Excitement builds for potential new sleep aid

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Dear Pharmacist: I can't sleep well and have taken Ambien for years. What else do you recommend? — F.T., Bradenton

Dear F.T.: If you can't sleep on Ambien, I'd try something different. Another novel sleep drug is coming to the market called Suvorexant and, so far, I like it. The Food and Drug Administration is evaluating it right now.

Merck & Co. is manufacturing the drug, which supposedly does not induce memory loss, daytime fatigue or attention difficulties, all common side effects with the benzodiazepines and Z drugs that dominate the multibillion-dollar insomnia market. You know them by names like Ambien, Lunesta, Sonata, Xanax, Valium and Halcion.

The drugs increase GABA levels, a neurotransmitter that induces sleep. Tickle those GABA receptors and you will fall asleep, and likely have cognitive problems, full-body muscle relaxation, daytime fatigue and bizarre hypnotic events. Anything's possible.

Suvorexant doesn't affect GABA at all; it reduces a hormone called orexin (aka hypocretin). Instead of inducing sleep, this drug turns off the switch that keeps you awake.

Interestingly, elevated orexin are common in those prone to panic attacks ("Nature Medicine," 2010), but that is not Suvorexant's focus. It's marketed as a prescription sleep aid. There are well-designed, unbiased clinical trials that show orexin blockers improve sleep (and reduce panic).

Orexins keep you awake. If orexin levels suddenly drop, so do you, meaning you go to sleep. People with narcolepsy have swinging orexin levels. If orexin is high, you might feel panicky, anxious, wired or have insomnia.

Suvorexant is categorized as a dual orexin receptor antagonist, or a DORA blocker for short. Dual because it blocks both OX1 and OX2 receptor sites.

How do you feel if you wake at 4 a.m. on your sleep medication? Researchers compared conventional GABA blockers to DORA blockers to find out. Monkeys given popular GABA blockers were much foggier, confused and slower to respond as compared with those given a DORA blocker. We're not monkeys, though the point is made.

Is Suvorexant the next best amazing sleep drug? Time will tell. So far, headache is the most commonly reported side effect.

But sleep aids are for short-term use, they are not a forever thing. Always use the lowest effective dose and for short terms. Never combine sleep drugs with sedatives or alcohol. Clean your bedroom, turn off lights and implement healthier sleep hygiene practices. Go to my website to read about natural remedies if those interest you.

This is not intended to treat, cure or diagnose your condition. Go to SuzyCohen.com.

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