Sleepless nights for one Italian out of 5. 20% of the inhabitants of the Peninsula suffer from insomnia or other sleep disorders, a problem that afflicts over a third of the world’s population. Very often the discomfort is chronic – with persistent symptoms in 80% of cases one year after diagnosis and in 60% of cases after 5 years – and can be accompanied by psychiatric or psycho-emotional disorders, mainly depression and anxiety. A domino effect that Covid has also helped to trigger, between lockdowns and confinements that have fueled anxiety problems, mood disorders, post-traumatic stress paintings, alcohol addictions. To regain lost sleep, a new drug in tablet form is available which acts on orexin, the ‘conductor’ of the sleep-wake rhythm, practically ‘resetting’ the biological clock. This was discussed in one of the main scientific sessions of the 24th National Congress of the Italian Society of Neuropsychopharmacology (Sinpf), underway in Milan and Venice.
The new molecule is called daridorexant and belongs to the Dora family (Dual Orexin Receptor Antagonists), the experts explain. In other words, it is a new antagonist capable of acting on the neurotransmitter orexin, blocking its activity on the two most important receptors. Its effectiveness is confirmed by two studies recently published in ‘The Lancet’ and ‘Sleep Journal’. Daridorexant ‘targets’ a different target than those of traditional medicines, regulating altered sleep-wake cycles in those with sleep problems and thus also improving daytime performance. All this in the face of a favorable safety profile and a reduction in adverse effects. “A quantum leap in the treatment of insomnia,” assure the specialists.
“Insomnia is defined as dissatisfaction with the quantity or quality of sleep, associated with difficulty in initiating and maintaining sleep for at least 3 months – says Claudio Mencacci, director emeritus of psychiatry at the Fatebenefratelli hospital in Milan and co-president of Sinpf – Sleep is therefore disturbed by frequent awakenings or by problems falling asleep again after awakenings, with a consequent impact on daytime hours: drowsiness, hyperactivity and a general deterioration in the quality of life are the most evident consequences”.
“In some cases, insomnia can also be recognized as a symptom of some psychiatric disorders. In this case – specifies the expert – the causes can be attributable to various factors: a misalignment of the sleep-wake rhythm with respect to a rhythm considered normal, due, for example, to changes in time zones, work shifts or other causes; a phase shift in the biological rhythm, as the primary cause, typical, for example, of those suffering from sleep-wake rhythm irregularities; a delay or an advance of the sleep phase , which respectively induce an initial insomnia or an evening drowsiness with an early awakening in the morning, a sleep-wake rhythm different from the 24 hours, with a delay of 1-2 hours which adds up from day to day with inevitable consequences. , altered sleep cycles can also be due to situational insomnia, when, for example, reactive insomnia tends to be resolved by indulging in one’s physiological times of falling asleep and waking up morning, regardless of the conventional hours”.
“For all these contexts – highlights Matteo Balestrieri, full professor of Psychiatry at the University of Udine and co-president of Sinpf – today we have ad hoc therapies which, thanks to the different plurality of actions, allow to modulate and personalize the treatment. For example, by packaging a therapy according to the presence of comorbidities of anxiety and depression; of the duration of insomnia, choosing drugs that are not addictive in the long term; of the patient’s age, for example using drugs that do not compromise daytime ability in the elderly. The new drugs that act by antagonizing orexin, of which today thanks to the extension of the prescribability the psychiatrist can also take advantage of, allow to obtain efficacy benefits in the face of the containment of the often very high social and welfare costs of insomnia”.
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