Adults frequently experience insomnia, which has been linked to health hazards. However, the efficacy and safety of current treatments leave a large patient group with unmet requirements. The first-line treatment for insomnia is cognitive behavior therapy, which enhances sleep quality in adults with insomnia. However, if cognitive behavior therapy for insomnia is ineffective for the patient, pharmacological treatment may be necessary.
Doctors generally prescribe benzodiazepines and other sedative-hypnotic drugs to address insomnia in adults. The FDA has approved Dayvigo (Lemborexant) and Ambien (Zolpidem) as treatments for insomnia. Lemborexant, a dual orexin receptor antagonist that is orally active and under investigation, inhibits orexin receptors 1 and 2 to reduce orexin activity and control the sleep/wake function.
As newer emerging treatments become available, is Dayvigo an additional option for sleep onset and sleep maintenance difficulties in insomnia? Does Dayvigo therapy effectively treat insomnia disorder compared to Ambien therapy? Let us see how Dayvigo and Ambien work in sleep disorders.
Zolpidem (Ambien), an imidazopyridine, is a nonbenzodiazepine hypnotic indicated for the short-term treatment of insomnia. Zolpidem improves sleep difficulties in patients with insomnia.
Uses of Ambien
Zolpidem, an imidazopyridine, is a GABA-A agonist. It binds to the benzodiazepine ω1 receptor. Zolpidem does not generally change sleep architecture.
The binding of Zolpidem at this receptor mediates the hypnotic effects, thereby inducing sleep. Zolpidem reduces the time to sleep onset and prolongs total sleep time.
On 20 December 2019, the US FDA approved Lemborexant (Dayvigo) for insomnia in adults, characterized by difficulties with sleep onset or sleep maintenance. The mechanism of action of lemborexant is via its dual OXR antagonism. Lemborexant is a Schedule IV controlled substance.
Uses of Dayvigo
Dayvigo acts as a competitive antagonist at the receptors- OXR1 and OXR2. It is the second dual orexin receptor antagonist, and blocks wake promotion by blocking the binding of neuropeptides, orexin A, and orexin B.
Competitive antagonism at both receptors interferes with orexin neurotransmission to facilitate sleep onset and maintenance.
A drug's prescribed dose determines whether patients experience maximum effectiveness, toxicity that could result in death, or no impact at all. Dosage is crucial for diseases and medications that can reduce severe morbidity or extend life. Improper dosing increases the risk of potential adverse effects caused by supratherapeutic or subtherapeutic doses.
Side effects are undesired effects caused by a drug. When taking these medications, inquire with your doctor about the precautions you should follow to lower the risk. Tell your doctor if you experience any unlikely but severe adverse effects, such as memory loss or mental or behavioral disorders.
| Ambien | Dayvigo |
| Dizziness | Drowsiness |
| Weakness | Headache |
| Dry mouth | Nightmare |
Abuse of lemborexant is possible, albeit the risk is comparable to other drugs for insomnia- Zolpidem and suvorexant. Zolpidem is a central nervous system depressant; next-day impairment is possible at therapeutic doses.
Lemborexant had no adverse effects on next-day functioning or memory in clinical studies of patients without anxiety, depression, or a history of substance abuse, except when combined with alcohol.
Unlike Zolpidem, lemborexant does not induce rebound insomnia or withdrawal symptoms. Hence, there is no need to taper it off, and the drug can be discontinued abruptly.
In two double-blind, randomized, placebo-controlled studies involving about 800 adults, lemborexant was compared with Zolpidem and a placebo for the onset and maintenance of sleep. In phase 3 randomized clinical trial of older persons with insomnia, lemborexant outperformed the control group, and zolpidem tartrate extended-release (Ambien CR) was the best treatment option. It was shown to enhance both objective and subjective measures of sleep.
The effects, which include quicker sleep onset and fewer nightly awakenings, are seen within a week and maintained for at least 12 months.
From a baseline delay of about an hour, patients experienced an average reduction in sleep time of 26 minutes with either dose of lemborexant after 12 months of nightly treatment.
Lemborexant added about 43 minutes to the duration of the first awakening. It improved the time it takes adults over 55 to fall asleep by roughly 20 minutes instead of 7.5 minutes with the extended-release of Zolpidem.
Lemborexant gave patients an extra seven to nine minutes of sleep before their initial awakening, showing a slight improvement over Zolpidem in this area.
Precautions are steps taken to prevent any unwanted effects from occurring. These steps are taken into account before administering the drug to the patient. Healthcare providers must inform the patients of the necessary precautions to be followed to ensure the safety of the medication.
Sleep disorders are widespread and impact both the quantity and quality of sleep. Studies show that poor sleep quality is one of the primary issues individuals face. Diagnosed based on history findings, insomnia is the trouble falling asleep or staying asleep that impairs daily functioning.
Cognitive behavior therapy is the first line of treatment with or without sleep hypnotics. Dual orexin receptor antagonists might be a better option than the current medicines. Dual orexin receptor antagonists might be a better option than the existing medicines. In regulating wakefulness and sleep/wake transitions, orexins are essential.
Dayvigo, a member of the novel class of dual orexin receptor antagonists, offers the possibility of increased efficacy and the potential for fewer adverse effects than Zolpidem, particularly in cognition, memory, and psychomotor behavior.
These findings imply that lemborexant may be a beneficial prospective treatment option, particularly in individuals at risk for falls, as safety is a primary concern for clinicians who prescribe sleeping drugs.
