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/recommended CBT-I which may also dx and clarify comorbid anxiety spectrum disorder that needs to be addressed and treated.

-melat...