What’s New for Insomnia

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Three to four times a day I talk to patients about it: insomnia is the most common sleep disorder, affecting millions worldwide. It is more common in women who have a lifetime risk 1.5 – 2 times higher than men. While this may seem obvious, insomnia is characterized by repeated difficulty with falling asleep, maintaining sleep or with a lack of quality of sleep despite adequate sleep opportunity.

Should I take medications for insomnia?
For short term sleep disruption the answer is likely no. When the symptoms of insomnia persist beyond 3 months, the insomnia is reclassified as one of the chronic subtypes with psychophysiologic insomnia (insomnia due to depression, anxiety or another mood disorder) and idiopathic (we don’t know why you have it) insomnia being the most common. You may need meds for sleep at this point.

The biology of sleep, what you need to know:

It helps to know about the neurobiology of insomnia so you can think about what’s happening and how your medications for insomnia work. The sleep-wake state represents an interaction between arousing and sleep-inducing physiologic systems. So it’s a dance between getting you to sleep and getting you ready for action in the morning. The neurotransmitters that promote wakefulness are: noradrenaline, serotonin, acetylcholine, dopamine, and orexin. The neurotransmitters that promote sleepiness are: ɣ-aminobutyric acid (GABA), glycine, melatonin, and adenosine.

The current meds:
The big players in prescription insomnia medications are Ambien (zolpidem), Sonata (zaleplon) and Lunesta (eszopiclone) which work on those GABA receptors.

The newcomer:
There is something completely new awaiting approval by the FDA called suvorexant. The really cool thing about suvorexant is that it’s the first of a new class of drugs called dual orexin receptor antagonist (DORA). This is a new target area for insomnia which will expand possibilities for medications for insomnia: you block the receptors that promote wakefulness thereby helping induce sleepiness.

Does suvorexant work?

Several studies have been done, all with promising results. People taking suvorexant showed significant improvement in sleep pattern, both in initiating and maintaining sleep.

Here it comes.

Dr O.

Drugs featured in this story

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