGI-I scale between the recently started group and switched group (3.0 &plusmn; 0.9; 3.3 &plusmn; 0.8). Furthermore, there was no significant difference in the 24-weeks continuation rate between the recently started group and switched group. These results indicate that the use of lemborexant may lead to safe and maintenance therapy, which is one of the exit strategies for hypnotics, and may in turn improve drug adherence.</p>