Orexin Antagonists

There are 2 newer medications (Suvorexant/Belsomra & Lemborexant/Dayvigo) that are approved for insomnia in adults. Studies have shown both to be effective and safe for teenagers and geriatric populations. 

What is one of the most important findings of these orexin antagonists? 
Unlike most other sleep medications, they actually promote normal sleep architecture. 

What is the mechanism of the orexin antagonists? 
Orexin is one of the main peptides in the brain that causes us to be awake. It is thought that in those with insomnia, orexin is present in excess levels, which makes it difficult to fall asleep. By blocking this peptide from activating various cellular receptors at night time, patients are better able to sleep.

What are the doses of Suvorexant/Belsomra & Lemborexant/Dayvigo? 
*Lemborexant/Dayvigo: 5/10mg with 10mg being the max. Start at 5mg in all ages and increase to 10mg on day 4 if needed. If no benefit after 7 days at the highest dose, then stop. 
*Suvorexant/Belsomra: 5/10/15/20mg with 20mg being the max. Start at 5mg in teenagers and can move to 10mg on day 3 if needed. Take 30 mins before bedtime. If no benefit after 7 days at the highest dose, then stop. 

Have orexin antagonists been studied over more than just 8 weeks? 
Yes, this very large study showed continued improvements with little negative impact even after 6 months.

Have orexin antagonists been studied in teenagers?
Yes, suvorexant has, and it has been shown to help without dangerous side effects.

Are safe in patients with sleep apnea? 
Yes, study results show that they are thought to be safe in patients with sleep apnea. https://pubmed.ncbi.nlm.nih.gov/26194728/

What are the main side effects of orexin antagonists? 
It is shown to be very well tolerated and without the risks that come with addictive sleep medications such as zolpidem (Ambien), eszopiclone (Lunesta), clonazepam (Klonopin), and temazepam. https://www.psychiatrist.com/read-pdf/34003/
Side effects include: 
-Sedation
-Bad dreams
-GI upset
-Headache occurred in less than 1/20 patients