Daridorexant
The gold-standard treatment for insomnia is CBT-I, however this is not available in many parts of the UK. As a result, many GPs prescribe traditional sedating sleeping tablets, however, their evidence for long-term insomnia is very poor. This article will look at a new non-sedating sleeping tablet called daridorexant, which works in a very different way.
Chronic insomnia is defined as the trouble falling asleep or staying asleep, for at least three nights per week, for at least three months, with a significant knock-on effect on your daytime function. Acute insomnia is when the difficulty sleeping is less than three months.
The traditional sleeping tablets are drugs like zopiclone, diazepam and temazepam. These are sedatives and can make falling asleep easier, however, they can reduce the quality of your sleep so this may not result in you feeling better rested in the day. As they are global brain sedatives, they also reduce your focus and concentration, can make you unsteady on your feet, and cause a hangover effect in the morning.
There is better evidence for them working in short-term insomnia, but very poor evidence in long-term insomnia. Due to the lack of effectiveness, but good evidence of risk, they should be avoided in this situation.
Daridorexant is a completely different type of sleeping tablet. It’s also known as Quivivic and is from the class of medicines called DORAs, which stands for Dual Orexin Receptor Antagonist.
The orexin system is in the brain and works to promote wakefulness. Daridorexant blocks this system and so reduces the drive to be awake.
Rather than sedating the entire brain like the older sleeping tablets, Daridorexant works on a specific system, and so doesn’t have the same side effects as the older sleeping tablets.
Daridorexant also doesn’t diminish the quality of your sleep, known as your sleep architecture.
Should I take Daridorexant?
The best treatment for insomnia is CBTi, which is very effective and evidence-based: around 80% of people find this an effective treatment.
Daridorexant is for people who either cannot access CBTi because it isn’t available, or they are unable to do it; or for people who have tried it but didn’t find it effective.
For people who don’t respond to CBTi, it is often worth understanding exactly what aspect of CBTi was tried, as there are many several different types of CBTi, and also how it was delivered – there are several CBTi video courses and apps available which can work for some people, but are shown by research not to be the most effective method.
Sometimes it is through understanding you, and your sleep, that the right CBTi approach can be used and delivered in a personal and understandable way so that your sleep does improve. But if this has been tried then daridorexant is an evidence-based option.
If you would like to discuss your insomnia and whether daridorexant is the right choice for you then book a consultation with one of our sleep doctors who can discuss this in more detail.
