Scientists from Oxford University found two drugs, eszopiclone and lemborexant—both not currently licensed for the treatment of insomnia in the UK—were shown to perform better than others, both in the short-term and long-term treatment of insomnia.
The research is published in The Lancet and was conducted by Professor Andrea Cipriani et al.
Insomnia is defined as dissatisfaction with sleep quantity or quality and is linked to at least three months of difficulty getting to or staying asleep.
It affects up to 20% of the population and for a high proportion of these people, it can last for a number of years.
In the study, the team reviewed 154 clinical trials including 44,000 people assigned to one of 30 licensed or not licensed drugs, or placebo.
They sought to estimate the effectiveness of short-term and long-term of treatments for insomnia disorder, where the condition is not accompanied by a mental health co-morbidity, such as depression or physical illness.
These people were assessed on their quality of sleep, the effects of treatment discontinuation, and the presence of any adverse events, such as dizziness, nausea, fatigue, headache, sedation and somnolence (feeling drowsy).
The team says the study shows that some of these drugs can also be effective, and should be used in clinical practice, when appropriate.
For example, where treatments such as improved sleep hygiene and Cognitive Behavioural Therapy have not worked, or where a patient wants to consider taking medication as part of their treatment.
Although the study identified that eszopiclone could be effective as a treatment for insomnia, it may also cause substantial adverse events, such as dizziness and nausea, and safety data on lemborexant were inconclusive.
Other findings suggest that there was insufficient evidence to support the prescription of benzodiazepines and zolpidem in the long-term treatment for insomnia.
The team says that it should also be noted that the drug lemborexant acted via a different pathway in the brain (the orexin neurotransmitter system), a relatively novel mechanism of action.
More selective targeting of this pathway and orexin receptors could lead to better pharmacological treatments for insomnia.
The validity of the study’s results should be tempered by the potential limitations of the current analysis.
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