Sleeping pill that doesn’t leave you groggy next day

NHS PATIENTS with insomnia may soon benefit from a new sleeping pill that can send them into a slumber without suffering grogginess the next morning, or risking addiction.

Unlike existing sleeping pills which increase chemicals that make us sleepy, daridorexant targets the brain cells that keep us awake. Trials show this can double a user’s sleep while side effects are dramatically reduced.

The Medicines and Healthcare Products Regulatory Agency, the UK’s regulator, gave daridorexant the green light late last month following approval in Europe and the US earlier this year. Experts expect it will be available to NHS patients in the new year.

Professor Dieter Kunz, a psychiatrist and sleep researcher at the University of Basel in Switzerland, says: ‘Current sleep medications knock you out, but they don’t allow for the brain to enter deep sleep – which is when your brain does important sorting processes. Daridorexant works in a completely different way, allowing high-quality sleep because it doesn’t interfere with this crucial brain activity.’

Experts recommend between six to eight hours of sleep per night for optimum mental and physical health. But about a fifth of Britons suffer insomnia – defined as having trouble sleeping at least three times a week for more than three months.

Doctors may first suggest trying a low potency sleep aid from a pharmacist, such as tablets or liquids with natural ingredients like lavender or melatonin. Antihistamines,

usually given to treat allergies, can also help. But all of these medications can induce drowsiness the following day, so the NHS recommends they are used for no longer than two weeks.

A GP may also suggest a type of therapy designed for insomnia, called CBT-i and lifestyle changes, such as a regular bedtime routine and avoiding screens before bed. If these fail, a doctor may then prescribe a sleeping pill as a shortterm fix.

These pills are known as z-drugs, such as zopiclone and zolpidem. They work by increasing the activity of the brain chemical gammaaminobutyric acid (GABA), which induces feelings of relaxation and sleepiness. But this can disrupt the fine balance of other brain chemicals in areas not associated with sleep. This is why the sedative effects can continue into the next morning, and patients who stop taking them can experience withdrawal symptoms such as headaches, nausea and memory loss.

The imbalance also means other chemicals involved in wakefulness are boosted too, making the deep, restorative sleep, called REM, less likely. And studies show that the brain quickly develops a tolerance to z-drugs, so a stronger dose becomes necessary for them to work. This makes patients more likely to become addicted.

But daridoxident works on an altogether different set of brain chemicals. It is known as a dual orexin receptor antagonist (DORA), which means it reduces the activity of a chemical called orexin.

The link between orexin and sleep was discovered two decades ago, when scientists found that people with the sleep disorder narcolepsy, which can cause them to suddenly fall asleep at any time of the day, had extremely low levels of it.

‘Rather than increasing chemicals that make you sleepy, this drug reduces orexin, which makes us awake and alert,’ explains Prof Kunz, who was involved in daridorexant trials. ‘This seems to have less of a knock-on effect on other substances in the brain.

‘Follow up studies show that even taking the drug for a year seems to be safe. What’s more, patients find the improved sleep continues even after they stop taking the medication. It is the most promising results in 25 years of sleep research.’

ONE of Prof Kunz’s patients, a 58-year-old nurse, went from sleeping just four hours most nights to seven and a half. ‘She’d had insomnia for 20 years and was taking z-drugs most weeks,’ says Prof Kunz. ‘For the first two weeks on the new drug, she didn’t see much improvement. But after six weeks she noticed she was more relaxed during the day and generally less anxious.

‘Within two months she was sleeping for six hours and, within three months, seven and a half.

‘Two years later, she’s stopped taking daridorexant and averages about six and a half hours sleep per night. She tells me her mental health is better than it has been in 30 years – it’s the outcome every sleep doctor hopes for.’