Section - Quick Takes

02. Dual Orexin Receptor Antagonists for the Treatment of Insomnia: A Systematic Review and Meta-Analysis on Randomized, Double-Blind, Placebo-Controlled Trials of Suvorexant and Lemborexant

Published on June 1, 2023 Certification expiration date: June 1, 2026

James Phelps, M.D.

Research Editor - Psychopharmacology Institute

Key Points

Sleep is driven by 2 factors: Homeostatic drive (sleep deficit) and circadian rhythm.
Social rhythm therapy and CBT-I Coach are effective alternatives to medication for improving sleep. It is recommended to use these options before considering medication.
When medication is needed, zolpidem and eszopiclone are recommended over suvorexant and lemborexant due to their known safety profile. A combination of medication and CBT-I may also be effective if the medication use is time limited.

To unlock this audio you need to become a Silver, Gold, Silver extended or Gold extended Member.

Check Our CME Program

Downloads for Offline Access

Download Audio File (MP3)

Text version

Caution. This Quick Take is supposed to be about orexin antagonists and I will get there eventually, but I’ll spend more time on an alternative treatment that according to sleep specialists should always precede or accompany consideration of medications for sleep. Know what that alternative is?

Hi! Jim Phelps here for the Psychopharmacology Institute. Let’s start with this. What makes people sleep anyway? Sleep science says it’s when the S-curve meets the C-curve, the 2 main drivers of sleep. The S-curve or homeostatic drive is your sleep deficit. How much sleep have you had? When was the last time you slept? The more deficit you accumulate, the stronger the homeostatic drive to sleep. The C-curve is your circadian rhythm. When it says it’s nighttime and your S-drive is saying, you got to get some sleep, there, you fall asleep—well, if your circumstances allow it. This includes not just driving or

Unlock this Quick Take and earn 0.50 CMEs
Become a Silver, Gold, Silver extended or Gold extended Member.

Get Instant Access

Already have an account? Sign in

Next Section

03. Pharmacologic Treatments for Cocaine Craving: What Is the Way Forward? A Systematic Review

Learning Objectives:

Evaluate the results of a network meta-analysis of treatment options for psychosis in Parkinson’s disease.
Discuss treatment options for insomnia using the recommendations of the American Association for Sleep Medicine and other guides.
Evaluate pharmaceutical options for reducing cocaine craving.
Examine the evidence regarding pharmacologic options after clozapine in treatment-resistant schizophrenia.
Discuss the potential benefits of olanzapine–samidorphan for managing weight gain in patients with first-episode psychosis.

Original Release Date: June 1, 2023

Review and Re-release Date: March 1, 2024

Expiration Date: June 1, 2026

Expert: James Phelps, M.D.

Medical Editor: Melissa Mariano, M.D.

Relevant Financial Disclosures:

James R Phelps declares the following interests:

- McGraw-Hill: Royalties

- W.W. Norton & Co.: Royalties

All of the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

Instructions for Participation and Credit:

Participants must complete the activity online during the valid credit period that is noted above.

Follow these steps to earn CME credit:

View the required educational content provided on this course page.
Complete the Post Activity Evaluation for providing the necessary feedback for continuing accreditation purposes and for the development of future activities. NOTE: Completing the Post Activity Evaluation after the quiz is required to receive the earned credit.
Download your certificate.

Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.