Enhanced Brain Activity to Promote Insomnia and Other Chronically Innistered People in the 21st Century: A Search for New Ways to Help

Fortunately for Miranda and millions of others with chronic insomnia, new treatments are arriving. The emergence of a class of pharmaceuticals that induces sleep through a different brain pathway from existing drugs is a welcome development, and molecules in cannabis and specialized medical devices to promote sleep are also showing potential as sleep aids. Soon, those struggling with sleep could have a range of new options available to help.

Some studies suggest that insomnia can stem from a high level of underlying brain activity during sleep. This raises the question of whether reducing this activity could treat insomnia, says Ruth Benca, a psychiatrist at Wake Forest School of Medicine in North Carolina. Wearable devices that use mild electrical stimulation to increase brain activity are being tested by companies and research groups. Evidence suggests that some devices could increase the duration of deep sleep. Last June, for example, researchers at Elemind Technologies in Cambridge, Massachusetts, confirmed that auditory stimuli delivered in sync with specific brain-wave rhythms generated in a headband allowed people who usually struggle for more than 30 minutes to fall asleep to shave an average of 10.5 minutes off that time13.

A Digital Platform for Evaluating In-Person and Electronic Treatments of Insomnia Using Melatonin Receptors

Uptake among physicians has been slow so far, Krystal says. He said, “I imagine a world where digital care is the first stop, and if it’s not successful, you see a therapist.”

A few companies and health systems, including the US Department of Veterans Affairs and the Cleveland Clinic in Ohio, have also created or are developing digital platforms for delivering CBT-I. These apps take users through regimens that are tailored to their symptoms. SleepioRx, for example, is a 90-day digital programme that has had more than two dozen clinical trials and has shown efficacy as high as 76%. This includes helping people to fall asleep faster, sleep better throughout the night and feel better the next day. The programme was developed by Big Health in San Francisco, California. A 2024 meta-analysis of 15 studies that compare in-person and electronically delivered CBT-I concluded that the two approaches were equally effective12.

The search for more effective insomnia treatments continues in other realms, as well. Some research groups are experimenting with different receptors that they hope could lead to new classes of drugs. One of the brain’s melatoninreceptors, called MT2 has been homed in by a clinical psychiatrist and researcher at Canada’s McGill University. “We want to find an alternative mechanism without any addiction liability and with fewer side effects, especially for use in children and elderly people,” she says. The molecule that the team developed increased the time rats spent in deep sleep. Gobbi is aiming to conduct clinical trials in the next couple of years.

It’s not known what a safe and effective dose of cannabinoids is, and which cannabinoids promote sleep. The director of a foundation that studies cannabinoids says there’s no good evidence to support the idea that people are using the drug for insomnia.

DORA drugs are under investigation in other populations. Merck has sponsored investigator-led studies of suvorexant in people with insomnia as well as depression or substance-use disorders, and Idorsia is sponsoring studies of daridorexant’s safety and efficacy in sub-groups of people who have insomnia and other conditions.

The main drawback to DORA drugs, Buysse says, is not medical but financial: their high cost keeps them out of reach of many people who could benefit from them. “There are many patients I would like to prescribe these drugs for, but I know in order for them to get one of these medications we’ll have to go through trials of several other drugs before the request will be considered,” Buysse says. DORA drugs are only available in a few countries.

Failure of an Antihistamine for the Diagnosis of Chronic Insomnia: How an Insurance Company Can Help Cover Belsomra

It was the beginning of a years-long journey to find an effective sleep aid with no negative side effects. The first medication I tried was 50 milligrams of an antihistamine called hydroxyzine, prescribed to me after a five-minute telehealth appointment. It knocked me out, but left me so weak that I couldn’t get out of bed the next morning. I stopped taking it.

CBT-I also doesn’t work for everyone. Miranda has received talking therapy for over a decade, with limited success. “It only helps so much,” she says.

In the United States, about 12% of adults have been diagnosed with chronic insomnia — when a person struggles to sleep for more than three nights each week for at least three months, and experiences daytime distress as a result. Research suggests that the worldwide figure is 10–30%. It leads to a vicious cycle with other conditions, including chronic pain, depression and anxiety.

I held out hope that my health-insurance company, one of the largest in the United States, would eventually agree to cover Belsomra. The initial rejection note from the company said that they wanted me to try the cheaper drugs first and that they were also at risk of dependency. My PA and I worked together to make a case that there were no suitable prescriptions for them. And finally, in late March, we had success: the insurance company agreed to pay for Belsomra for the next year. Even with that coverage, however, I’m still required to pay a steep $150 for a month’s supply of the drug, which my pharmacist confirmed is normal for this medication. So, until a generic DORA drug comes out, this particular sleep solution will unfortunately be available only for those who have enough extra income to be able to pay for the privilege.

It shouldn’t be like this. Medical professionals should be in charge of the care of their patients because insurance companies should not be trying to make as much profit as possible from their clients who are already paying high premiums. However, until the system changes, millions of people will continue to take the same tortuous path that I have been forced onto, and resort to medications that might have harmful long-term effects while the most advanced therapies remain tantalizingly out of financial reach.

A Physician’s Assistant in the State of Colorado for COVID-19: An Empirical Journey Through the Dusty Cycle of Depression and Depression

I never had issues with sleep until the COVID-19 pandemic. A couple of months into lockdown in 2020, I found myself unable to fall or stay asleep. My worries played on an unstoppable loop, and the longer I lay in bed, the more anxious I became about not sleeping. I was left exhausted by this vicious cycle. I became depressed after a few months. The time had come for professional help.

I found a sympathetic primary-care provider in the form of a physician’s assistant (PA) — a licensed medical professional who, in some states, can prescribe medications but isn’t actually a physician. She asked questions about my life and listened to my problems. She agreed at the end of the visit that I should try bupropion. I was still having trouble sleeping, however, and my night-time anxiety spiked following the election. My PA said that we were getting a lot of messages. Buspirone was added to my daily regimen. I began to sleep better. Buspirone made me feel uninspired and deflated during the day. My PA suggested that, as long as I didn’t develop serious depressive thoughts, I should stick it out for a month to give my body time to adjust.

It took almost three weeks for me to receive the prescription, and my insurance would not cover it. There are not any generic DORA drugs. Thirty daily tablets of Belsomra was going to cost me an astronomical US$500. $150 off the bill was knocked off when I was desperate to get some sleep due to the fact that my pharmacist was able to find a coupon. I sucked it up and paid.