Insomnia Treatment Update With a Focus on Orexin Receptor Antagonists

Insomnia is a common condition that can have negative effects on cognition, productivity, and quality of life. A number of different types of insomnia have been identified. Recent studies suggest that insomnia is a risk factor for mood disorders, hypertension, and relapse of depression and alcoholism. Cognitive-behavioral therapy is considered the first-line treatment for insomnia. Pharmacotherapy involves the use of sedative-hypnotics, with traditional targets of these agents being gamma-aminobutyric acid, histamine, and melatonin receptors. Alternative medications, such as antidepressants and antipsychotics, may be used in patients with certain comorbidities. Herbal supplements also have been used to treat insomnia. Orexin receptor antagonists are a novel class of sedative-hypnotics for sleep-onset and sleep-maintenance insomnia, and currently three agents have been approved by the FDA.