From the Guidelines
Lemborexant can be used for circadian rhythm disorders, though it's primarily FDA-approved for insomnia treatment. For circadian rhythm disorders, lemborexant (brand name Dayvigo) may be prescribed off-label at doses of 5-10 mg taken 30 minutes before bedtime. The medication works by blocking orexin receptors, which helps regulate the sleep-wake cycle by inhibiting wakefulness signals in the brain. This mechanism makes it potentially useful for conditions like delayed sleep phase disorder or shift work disorder where sleep timing is disrupted. Treatment duration varies based on individual response and the specific circadian disorder being treated. Patients should be aware that common side effects include headache, drowsiness the next day, and abnormal dreams. It's essential to avoid alcohol while taking lemborexant, as this can increase sedation. The medication should be used as part of a comprehensive approach that includes good sleep hygiene practices and, when appropriate, light therapy to help reset the body's internal clock, as suggested by the American Academy of Sleep Medicine clinical practice guideline 1. Key considerations in treating circadian rhythm disorders include the timing and duration of light exposure, the use of melatonin or melatonin agonists, and the potential benefits of behavioral interventions, such as maintaining a consistent sleep schedule and avoiding stimulating activities before bedtime. However, the provided evidence does not specifically address the use of lemborexant for circadian rhythm disorders, highlighting the need for further research in this area. In clinical practice, the decision to use lemborexant for circadian rhythm disorders should be based on a thorough evaluation of the patient's individual needs and circumstances, taking into account the potential benefits and risks of treatment. Ultimately, a comprehensive treatment plan that incorporates multiple strategies, including medication, behavioral interventions, and light therapy, is likely to be the most effective approach for managing circadian rhythm disorders.
From the Research
Lemborexant for Circadian Rhythm Disorder
- Lemborexant has been studied as a potential treatment for irregular sleep-wake rhythm disorder (ISWRD) in patients with Alzheimer's disease dementia 2.
- The study found that lemborexant improved circadian rhythm parameters, including least active 5 hours (L5) and relative amplitude of the rest-activity rhythm (RA), compared to placebo 2.
- Lemborexant also reduced restlessness and improved distinction between night and day, suggesting its potential utility in treating ISWRD 2.
- However, the study was limited to patients with ISWRD and Alzheimer's disease dementia, and its findings may not be generalizable to other populations with circadian rhythm disorders.
- Other studies have investigated the role of melatonin in circadian rhythm regulation and its potential as a treatment for circadian rhythm sleep disorders 3, 4.
- While lemborexant has been approved for the treatment of insomnia, its use in circadian rhythm disorders is still being investigated, and more research is needed to fully understand its efficacy and safety in this context 5, 6.
Key Findings
- Lemborexant improved circadian rhythm parameters in patients with ISWRD and Alzheimer's disease dementia 2.
- Melatonin plays a crucial role in regulating circadian rhythms, and its dysregulation is associated with circadian rhythm sleep disorders 3, 4.
- Lemborexant is a dual orexin receptor antagonist that has been approved for the treatment of insomnia, but its use in circadian rhythm disorders is still being investigated 5, 6.