Insomnia can make it difficult for you to fall asleep, stay asleep, or both. You have a number of options to manage insomnia, including lifestyle changes, cognitive behavioral therapy, and medication.
Dual orexin receptor antagonists (DORAs) are a newer class of insomnia medications. They work by blocking signals in the brain that stimulate wakefulness.
Although there have been DORAs on the market for several years, the Food and Drug Administration (FDA) recently approved a new drug in this class.
DORAs may offer an alternative to people who live with insomnia and don’t want to take potentially habit-forming medication. Clinical trials and research studies have shown DORAs are potentially very effective at helping people to fall asleep faster and to stay asleep.
DORAs are oral medications you take right before bed. They block chemicals in the brain that help you stay awake. This may reduce wakefulness and help you fall asleep.
There are currently three DORAs approved by the FDA for insomnia:
- daridorexant (Quviviq)
- lemborexant (Dayvigo)
- suvorexant (Belsomra)
Suvorexant was the first DORA approved by the FDA. That approval came in August 2014. Lemborexant is a newer drug, receiving approval in
Orexins are kinds of neuropeptides, chemical messengers in the brain. There are two distinct types: orexin A and orexin B. Each one binds to specific receptors (OX1R or OX2R) that are critical to the sleep-wake cycle.
Orexins are therefore part of the brain’s mechanism that keeps you awake. DORAs stop orexins from binding with OX1R and OX2R receptors. As a result, your body doesn’t get the same signal to wake up and
DORAs are called dual orexin receptor antagonists because they work on both receptor types (OX1R and OX2R). Researchers are also
Other medications for insomnia
- Benzodiazepines and Z-drugs work on brain signaling to create hypnotic, sedative, and muscle-relaxing effects.
- Melatonin receptor agonists work to create a manageable circadian rhythm, or sleep-wake cycle.
- Many over-the-counter sleep aids
containsubstances such as diphenhydramine, which produce drowsy effects.
DORAs, instead of making you want to fall asleep or resetting your biological clock, prevent you from feeling awake. They’re the only insomnia medication to block the action of orexins.
Clinical trials and research studies appear to show DORAs can be effective in some people.
A 2017 study of 291 participants with a clinical diagnosis of insomnia found lemborexant helped people get to sleep faster and sleep longer than a placebo. The trial was performed over the course of 2 weeks. It was funded by the makers of lemborexant.
A 2017 meta-analysis of studies investigating suvorexant found that the drug improved people’s perception of total sleep time, sleep quality, and time to sleep onset. The authors concluded suvorexant had apparent effectiveness, but also recommended comparative studies.
DORAs appear to work for people with insomnia. In addition, they may have some benefits over other medications for insomnia.
Specifically, DORAs don’t seem to
In general, DORAs are considered safe. But they do come with risks and potential side effects.
DORAs may cause daytime drowsiness the next day, especially if you weren’t able to get a full night’s sleep.
People with narcolepsy should not take DORAs because they can increase daytime sleepiness. Part of the mechanism of narcolepsy is
Other potential side effects include:
You should talk with your doctor if you experience:
- worsening depression or suicidal ideation
- sleep paralysis
- complex sleep behaviors (e.g., sleepwalking)
Let your doctor know about any other medications or supplements you’re taking to avoid potential interactions.
DORAs work on brain signaling that encourages wakefulness. By turning off this signaling temporarily, these drugs help people to get better and longer sleep.
DORAs come with some side effects but appear to be non-habit-forming and a potential option for people with insomnia.