Opinion
Video
Why Choose a DORA? Clinical Considerations for Patients With Insomnia
Author(s):
A panelist discusses how clinicians choose between sleep aids like dual orexin receptor antagonists (DORAs) and other medications based on patient comorbidities, chronicity of insomnia, and adverse effect profiles, with DORAs offering a safer, long-term solution for patients with chronic insomnia and sleep maintenance issues.
When choosing among sleep aids like dual orexin receptor antagonists (DORAs), benzodiazepines, Z-drugs, or melatonin receptor agonists, clinicians base their decisions on factors such as the patient's comorbidities, the chronicity of insomnia, and the adverse effect profile of the medications. DORAs, in particular, are preferred for patients with chronic insomnia, especially when sleep maintenance issues are involved. Benzodiazepines and Z-drugs are typically reserved for short-term use, such as during emotional or traumatic events, due to their withdrawal potential and risk of tolerance. DORAs offer a safer long-term solution, with better tolerability, minimal withdrawal effects, and no significant impact on memory or mobility, making them suitable for older patients who may have multiple comorbidities.
Another advantage of DORAs is their safety profile, particularly for patients with sleep apnea or those on other medications, including pain relievers or anxiolytics. DORAs do not exacerbate respiratory suppression or interact negatively with other medications, making them a strong choice for patients with these overlapping health issues. For patients with chronic insomnia and accompanying sleep-disordered breathing, DORAs have proven effective in promoting quality sleep without worsening other medical conditions.
To evaluate the efficacy and next-day functioning of patients on DORAs, clinicians often use the Insomnia Daytime Symptoms and Impacts Questionnaire. This tool measures the impact of insomnia on cognition, alertness, sleepiness, and mood, providing a visual scale for patients to rate their symptoms. Significant improvements in daytime sleepiness have been observed with the 50-mg dose of DORAs, highlighting their effectiveness. Other assessments, such as the Insomnia Severity Index and the Epworth Sleepiness Scale, are also used to monitor patient progress and ensure optimal treatment outcomes.
