CATEGORY: SLEEP & RECOVERY
Older adults with chronic insomnia who took a newer class of sleep medications—known as orexin blockers—slept roughly 20 to 34 more minutes a night than those given placebo, and spent up to 21 fewer minutes lying awake after first falling asleep, in a pooled analysis of five randomized trials covering more than 3,600 adults aged 65 and older, published in the journal Sleep.1 For a group in whom insomnia is common and the older generation of sleeping pills carries real risks, the analysis offers something scarce: evidence from trials, measured in plain minutes.
Switching Off “Awake” Instead of Forcing “Asleep”
Orexin is a brain chemical whose job is to keep you awake—a built-in stay-alert signal. The drugs in this analysis, including suvorexant, lemborexant and daridorexant, work by temporarily blocking that signal. That is a different approach from older sleeping pills such as benzodiazepines and the related “Z-drugs,” which push the whole brain toward sedation—something like dimming every light in the house—and which are linked in older adults to next-day grogginess, confusion and falls. An orexin blocker instead aims to switch off the one porch light that was keeping the house up.
Five Trials, a Sleep Lab and Two Ways of Counting Sleep
Researchers combined the results of five randomized trials—studies in which each participant was assigned by chance to take the drug or a placebo, the design that lets a result be credited to the drug itself—totaling 2,235 adults aged 65 and older on an orexin blocker and 1,409 on placebo. Sleep was measured two ways: objectively, in a sleep laboratory where sensors record brain activity through the night, and subjectively, through participants’ own sleep diaries. The trials ran from about two weeks to six months, with the pooled results centered on the one-month mark. One honest caveat from the authors: most of the underlying trials enrolled adults of all ages, and the older-adult results had to be pulled out separately.
Twenty-One Fewer Minutes Awake, Half an Hour More Asleep
On the laboratory measurements, the higher dose of daridorexant cut the time spent awake after first falling asleep by 21.2 minutes compared with placebo, and the lower dose by 13.0 minutes; participants on the lower dose also fell asleep about 9 minutes sooner. Lemborexant added 34.1 minutes of recorded total sleep—roughly a full sitcom episode’s worth. Participants’ own reports pointed the same way: by diary, daridorexant added about 20.5 minutes of nightly sleep and suvorexant between 16 and 23 minutes, depending on dose. Modest numbers, but for someone staring at the ceiling at 3 a.m., minutes measured in a lab are a more trustworthy currency than promises.
What the Side-Effect Tallies Showed
Daridorexant’s side-effect rates looked much like placebo’s, a profile the authors called favorable. Lemborexant and suvorexant produced more overall side effects than placebo—though without an increase in serious events. The authors are candid about the limits of the evidence: results varied considerably between studies on some measures, the trials lasted months rather than years, and evidence gathered specifically in older adults remains thin. The analysis measured sleep, not the outcomes that most worry clinicians about sedatives in this age group, such as falls and fractures, over the long term.
Where Therapy Still Fits
Medication is not the only route that has passed a randomized test in this age group. A 2025 trial of online cognitive behavioral therapy for insomnia—a structured program that retrains sleep habits and the thinking patterns that keep people awake—found that older adults who completed it were far more likely to see their insomnia lift than those given sleep education.2 The two approaches attack the same problem by entirely different routes, and the therapy option carries no drug side effects at all.
Key Takeaways
- Across five randomized trials of more than 3,600 adults aged 65 and older, orexin-blocking insomnia drugs added roughly 20 to 34 minutes of nightly sleep versus placebo and cut time awake after falling asleep by up to 21 minutes.
- Daridorexant showed side-effect rates similar to placebo; lemborexant and suvorexant caused more side effects overall, but serious events did not increase with any of the drugs.
- The trials lasted two weeks to six months, and most were not designed solely for older adults—so long-term evidence specific to this age group is still limited.
- In a separate 2025 randomized trial, structured online insomnia therapy also worked well for older adults, offering a drug-free route to the same goal.
References
- Rollo E, Antonioni A, Manzoli L, Di Lorenzo F, Flacco ME. Treatment of chronic insomnia in elderly adults with dual orexin receptor antagonists: a systematic review and meta-analysis. Sleep. 2026;49(8):zsag135. link
- Ritterband LM, et al. A randomized controlled trial of a digital cognitive behavioral therapy for insomnia for older adults. npj Digital Medicine. 2025;8(1):458. link