Opinion
Video
Real-World Clinical Insights Regarding Chronic Insomnia Treatments
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A panelist discusses the strong efficacy and tolerability of dual orexin receptor antagonists (DORAs) for insomnia, noting their minimal adverse effects compared to older medications like benzodiazepines. DORAs are now seen as a first-line treatment option due to their favorable balance of safety and effectiveness, although insurance coverage can influence their availability.
In clinical experience, dual orexin receptor antagonists (DORAs) have demonstrated strong efficacy and tolerability for treating insomnia. Patients commonly report improvements in both initiating and maintaining sleep without experiencing significant adverse effects. Unlike some older medications, DORAs are generally not associated with issues like excessive daytime sleepiness, parasomnias, or cognitive impairment. This makes them a favorable option for those seeking both effectiveness and minimal disruption to daytime functioning.
When selecting a treatment for insomnia, several factors guide the choice of medication. Historically, benzodiazepines were widely used, but concerns over their potential for dependence, tolerance, and withdrawal have led to more cautious use. While Z-drugs (nonbenzodiazepine hypnotics) present a lower risk in some respects, emerging research has raised concerns about their long-term effects, including possible links to cognitive decline. Melatonin receptor agonists are another option, but they may be less potent for certain types of insomnia. In contrast, DORAs offer a balance of efficacy and safety, showing positive results in reducing insomnia symptoms without many of the risks associated with older drug classes.
Due to this favorable profile, DORAs are now often considered a first-line treatment option for chronic insomnia. Their ability to promote sleep by targeting the wakefulness system—rather than inducing sedation—may also align more closely with the underlying causes of insomnia for many patients. However, access to these medications can sometimes be affected by insurance coverage or payer approval, which may influence the final prescribing decision. Overall, the combination of clinical benefit and a relatively clean safety profile positions DORAs as a preferred choice in modern insomnia management.
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