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Dr Margaret Moline Speaks on Simple Remedies, Pharmacological Options for Treatment of Insomnia


For patients with insomnia amid the COVID-19 pandemic, certain nightly habits can promote sleep hygiene; in addition, lemborexant has emerged as a novel indication if drug intervention is needed.

For patients dealing with insomnia amid the coronavirus disease 2019 (COVID-19) pandemic, nightly remedies such as limiting cell phone and television usage, as well as avoiding large meals can promote sleep hygiene. Additionally, lemborexant has emerged as a novel indication for insomnia among adults if pharmacological intervention is warranted, said Margaret Moline, PhD, executive director and international project team lead for Eisai Inc.


AJMC®: Amid the COVID-19 pandemic, increased mental health and sleep issues have been reported in an intensifying trend. What is the current standard of care for adults with insomnia who have difficulties with sleep onset and/or sleep maintenance?

Moline: During COVID-19 there's a lot more attention being paid to sleep problems. So, it's important for someone to take a look at what he or she is doing as far as routines that can help them sleep, and if some of the simple remedies, which I'll talk about in just a moment, are not sufficient, then they should really be encouraged to speak to their clinician.

Now, there are non-pharmacological treatments for insomnia, behavioral techniques, which are recommended as first-line. So, some of these simple techniques that people should think through include not conducting activities that are alerting right before bed. So, this means put your cell phone away, don't necessarily watch television right before you're trying to go to sleep, making sure that the sleeping environment is quiet and comfortable and cool, which can be tricky at this time of year–and the person feels safe and making it quiet also.

So, not eating a large meal before bedtime and not exercising before bedtime. So, all of those are really good sleep hygiene tips, but if they're not working, again, a person should be encouraged to talk to his or her clinician to get additional strategies to help with the insomnia.

For patients who need more help, there are a variety of different therapeutic options that are available, and 1 that we'll be talking about in more detail today, lemborexant, was recently approved by the US FDA for the treatment of adult patients with insomnia.

AJMC®:Can you tell us a little bit about Eisai Inc’s lemborexant, sold as DAYVIGO? What are the mechanisms behind this indication and what benefit it aims to provide patients with insomnia?

Moline: Lemborexant is a dual orexin receptor antagonist. This means it's blocking the effect of orexin in the brain. Orexins are involved in maintaining wakefulness, so the idea here is that lemborexant would help to dampen wakefulness at the time that the person wants to sleep. So, it's a different class of drugs than some people may be familiar with, and is relatively new as a therapeutic option in the last few years.

AJMC®:What further innovations within the field of sleep therapy are Eisai Inc currently working on or considering?

Moline: So, lemborexant has been studied in a circadian rhythm sleep disorder called irregular sleep wake rhythm disorder. It's not insomnia because this is a problem that happens to people with dementia where their sleep is fragmented at nighttime and their daytime has many sleep episodes in it.

So, we're looking to see whether lemborexant has the potential to help people stay asleep longer at night and stay awake longer during the day. So, that's an active area for us at the moment with lemborexant.

AJMC®:Lastly, do you have any other concluding thoughts?

Moline: I'm excited about the breadth of information about lemborexant that we're preparing to show at the SLEEP 2020 virtual conference and we hope it will be interesting and informative for clinicians so that we can help patients sleep better and improve the quality of their lives.

AJMC®:To learn more, visit our website at ajmc.com. I’m Matthew Gavidia, thanks for joining us!

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