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Emerging and upcoming therapies in insomnia
1Inje University College of Medicine, Busan, Korea.
Translational and Clinical Pharmacology
|April 8, 2024
Summary
New insomnia treatments like dual orexin receptor antagonists (DORAs) offer safer alternatives to benzodiazepines. Cognitive behavioral therapy for insomnia (CBT-I) and digital therapeutics also show promise for improved sleep management.
Area of Science:
- Pharmacology and Sleep Medicine
- Neuroscience of Sleep Regulation
Background:
- Benzodiazepine receptor agonists (BZDs) for insomnia carry risks of abuse and dependence.
- Novel pharmacological and non-pharmacological interventions are being developed to address these limitations.
Purpose of the Study:
- To review the mechanism of action, pharmacokinetics, efficacy, and safety of dual orexin receptor antagonists (DORAs) and selective orexin-2 receptor antagonists (2-SORAs).
- To discuss the role of cognitive behavioral therapy for insomnia (CBT-I) and digital therapeutics in insomnia management.
Main Methods:
- Literature review of pharmacological agents (DORAs, 2-SORAs) and non-pharmacological interventions (CBT-I, digital therapeutics).
- Analysis of drug mechanisms, clinical trial data, and real-world safety information.
Main Results:
- DORAs (suvorexant, daridorexant, lemborexant) offer a novel mechanism by blocking wake-promoting orexin, inducing natural sleep without stage changes or cognitive impairment.
- Selective orexin-2 receptor antagonists (2-SORAs) are in clinical development.
- Cognitive behavioral therapy for insomnia (CBT-I), including digital formats like Somryst®, shows effectiveness but faces scalability challenges.
Conclusions:
- DORAs and 2-SORAs represent promising pharmacological alternatives for insomnia, with a focus on improved safety profiles.
- Digital CBT-I offers accessible non-pharmacological options, though limitations exist.
- Future insomnia treatment emphasizes safety, efficacy, and accessibility across pharmacological and non-pharmacological approaches.
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