When do you consider using dual orexin receptor antagonists (DORAs) for the treatment of insomnia?

I only consider using any hypnotic in insomnia when the patient is getting only 5 hours or less of sleep. In those cases, I will sometimes try using DORAs. I am a sleep neurologist who sees patients with MCI/early dementia, and I have found these medications useful in this population of patients wit...

My typical algorithm is:

• Screen for alcohol use and work towards cessation.
• Reduce/eliminate heavy marijuana use.
• Sleep hygiene counseling and information handout.
• Consider/recommend CBT-I, which may also diagnose and clarify comorbid anxiety spectrum disorder that needs to be addressed and treated...