Managing Out-of-Body Experiences Caused by Dayvigo (Lemborexant)
Discontinue Dayvigo immediately and contact your prescribing physician, as out-of-body experiences represent dissociative symptoms that are a known adverse effect of orexin receptor antagonists and require medication cessation. 1
Understanding the Problem
Out-of-body experiences fall under the category of dissociative symptoms that can occur with lemborexant, similar to other reported perceptual disturbances including:
- Sleep paralysis 1
- Hypnagogic/hypnopompic hallucinations (hallucinations occurring while falling asleep or waking up) 1
- Complex sleep behaviors 1
These symptoms occur in approximately 2-5% of patients taking lemborexant, with higher rates at the 10 mg dose compared to 5 mg 1
Immediate Action Steps
Stop the Medication
Abruptly discontinue lemborexant without concern for withdrawal effects or rebound insomnia. 2 Clinical trial data demonstrates that:
- Less than 20% of patients experience significant worsening of insomnia symptoms after stopping lemborexant 2
- No withdrawal symptoms occur following discontinuation, even after 6-12 months of continuous use 2
- Sleep improvements are generally maintained throughout a 2-week off-treatment period 2
Contact Your Physician
Inform your prescribing physician immediately because:
- Dissociative symptoms like out-of-body experiences warrant medication discontinuation 1
- Your physician needs to monitor for emergence of depression or suicidal ideation, which can occur with lemborexant 1
- Alternative insomnia treatments should be considered 1
What to Expect After Stopping
Timeline for Symptom Resolution
Given lemborexant's pharmacokinetics:
- Peak blood concentration occurs 1-3 hours after dosing 1
- Half-life is 17-19 hours 1
- The medication should be substantially cleared from your system within 3-4 days after the last dose
The dissociative symptoms should resolve within several days as the medication clears your system. 1
No Withdrawal Concerns
Unlike benzodiazepines or other sedative-hypnotics:
- Lemborexant does not cause tolerance to sedation 1
- No withdrawal effects have been observed on discontinuation 1
- Rebound insomnia is unlikely to occur 2
Alternative Approaches for Insomnia
If you still need treatment for insomnia after stopping lemborexant, discuss these options with your physician:
- Cognitive behavioral therapy for insomnia (CBT-I) should be considered as first-line non-pharmacological treatment 3
- Lower dose trial: If lemborexant was beneficial aside from the dissociative symptoms, your physician might consider restarting at 5 mg instead of 10 mg, as adverse effects are dose-dependent 1, though this should only be attempted if the out-of-body experiences were mild and the benefit-risk ratio is carefully reconsidered
- Alternative medications: Other insomnia medications with different mechanisms of action may be appropriate 1
Important Safety Considerations
Do Not Drive or Operate Machinery
Until the dissociative symptoms completely resolve:
- Avoid driving or operating heavy machinery 1
- Ensure at least 7 hours have passed since your last dose before engaging in activities requiring full alertness 1
Monitor for Other Psychiatric Symptoms
Be alert for:
- Emergence of depressive symptoms 1
- Suicidal thoughts or ideation 1
- Worsening of any pre-existing psychiatric conditions 1
Seek immediate medical attention if you experience suicidal thoughts or severe mood changes. 1
Why This Happens
Lemborexant works by blocking orexin receptors (OX1R and OX2R) in the brain, which are involved in regulating the sleep-wake cycle 4, 5. While this mechanism effectively induces sleep, it can occasionally cause:
- Disruption of normal consciousness boundaries 1
- Perceptual disturbances during sleep-wake transitions 1
- Dissociative experiences in susceptible individuals 1
These effects are not due to improper use but represent an idiosyncratic reaction to the medication that necessitates discontinuation. 1