Treatment for Insomnia Through Dual Orexin Receptor Blockers (DORA)
New Sleep Medication Offers Hope for Chronic Insomnia Sufferers
Chronic insomnia, a condition that affects millions of people worldwide, can have a significant impact on both physical health and mental well-being. Fortunately, a new type of sleep medication called Dual Orexin Receptor Antagonists (DORAs) is proving to be an effective and generally safer option for treating this persistent sleep disorder.
DORAs work by blocking the effects of orexin, a neurotransmitter that promotes wakefulness. By binding to orexin receptor 1 and orexin receptor 2, DORAs reduce wakefulness, helping people sleep.
In a phase 3 clinical trial conducted in 2020, participants who took Dayvigo, a type of DORA, experienced improved sleep quality, with an average increase of 70-74 minutes in total sleep time per night after six months of treatment. A follow-up report in 2021 showed that these benefits continued for those who continued to receive Dayvigo for 12 months.
Compared to traditional insomnia treatments like benzodiazepines and Z-drugs, DORAs offer several potential benefits. They are more effective in managing insomnia, with a generally favorable safety and tolerability profile.
One of the key advantages of DORAs is their reduced risk of dependence and tolerance. Unlike benzodiazepines and Z-drugs, DORAs do not carry the typical risks of dependence, tolerance, or withdrawal symptoms. Patients also report feeling more alert and less groggy the following day, making daytime performance less impaired.
While some side effects like somnolence, fatigue, and abnormal dreams may occur, their rates are relatively low (generally around 5-10%) and comparable to placebo. However, it's important to note that some patients may experience daytime somnolence, and DORAs are contraindicated in narcolepsy, a disorder caused by orexin deficiency.
The American Geriatrics Society recommends that older adults avoid Z-drugs, benzodiazepines, and doxepin due to increased risks of confusion, falls, and sudden drops in blood pressure. DORAs, on the other hand, may be a safer option for this demographic.
It's worth noting that DORAs are the only type of medication for insomnia that blocks the effects of orexin. However, they may interact with certain medications, so it's crucial to inform a doctor about all medications and supplements before taking a new medication.
The Food and Drug Administration (FDA) has approved two types of DORA for treating chronic insomnia in adults: suvorexant (Belsomra) in 2014 and lemborexant (Dayvigo) in 2019. The 2021 AASM guidelines recommend cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment for chronic insomnia. However, a doctor may prescribe a sleep medication such as a DORA when behavioral modifications alone are not enough to treat insomnia.
In summary, DORAs represent a newer, effective, and generally safer first-line pharmacologic option for chronic insomnia. They offer advantages over traditional sedative-hypnotics in terms of dependence, cognitive effects, and next-day safety. However, contraindications and individual response variability remain important considerations. As with any medication, it's essential to discuss the potential benefits and risks with a healthcare provider before starting treatment.
- Despite the risks associated with traditional insomnia treatments like benzodiazepines and Z-drugs, science has introduced a promising solution in the form of Dual Orexin Receptor Antagonists (DORAs), which are categorized under health-and-wellness for sleeping disorders such as insomnia.
- Uncategorized side effects like somnolence, fatigue, and abnormal dreams may occur with DORA use, although their occurrence is relatively low compared to others and similar to a placebo.
- Mental health is a crucial aspect of overall health, and the consideration of mental health is particularly relevant when discussing sleep disorders like insomnia, as effective treatment options like Dual Orexin Receptor Antagonists (DORAs) become available.
){kind=link}