THE ARISING · Longevity & Healthspan
Online Reviews Link Sleep Paralysis to Plans to Quit Insomnia Drug Dayvigo
Some people who try the newer insomnia drug lemborexant describe waking unable to move or speak, and those reports were among the strongest signals of who planned to quit.
A study in the journal Sleep Medicine analyzed 260 publicly posted online reviews of lemborexant, sold as Dayvigo. The researchers call it an infoveillance study: an observational look at what patients write on their own. They coded the reviews for themes and compared them with each reviewer's self-rated effectiveness (on a 1 to 10 scale) and their intention to continue or stop.
Reviews were split. About 30% of reviewers described meaningful improvements in sleep quality after starting the drug. Half reported minimal or no benefit.
Two-thirds (68%) reported at least one adverse outcome. The most frequent were more intense dream experiences, such as vivid dreams or nightmares, and worse sleep quality.
Lower effectiveness ratings and intent to discontinue were most strongly associated with self-reported sleep paralysis, intensified dreaming and next-day sleepiness. Longer treatment duration was associated with higher effectiveness ratings.
Lemborexant belongs to a class called dual orexin receptor antagonists. Orexin is a brain messenger that helps keep people awake, and these drugs block it. According to a Rutgers University release on the work, lemborexant was approved in the U.S. in 2019. In clinical trials it helped people fall asleep faster and stay asleep longer than a placebo.
The Rutgers release adds figures beyond the published abstract. It says the team classified 70 of the 260 reviewers as having stopped or planning to stop. Sleep paralysis came up in 40% of their reviews, compared with 15% of the rest. The release also says most reviewers, especially those who stopped, had used the drug for less than a month.
Individual reviews ranged from reports of frightening paralysis to descriptions of more natural sleep.
The release describes one proposed explanation. Dreaming sleep is when the brain normally switches off most body muscles, and blocking orexin can increase it. That may let vivid dreams and muscle shutdown spill into waking moments.
The release also compares the reviews with the drug's two main clinical trials. In those, fewer than 2 in 100 participants taking lemborexant had sleep paralysis, and about 1 to 3 in 100 reported nightmares or abnormal dreams. The researchers say people with the best or worst experiences are the most likely to post, so review percentages cannot be read as rates among all users.
Lead author Abanoub Armanious emphasized that how distressing a side effect feels can matter to treatment decisions even when the effect is uncommon in trials.
The researchers recommend discussing expectations and adverse experiences with a clinician. Patients should seek clinical advice before changing a prescribed sleep medicine.