Breaking Down the DORA Class in the Treatment of Insomnia - Episode 7
Clinical Perspectives on DORAs for Insomnia Management
A panelist discusses how dual orexin receptor antagonists (DORAs) are considered a first-line treatment for chronic insomnia, particularly for sleep maintenance issues, due to their superior tolerability, lack of withdrawal symptoms, and positive impact on daytime functioning.
The dual orexin receptor antagonist (DORA) class of medications is often considered a first-line treatment for chronic insomnia, particularly when patients experience sleep maintenance issues, insufficient total sleep time, or challenges with sleep latency and wakefulness after sleep onset. While DORAs are FDA-approved for treating chronic insomnia, other medications like selective serotonin reuptake inhibitors, trazodone, and off-label options such as doxepin or mirtazapine are sometimes used in clinical practice. However, DORAs are preferred for their superior tolerability, lack of withdrawal symptoms, and favorable adverse effect profiles. This makes them a more suitable option for long-term management of chronic insomnia, especially for patients who need consistent and safe sleep support.
Patients seeking treatment for insomnia commonly report difficulties with daytime functioning, including excessive sleepiness and fatigue. Addressing these concerns is crucial in treatment planning, and evidence from clinical trials shows that DORAs, particularly daridorexant, can significantly improve next-day sleepiness. It’s essential for health care providers to communicate these benefits to patients, as the impact on daytime functioning is a major concern for many individuals with insomnia. With DORAs, patients can experience relief from daytime fatigue, ultimately enhancing their ability to function normally during the day.
To assess the effectiveness of treatments like DORAs, questionnaires such as the Insomnia Daytime Symptoms and Impacts Questionnaire are valuable tools for evaluating next-day functioning. These tools provide a clear measure of improvements in sleepiness, cognition, and mood. Educating patients about the clinical trial results and the potential for better daytime functioning can help set realistic expectations and build trust in the treatment approach. By addressing these concerns upfront, clinicians can help patients feel more confident in their treatment plan.
