I’m not as familiar with insomnia treatments, but orexin antagonists seem to be an improvement over existing meds. Probably the biggest improvement is the lower risk of abuse and tolerance compared to other medications. Belsomra has been around for over 10 years and seems to be well tolerated and effective. Though it doesn’t work for everyone.
The argument that orexin antagonists could help people sleep more without making you sleepy during the day makes sense to me, with one caveat. If the half-life is long enough, the antagonist could block the orexin signal your body normally produces in the morning, making you feel sleepier than you otherwise would have. But perhaps this would be outweighed by the alertness one gets from a good nights sleep.
As for side effects (beyond daytime sleepiness and things we already know to watch for) I guess I would look for changes in motivation. Orexin has a (tenuous) link to reward seeking, addiction, and motivation. If you feel less energy and motivation during the day that might be something to look into. Indeed the point of a good nights sleep is to feel good and energetic the following day, so it’s good to check if an insomnia treatment actually delivers on that.
You may also want to consider adding psychological approaches like CBT-i or paradoxical intention. It seems like some insomnia features a self-reinforcing loop of bad sleep leading to frustration which begets more bad sleep.
I’m not as familiar with insomnia treatments, but orexin antagonists seem to be an improvement over existing meds. Probably the biggest improvement is the lower risk of abuse and tolerance compared to other medications. Belsomra has been around for over 10 years and seems to be well tolerated and effective. Though it doesn’t work for everyone.
The argument that orexin antagonists could help people sleep more without making you sleepy during the day makes sense to me, with one caveat. If the half-life is long enough, the antagonist could block the orexin signal your body normally produces in the morning, making you feel sleepier than you otherwise would have. But perhaps this would be outweighed by the alertness one gets from a good nights sleep.
As for side effects (beyond daytime sleepiness and things we already know to watch for) I guess I would look for changes in motivation. Orexin has a (tenuous) link to reward seeking, addiction, and motivation. If you feel less energy and motivation during the day that might be something to look into. Indeed the point of a good nights sleep is to feel good and energetic the following day, so it’s good to check if an insomnia treatment actually delivers on that.
You may also want to consider adding psychological approaches like CBT-i or paradoxical intention. It seems like some insomnia features a self-reinforcing loop of bad sleep leading to frustration which begets more bad sleep.
(ofc, none of this is medical advice)