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Orexin (hypocretin) is a neuromodulator that regulates wakefulness, and antagonists of its receptors, such as suvorexant, have been promising treatments for insomnia (NEJM JW Psychiatry Jun 11 2012). Two recent, randomized, placebo-controlled, 3-month, multicenter, registration trials of suvorexant dosing that were sponsored, conducted, and written by the manufacturer enrolled a total of 2030 participants with primary insomnia and no psychiatric or medical comorbidities (mean age, 56; ≥65, 41%).
At 40 mg for younger patients (ages, <65) and 30 mg for older ones, suvorexant was superior to placebo in improving several sleep measures. Subjective total sleep time (sTST) improved by about 30 minutes, and time to sleep onset by 10 minutes. On pol…