Advances in the Treatment of Chronic Insomnia: A Narrative Review of New Nonpharmacologic and Pharmacologic Therapies

Figures & data

Table 1 Selected Elements of Good Sleep Hygiene^155,156

Element
● Keeping a regular sleep/wake schedule
● Reducing bedroom noise
● Blocking out light
● Removing electronic devices from the bedroom
● Avoiding daytime napping
● Avoiding alcohol, nicotine, and caffeine before sleeping
● Avoiding eating dinner late
● Regular exercise
● Management of stress

Table 2 Orexin Receptor Antagonists Approved or in Development for Treatment of Insomnia Disorder

Name	Development Status	Doses	Half-Life	Use in Special Populations
Suvorexant (BELSOMRA^®)^Citation122	Approved	5 mg, 10 mg, 15 mg, 20 mg	Terminal half-life: approximately 15 hours (range, 10–22 hours)	● Not recommended in patients with severe hepatic impairment ● Safety and effectiveness have not been established in pediatric patients
Lemborexant (DAYVIGO^®)^Citation131	Approved	5 mg, 10 mg	Effective half-life for lemborexant 5 mg: 17 hours; effective half-life for lemborexant 10 mg: 19 hours	● Not recommended in patients with severe hepatic impairment ● Safety and effectiveness have not been established in pediatric patients
Daridorexant^Citation157	Filing in preparation	10 mg, 25 mg, 50 mg^Citation145,Citation146	Elimination half-life: 5.6–8.5 hours^Citation158	● Prescribing information not available
Seltorexant^Citation149	Phase 3	20 mg	Half-life: 2–3 hours^Citation149	● Under development for use in patients with major depressive disorder and insomnia ● Prescribing information not available

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