Advancements in Dual Orexin Receptor Antagonists (DORAs)

Dual orexin receptor antagonists (DORAs) are emerging as effective pharmacological options for managing insomnia, especially in patients with major depressive disorder. These medications, including suvorexant and lemborexant, have been FDA approved and have demonstrated improvements in sleep latency and efficiency, as well as total sleep time, primarily by promoting REM sleep. Notably, DORAs do not lead to tolerance, rebound insomnia, or withdrawal symptoms upon discontinuation, making them a favorable choice for long-term treatment. Additionally, DORAs have a safe profile in patients with obstructive sleep apnea, although they are contraindicated in individuals with narcolepsy due to their effects on orexin levels.