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Introduction Insomnia disorder affects 10% of adults and worsens quality of life and psychiatric comorbidities. NICE recommend cognitive behavioural therapy for insomnia (CBTi) as the first-line treatment for chronic insomnia in adults of any age. Anti-histamines and hypnotics such as benzodiazepines and Z-drugs are frequently used, but are associated with tolerance, dependence, and cognitive side effects. Daridorexant, a dual orexin receptor antagonist (DORA), was recently licensed in the UK for chronic insomnia. NICE guidelines recommend use if CBTi is not effective or not available. Although phase III trials support its efficacy, real-world long-term data in comorbid insomnia remains limited.Methods Patients referred to a specialist sleep clinic between April and December 2024 were initiated on Daridorexant 50mg nightly, following CBTi, in accordance with NICE guidance. Patients with comorbid obstructive sleep apnoea or restless legs syndrome were not excluded, 16/26 had comorbid mental health disorders. Insomnia Severity Index (ISI) scores were recorded at baseline and after a mean follow up of 10.1 (9-12) months in those who remained on treatment.Results Of 26 patients started on Daridorexant, 16 (61.5%) reported clinical benefit and continued treatment. ( Figure 1) These patients (10 males, 6 females; mean age 59 years) had a mean baseline ISI of 20.3, improving to 9.25 at follow-up. The mean reduction in ISI was 13.7, which was statistically significant (p < 0.001; Wilcoxon signed-rank test). 10 patients (38.5%) discontinued treatment due to lack of benefit or side effects. Side effects were reported by 7 patients, including fatigue/drowsiness, vivid dreams, sleep paralysis; one patient discontinued due to suicidal ideation.Discussion In this real-world cohort with comorbid insomnia, Daridorexant used after CBTi remained effective for chronic insomnia in 61% of patients. Many patients experienced a delayed but sustained improvement. However, 27% had side effects including vivid dreams, sleep paralysis and in one case suicidality.Abstract P11 Figure 1