New medication available to help Malaysians deal with insomnia | Multidisciplinary

A new medication has been approved for the treatment of insomnia. Lemborexant (Dayvigo™, Eisai), is a hypnotic agent belonging to the class of drugs known as dual orexin receptor antagonists (DORAs).

With the introduction of Dayvigo, it is hoped that Malaysians can enjoy a better quality of life, and subsequently prevent chronic diseases that may develop as a result of sleep deprivation. According to Kam Ai Teng, managing director of Eisai Malaysia, sleep is vital for the effective functioning of the body, yet it is often neglected by many.

The launch of the new medicine coincides with World Sleep Day, to raise awareness of sleep health by emphasizing the need for effective treatments for insomnia, which is now known as a sleep-wake disorder.

Speaking at the launch, Professor Dr Ng Chong Guan, a consultant psychiatrist at the University of Malaya, said one is considered to have insomnia based on the criteria listed in the 5^th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Symptoms	Sleep difficulty must be present for at least 3 months, and occurring at least 3 days per week despite adequate opportunity for sleep, plus the following:
1.	Predominant complaint of dissatisfaction with sleep quantity or quality, associated with one (or more) of the following symptoms: i) having trouble falling asleep. This may manifest in children as difficulty initiating sleep without parental intervention. ii) frequent awakenings or difficulties returning to sleep after waking. iii) waking up early in the morning and unable to fall asleep again.
2	The sleep disturbance leads to clinically significant distress or impairment in various aspects of life. These include social, occupational, educational, academic, behavioural, or other important areas of functioning.
3	The insomnia cannot be better explained by, nor does it occur exclusively during the course of another sleep-wake disorder such as narcolepsy, a breathing-related sleep disorder, a circadian rhythm sleep-wake disorder, or parasomnia.
4.	Current existing mental disorders and conditions do not adequately explain the predominant complaint of insomnia.
5.	The insomnia is not attributable to the physiological effects of a substance, such as a drug of abuse or a medication.

Excerpted from: https://pro.psycom.net/psychiatric-disorders/insomnia#dsm-criteria

On the pharmacokinetics of lemborexant, Ng said it reaches a maximum concentration in the blood about 1 to 3 hours post ingestion, which makes it different from other insomnia medications as those usually wear out by this point. [Clin Pharmacol Drug Dev 2021;10(2): 153–165] Thus, the patient can maintain sleep throughout the night. As an additional plus point, lemborexant is not a sedative, which means patients do not wake up feeling drowsy or unstable.

Being drowsy or unstable (also known as postural instability) can lead to falls and injury. Additionally, drowsiness may cause workplace or road accidents as the patient may fall asleep while handling a vehicle.

Also present at the launch was Dr Hazli Zakaria, a consultant psychiatrist. He said the availability of lemborexant can help spearhead the community’s conversation about sleep and its surrounding topics. These include sleep hygiene, ways to maintain good sleep and how to “protect” sleep before it becomes a sleep problem. Many people believe that insomnia is a night problem, but the real problem arises during the day after, where the patient is not feeling recharged, lethargic and is mentally distressed.