Novel Treatment Options for Insomnia

Drug Review: Volume 23, Issue 3 (PDF)

Insomnia is a sleep disorder that is characterized by symptoms of difficulty initiating sleep, difficulty maintaining sleep, or early-morning awakening with the inability to return to sleep for at least 3 months. These symptoms negatively impact daily tasks, work productivity, and social relationships. Insomnia also significantly increases the risk for mental health disorders, heart-related complications, and death. It is estimated that 10-13% of Canadians have insomnia.

Initial treatment options for insomnia include cognitive behavioural therapy, relaxation techniques and good sleep hygiene. If these therapies are insufficient, drug therapies may be considered. This includes benzodiazepines (e.g. Restoril), benzodiazepine receptor agonists (e.g. Imovane), and low dose antidepressants (e.g. Sinequan). These agents, however, have limited efficacy and are associated with dependency and tolerability issues. As patients continue to use these medications, they develop tolerance, leading to dependency on these medications.

Newer agents such as Dayvigo and Lunesta are now available for the treatment of insomnia.

Dayvigo has a unique mechanism of action blocking the orexin receptors, receptors responsible for promoting wakefulness. Thereby, Dayvigo decreases excessive wakefulness to help normalize the body’s sleep/wake cycle.

Lunesta is a new benzodiazepine receptor agonist that shares similar properties to Imovane, however is associated with less dependent tendencies. Both Dayvigo and Lunesta are efficacious at reducing the time needed to fall asleep, maintaining the length of time in sleep, and do not have the dependency and tolerability issues seen with the older agents for insomnia.

The costs of Dayvigo and Lunesta are comparable to other drug therapies reimbursed for insomnia. Given their clinical benefit and safety profile, these two treatment options are placed under Special Authorization for groups subscribed to ClaimSecure’s Managed Formulary.