The Oxford study revealed the best treatment for sleep problems

The Oxford study revealed the best treatment for sleep problems

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The silver solution against insomnia: Oxford chooses the best treatment for sleep problems

According to the Brazilian Sleep Society (ABS), 73 million Brazilians suffer from insomnia. Treatment varies, and may only include routine changes, such as regular sleep, or in more serious cases, the help of properly prescribed medications.

However, while necessary, it does not always mean putting an end to the problem. This is because many of the drugs available today have serious side effects, such as addiction or even long-term deterioration of sleep.

This reality requires new alternatives, which constitute the so-called new generation of insomnia treatment. One promising drug is lemborexant, sold under the brand name Dayvigo in the United States, which was approved by the Food and Drug Administration (FDA), the country’s regulatory agency, in 2019.

The drug was best listed for efficacy, acceptability and tolerability by a comprehensive review of studies of 36 drugs conducted over more than four decades. The work, by researchers at the University of Oxford, was published in the scientific journal The Lancet.

It should be noted that limporexant works through a different pathway in the brain, the orexin (hypocretin) neurotransmitter system, which is a new mechanism of action. More selective targeting of this pathway and the orexin receptor could lead to better drug therapies for insomnia.”

The drug, a new alternative for people with this disorder, is about to arrive in Brazil. GLOBO, the drug company responsible for lemborexant, the Japanese company Eisai, has sought that the drug has already been analyzed by Brazil’s national health monitoring agency, Anvisa, since 2021, and may reach pharmacies as early as next year.

“Reviewing the data is taking longer than expected due to the pandemic and the agency’s priority in reviewing and approving vaccines and drugs for the prevention and treatment of Covid-19. While we want approval faster, we understand the situation.” At the moment, we estimate that lemborexant will be approved in early 2023. Eisai has plans to make the drug available in the country within the next year,” says the pharmacist in charge and director of quality assurance at the Brazilian branch of Eisai, Luiz Silva.

New generation is welcome

For neurologist Dalva Poyares, professor of sleep medicine at the Federal University of São Paulo (Unifesp), the arrival of the alternative to the market is welcome, given the large number of people suffering from the disease in the country.

“We have to expand our options. Insomnia is very prevalent in the population, so the more safe drug options the better. And the new generation is already hypocretin, and they are developing more and more. I currently have 10 patients in the US using the drug, and reports of good tolerance, It has little residual effect in the morning and is safe. So it appears to be a great option for insomnia in the medium term,” says Boyaris.

Neurologist Rosana Alves, sleep specialist at Grupo Fleury, explains that Hypocretin, as newer drugs are classified, works through a system in the brain that differs from traditional medications.

“Hypocretin is a neurotransmitter whose main role is in maintaining alertness and wakefulness. So blocking this neurotransmitter increases and induces sleep. We will see in the coming years how the drug will work better, but its effects are promising,” he says. The specialist, who is a member of the Brazilian Sleep Society (ABS).

Regarding the drugs most used today in Brazil, the benzodiazepines, Dalva explains that they work in the opposite direction. Rather than inhibiting wakefulness, they stimulate a neurotransmitter called GABA, which promotes reduced nervous system activity and the consequent hypnotic effect.

Since its discovery in the 1960s, it has become one of the best-selling classes of drugs and is also used to treat anxiety.

“However, benzodiazepines cause dependence and in the long run favor cognitive deficits. So it is dangerous, even if in excessive amounts,” the doctor warns.

This is because although it has a good curative effect to induce sleep, its use should not exceed four weeks, and it should not be carried out without medical supervision. In addition, when mixed with alcohol or taken in excessive amounts, the drugs can cause respiratory arrest.

From the 1980s onwards, when these adverse effects began to be reported, the drug “declassification” movement began, to reduce the number of people dependent on them. However, to date, the use of drugs is higher than recommended.

Part of these efforts have been intensified with the arrival of Z drugs, which are drugs that also act on GABA, but are more specific because they target only one subunit of the neurotransmitter.

In fact, the profile is more favorable – an Oxford review indicated one of them, ezopiclone, as one of the options with the best results after lemborexant. However, in the long run, it can also cause dependence.

“One of the biggest concerns of these hypnotics is that the more effective and specific they are, the more likely adverse events will occur, such as falls in the elderly, mental confusion and intolerance. Over time, a person may have more difficulty falling asleep,” explains Dalva.

Medicines are necessary, but they are not the first choice

Therefore, Rosana, from ABS, stresses that treating insomnia is always a priority through non-pharmacological measures. Medicines are effective and important, but they should not be the first alternative, and they can only be taken under the guidance of specialists.

“Healthy sleep techniques, such as regular sleep schedules, avoiding electronic devices before going to bed, and not consuming energy drinks, among others, as well as relaxation techniques and cognitive behavioral therapy are always the first bet for solving the problem,” says the neurologist. .

She also explains that the arrival of lemborexant, although encouraging, should not be seen as a solution to the problem of insomnia.

“Every time we have a new drug, we have to be careful that it doesn’t look like a miracle. In most cases of insomnia, you need to identify its causes and avoid long-term drug use. This new class of drug seems promising. But we have to wait as time goes on.” Rosanna says.

Experts explain that insomnia is characterized by sleep difficulties that lead to problems with memory, concentration, concentration, daytime sleepiness and irritability leading to personal and occupational damage. In the long run, insomnia also increases the risk of cardiovascular disease and metabolic diseases such as diabetes and obesity.

Neurologists say that there are factors, such as stressful situations at work or in the family, that can lead to insomnia, but there are genetic elements that lead to this predisposition to wakefulness.

One way to determine if sleep problems could be a symptom of insomnia, rather than just a temporary one, is to monitor whether they occur at least three times a week over a period of at least three months.

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