A new treatment for insomnia, really?  |  Press room

A new treatment for insomnia, really? | Press room

insomnia

Insomnia is both a public health problem and a societal issue, associated with many factors that need to be taken into account for the well-being of patients. Credits: Unsplash

Good news for people who suffer from insomnia? While 15 to 20% of the French population would be affected by this pathology, half of which in a severe form, the announcement of the approval of a new drug by the European Medicines Agency was something to delight some. This new molecule, baptized daridoxerant, acts on orexin receptors, a neurotransmitter which notably regulates the states of wakefulness and sleep. Clinical trials conducted in 18 countries have shown this drug to be safe and quite effective at doses of 50 mg, reducing the speed of falling asleep, decreasing the duration and frequency of awakenings during sleep and improving the quality of wakefulness.

If this treatment makes it possible to broaden the therapeutic arsenal available, caution must remain in order. Indeed, a new drug will not solve everything on its own, especially when it comes to a multifactorial disease such as insomnia, with psychological, physiological and neurobiological components that are difficult to dissociate.

Take care of insomnia

Before the authorization of this new treatment, several therapeutic options were already available. First of all, it should be emphasized that non-drug treatment must remain the first option offered to patients. They should be accompanied to correct bad habits related to sleep, in particular by promoting a regular bedtime and avoiding certain harmful behaviors. Looking at screens before going to bed is, for example, a very frequent practice in many countries of the world, but several studies have shown that it is associated with a delay in falling asleep and in particular that it can disturb the sleep of adults as well as that of children.

If pharmacological management must be considered, the scientific literature suggests that cognitive-behavioural therapies (TCC) must first be offered with long-term efficacy superior to drug treatments. These therapies are based on the principle of replacing maladaptive behaviors and erroneous beliefs about sleep with other, more appropriate ones. Through several sessions, patients are made to become aware of the factors and mechanisms on which the sleep/wake rhythm depends and therefore of the errors that lead to their insomnia. Although the data are heterogeneous, they nevertheless indicate a beneficial effect of these therapies, with an improvement in the quality of life.

However, since access to these therapies is sometimes limited depending on the territory, studies have recently shown that they can also be offered online with rather promising results.

In general, the fight against insomnia requires a deconstruction of received ideas integrated by patients, whether or not they have recourse to cognitive-behavioral therapies.

Among these ideas, we find in particular the notion that everyone needs a mandatory 8 hours of sleep per night to stay in good shape. While adults do indeed need 7-9 hours of sleep on average, this is just an average.

There would in fact be significant individual differences in the amount of sleep each needs: thus, a small percentage of people will need less than 7 hours, another more.

The mantra of “8 essential hours of sleep” is often incorporated as a rule by many people, which can lead to some anxiety in the event of lack of sleep. But it actually corresponds to the average of individual needs.

In order to determine the length of sleep you need, the best thing is still to be attentive to your state of alertness during the day, according to the number of hours spent sleeping the day before. Daytime performance and quality of life should not always be attributed to impaired nighttime sleep quantity or quality.

And the drugs?

As far as drug treatments are concerned, benzodiazepines and related drugs have since the 1970s been one of the most prescribed treatments for chronic insomnia. Although these drugs are safe and the risk of overdose is limited, their side effects are still numerous (drowsiness, confusion, loss of memory, loss of coordination and balance, etc.).

In the long term, their use is associated with addiction and a loss of treatment efficacy. Other drugs were then developed (derivatives of melatonin, antihistamines, sedative antidepressants, etc.), but similar effects persist both in terms of efficacy and tolerance.

Drugs that inhibit orexin, such as daridoxerant, are one of the promising avenues studied in recent years, being effective on sleep onset delay, the number and duration of intra-sleep awakenings and daytime performance. However, they alone will not solve the issue of insomnia, which is both a public health problem and a societal issue, associated with many factors that need to be taken into account for the good. – be patient.

Text produced with the support of Yves Dauvilliers, INM: Montpellier Neuroscience Institute

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