Last week, the National Institute for Health and Care Excellence (NICE) issued a new piece of guidance recommending QUVIVIQ™ (daridorexant) for treating insomnia in adults with symptoms lasting for three nights or more per week for at least three months, and whose daytime functioning is considerably affected. And, to only be prescribed if cognitive behavioural therapy for insomnia (CBTi) has been tried but not worked, or CBTi is not available or is unsuitable.
Here at The Sleep Charity, we welcome this news as we receive many calls on our National Sleep Helpline where people are frustrated, exasperated and are at crisis point because of sleep deprivation and lack of treatment available for them. While we all may experience short periods of sleeplessness, people living with chronic insomnia are persistently deprived of the restorative sleep they need, which can have a major impact on their overall health and wellbeing. This announcement from NICE will be a welcome relief to those who are struggling with sleep, by making available a suitable new treatment option.
CBTi is still the recommended first line of treatment, and one we believe needs more funding behind to ensure access to it is more widely available. But this is another option where CBTi is unavailable, not suitable or has been tried and been unsuccessful.
We also agree with NICE which recommends that the length of treatment with daridorexant should be as short as possible and assessed within three months of starting and should be stopped in people whose chronic insomnia has not responded adequately. If treatment with daridorexant is continued, it should be assessed at regular intervals to determine whether it is still working.
Chronic insomnia occurs when the impact on sleep quantity or quality is present for at least three nights per week, lasts for at least three months, and occurs despite an adequate opportunity to sleep. The creator of daridorexant, Idorsia, estimates that chronic insomnia affects around 7% of the UK adult population with a key symptom being the impairment of daytime functioning, which is linked to significant reductions in health status, such as fatigue, reduced energy, mood alteration and cognitive difficulties. Furthermore, suboptimal management of this condition is associated with decreased workplace productivity, and increased risk of workplace accidents, falls, and costly workplace errors.
Currently, the most commonly prescribed medications for insomnia induce sleep through broad inhibition of brain activity, and can be associated with patients developing dependency, or experiencing next-morning grogginess. Daridorexant works differently by selectively blocking only the activation of orexin receptors, thereby directly targeting the mechanism that controls overactive wakefulness. In clinical studies, after 12 months of treatment, daridorexant was not associated with physical signs of dependency, tolerance or rebound insomnia after it’s discontinuation.
For the full report, visit Project information | Daridorexant for treating insomnia disorder [ID3774] | Guidance | NICE