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The orexin system plays a critical role in the regulation of the transition between sleep and arousal. Suvorexant is a novel, orally active potent orexin receptor antagonist being investigated as a treatment for insomnia. Because insomnia treatments are often used long-term, but clinical trials have typically lasted less than 3 months, researchers conducted a manufacturer-funded trial, randomizing 781 adults with primary insomnia seen at 106 investigational centers to receive double-blind treatment for 1 year with suvorexant (30 mg nightly for those aged 65 or older; 40 mg nightly for younger patients) or placebo at a 2:1 ratio. The primary outcome at 1 year was safety and tolerability. After one year, patients assigned to receive suvorexan…