USA: Suvorexant is a well-tolerated and effective treatment for insomnia associated with hot flashes in perimenopausal and postmenopausal women, suggests a recent study in the journal Sleep.
The neuropeptide orexin is shown to promote wakefulness, modulate thermoregulation, increase after menopause, and is normalized in women receiving estrogen therapy. This suggests a role for orexin antagonism for the vasomotor symptom (VMS)-associated insomnia disorder treatment.

Considering the above, Hadine Joffe, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA, and colleagues tested the efficacy of the dual orexin receptor antagonist suvorexant for chronic insomnia related to nighttime VMS in a double-blind, placebo-controlled trial.
The trial included 56 women with chronic insomnia associated with nighttime VMS, Insomnia Severity Index (ISI) scores ≥15, and >30 min of diary-rated wake after sleep-onset (WASO). They were randomized to receive oral suvorexant 10–20 mg (n = 27) or a placebo (n = 29) nightly for 4 weeks. Analysis of within-person change in ISI was adjusted for baseline ISI and race.
Salient findings of the study include:
Mean baseline ISI scores were 18.1 and 18.3 in the suvorexant and placebo groups, respectively.
The average 4-week ISI within-person decrease from baseline was greater on suvorexant (−8.1) compared to placebo (−5.6).
Compared to placebo, nighttime diary-rated VMS frequency was significantly reduced with suvorexant.
While diary-rated WASO and total sleep time trended toward improvement on suvorexant, findings were not significant after adjustment for multiple comparisons.
Daytime VMS and other sleep-related outcomes did not differ between groups. Suvorexant was well tolerated.
"Findings suggest that suvorexant is likely a well-tolerated and efficacious treatment for VMS-associated insomnia disorder and reduces nighttime VMS," wrote the authors. "Orexin receptors' antagonism could provide a novel therapeutic option for midlife women with VMS-associated chronic insomnia."
Reference:
Shadab A Rahman, Margo D Nathan, Aleta Wiley, Sybil Crawford, Aviva Y Cohn, Jessica A Harder, Leilah K Grant, Athena Erickson, Akanksha Srivastava, Kathleen McCormick, Suzanne M Bertisch, John W Winkelman, Hadine Joffe, A double-blind, randomized, placebo-controlled trial of suvorexant for the treatment of vasomotor symptom-associated insomnia disorder in midlife women, Sleep, 2022;, zsac007, https://doi.org/10.1093/sleep/zsac007
KEYWORDS: Sleep journal, insomnia, vasomotor symptom, orexin receptors, antagonism, hot flashes, night sweats, menopause, postmenopausal, women, perimenopausal, suvorexant, Hadine Joffe