Suvorexant for Insomnia
Suvorexant is a sleep medication designed to treat insomnia. This medication, sold under the brand name Belsomra, was officially approved by the U.S. Food and Drug Administration (FDA) as an insomnia therapy in 2014.2 It can be taken by people who have a hard time getting to sleep or staying asleep.
This medication may help some people sleep more soundly. However, it can also lead to side effects that can occasionally be serious. It’s important to know the benefits and risks, as well as other treatment options, before taking suvorexant.
How Can Suvorexant Help With Insomnia?
There are many processes in the brain that help control wakefulness and sleepiness. One of these processes involves orexins — molecules that activate neurons in the brain that make you feel more awake.3
Suvorexant is a type of medication called a dual orexin receptor antagonist or DORA. These medications block orexins from interacting with their target neurons. This helps prevent wakeful processes from being turned on in the brain, shifting the balance towards sleepiness.4
How Well Does Suvorexant Work?
Clinical studies have found that suvorexant can help improve various measures of sleep, although these improvements are sometimes minor. Research has found that after using the drug regularly, study participants have seen the following effects:4-7
- They fall asleep more quickly — different studies found that people got to sleep about 8 to 13 minutes sooner after using the drug, compared to people using a placebo (sugar pill)
- They spend more time asleep — people using suvorexant were asleep for 10 to 25 minutes longer each night, compared to those taking a placebo
- They say that they feel they got a better night’s sleep
There haven’t been any studies that have directly compared suvorexant to other sleep aids, so it’s not clear whether this medication is more or less effective than other options.7
Suvorexant Recommended Dosage
Suvorexant comes in tablets containing 5, 10, 15, or 20 mg dosages. When you first start taking this medication, your doctor will likely prescribe a low dose — often 10 mg. If this doesn’t help, they may give you a higher dose, although taking more can lead to worse side effects.6
Doctors will usually instruct you to take suvorexant once per day. It should be taken within 30 minutes of when you want to go to sleep. Suvorexant works more quickly if it’s taken on an empty stomach, so you may want to make sure to finish eating dinner a couple of hours before bedtime.8
Always follow your doctor’s instructions when taking suvorexant. If their recommendations aren’t clear, ask your doctor or pharmacist to explain.
Suvorexant Side Effects
Suvorexant can also cause other side effects, such as:5,8
- Dry mouth
- Strange dreams
- Sleepwalking or doing other activities while asleep
More severe side effects can also happen, but these are rare. Serious health effects include hallucinations, sleep paralysis (being awake but not being able to move), or weakness in the leg muscles. Some people also experience changes in behavior or thinking such as unusual aggressiveness, confusion, or suicidal thoughts. Tell your doctor if you experience these issues or notice any other health changes after starting suvorexant or increasing your dose.5,8
Is Suvorexant Safe?
Some sleep medications can lead to dependence — they make you feel like you have to keep using the drugs in order to sleep. People may also be tempted to abuse drugs and use them too often or at a higher dose than recommended. Suvorexant can sometimes lead to abuse, although this is not too common. About 3 to 4% of people taking the medication abuse it.5
Make sure to only take your prescribed dose of suvorexant. Don’t take it for a longer time period than recommended by your healthcare provider.8
People with depression should avoid using suvorexant. This medication can sometimes make depression worse. You may also need to find a different treatment option if you have sleep apnea or chronic obstructive pulmonary disease (COPD).5
Can You Drink While Taking Suvorexant?
Experts say that suvorexant should not be combined with alcohol.8
Other Insomnia Treatment Options
Suvorexant may be effective for you. However, it can also lead to uncomfortable side effects. It’s also not entirely clear how well the medication works long-term.4
Sleep experts recommend that people with insomnia first try cognitive behavioral therapy for insomnia (CBT-I).9 This treatment can help people change their underlying feelings and behaviors around sleep that may be keeping them up at night. It works just as well as sleep aids, doesn’t cause side effects, and provides long-term relief.10
With Dawn Health, you can try CBT-I from the comfort of your own home! Fill out our questionnaire to learn more about CBT-I and get matched with a sleep coach who can help guide you towards a better night’s rest.
Centers for Disease Control and Prevention. (2013, August). Prescription Sleep Aid Use Among Adults: United States, 2005-2010. https://www.cdc.gov/nchs/products/databriefs/db127.htm
Yang L. P. (2014). Suvorexant: first global approval. Drugs, 74(15), 1817–1822. https://doi.org/10.1007/s40265-014-0294-5
Inutsuka, A., & Yamanaka, A. (2013). The physiological role of orexin/hypocretin neurons in the regulation of sleep/wakefulness and neuroendocrine functions. Frontiers in endocrinology, 4, 18. https://doi.org/10.3389/fendo.2013.00018
Rhyne, D. N., & Anderson, S. L. (2015). Suvorexant in insomnia: efficacy, safety and place in therapy. Therapeutic advances in drug safety, 6(5), 189–195. https://doi.org/10.1177/2042098615595359
Gauld, A. R. (2016). Suvorexant (Belsomra) for Insomnia. American family physician, 93(12), 1016–1020. https://www.aafp.org/pubs/afp/issues/2016/0615/p1016.html (https://www.aafp.org/pubs/afp/issues/2016/0615/p1016.html)
U.S. Food and Drug Administration. (2014, August). Belsomra (suvorexant) tablets, for oral use. https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/204569s000lbledt.pdf (https://www.accessdata.fda.gov/drugsatfda_docs/label/2014/204569s000lbledt.pdf)
Lee-Iannotti, J. K., & Parish, J. M. (2016). Suvorexant: a promising, novel treatment for insomnia. Neuropsychiatric disease and treatment, 12, 491–495. https://doi.org/10.2147/NDT.S31495
MedlinePlus. (2022, February 15). Suvorexant. https://medlineplus.gov/druginfo/meds/a614046.html (https://medlineplus.gov/druginfo/meds/a614046.html)
John M. Eisenberg Center for Clinical Decisions and Communications Science. (2017). Management of Insomnia Disorder in Adults: Current State of the Evidence. In Comparative Effectiveness Review Summary Guides for Clinicians. Agency for Healthcare Research and Quality (US).
Rossman J. (2019). Cognitive-Behavioral Therapy for Insomnia: An Effective and Underutilized Treatment for Insomnia. American journal of lifestyle medicine, 13(6), 544–547. https://doi.org/10.1177/1559827619867677
Dr. Colleen Ehrnstrom is a licensed clinical psychologist with a specialty practice in Acceptance and Commitment Therapy (ACT). Areas of expertise include insomnia and other sleep disorders, anxiety, and depression.
Dr. Ehrnstrom is not a medical provider and is not providing any recommendations regarding medications. Rather, she is sharing and reviewing the research as it relates to education when learning how best to treat insomnia.