Opinion
Video
Counseling About Insomnia Medications Q6
Author(s):
A panelist discusses how managing chronic insomnia often requires tailored treatments like dual orexin receptor antagonists (DORAs), which offer long-term benefits for sleep maintenance without the risk of tolerance or rebound insomnia, while emphasizing patient counseling and realistic expectations for gradual improvement.
When managing chronic insomnia, patients often require tailored treatments, especially when they've tried multiple medications without success. For sleep maintenance insomnia—characterized by waking up in the middle of the night and having trouble getting back to sleep—a long-term solution is typically needed. Unlike short-term sleep aids, newer medications like dual orexin receptor antagonists (DORAs) are designed to be taken nightly to provide consistent, lasting benefits. These treatments focus on improving sleep quality without the risk of tolerance, withdrawal, or rebound insomnia, making them preferable for chronic insomnia patients.
Patient counseling is crucial when introducing sleep medications, as many expect immediate results. However, it’s important to set realistic expectations: While some medications might help on the first night, DORAs often require more time to show their full benefits. Patients are advised that it can take several weeks—typically 4 to 8 weeks—to notice significant improvement. Managing patient frustration during this time involves emphasizing the importance of consistent use and combining medication with good sleep hygiene practices. This combination enhances both short-term and long-term sleep outcomes.
Another consideration when prescribing sleep medications is minimizing next-day drowsiness and other adverse effects. Traditional sleep aids may cause daytime grogginess or memory issues, but DORAs generally have a more favorable adverse effect profile. With a reduced risk of residual effects, patients are less likely to experience cognitive impairment the next day. Furthermore, maintaining proper sleep hygiene and adhering to a long-term treatment plan is essential to maximize the effectiveness of these agents. By sticking with the treatment protocol, many patients experience significant improvements over time.
