Orexins: An Expert Q&A

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Monday, December 9, 2013

Emmanuel Mignot

Emmanuel Mignot

For this "Ask the Expert" feature, NSF sat down with sleep docs Emmanual Mignot and Jerrold Kram to get their thoughts on orexin receptor antagonists, a new class of sleep aids.


How are the new orexin receptor antagonists different from existing sleep aids? 

Unlike sleep aids that are currently sold in the market, orexin receptor antagonists do not work on GABA (promoting a sleep inducing system that shuts down the brain), but rather they inhibit the hypocretin/orexin system, a wake promoting system.  They act more closely to an antihistamine than to classic sleeping pills. 

What do you think about orexin antagonists as a new sleep aid?

It’s always exciting to have a completely different class of drug because it offers more choices for patients.

Jerrold Kram

Jerrold Kram

Preliminary data suggests consistent benefit with minimal side effects.

Might orexin antagonists work for a person with insomnia for whom other sleep aids haven't worked?

Yes, because it works completely differently.  If your current sleep aid isn’t working for you anymore, it’s time to talk to your doctor and ask about the different options.  To have more choices always helps patients.  


What type of patient might consider taking an orexin antagonist for insomnia and what should this patient look out for?

We would think it would be a patient who has tried sleep aids that are currently on the market but found them to be ineffective, or if there are concerns about experiencing some side effects found in traditional medications (such as nocturnal behaviors in the elderly, particularly women). As with most drugs, orexin antagonists may cause some side effects, such as carry over sedative effects in the morning, so patients should monitor their reactions closely and discuss with their doctors.  Unlike other sleeping pills, they increase REM sleep, which is probably good, but in some cases could be bad, for example increasing bad dreaming for some predisposed individuals.

This "Ask The Experts" Q&A is courtesy of Emmanuel Mignot, MD, and Jerrold Kram, MD.