333. Evaluation of Daridorexant for insomnia in patients with mental health disorders within Vale Royal Community Mental Health Team (CMHT)

Abstract

Abstract Background One-third of adults in the general population experience insomnia at least once a week in western countries. Known data about the prevalence of insomnia suggests that around 50% of these people will have comorbid mental health disorders. Adequate treatment of insomnia is of a particular importance as studies have demonstrated reduction in stress, anxiety, rumination, depression, and psychotic symptoms following effective sleep intervention. Evidence also indicates an almost dose–response relationship as improvement in sleep quality correlates with mental health benefits. However, clinical audits continue to demonstrate lack of clinical attention to sleep treatment in patients with mental health disorders. Daridorexant was recently approved by the National Institute for Health and Care Excellence (NICE) for the management of long-term insomnia. Its novel mechanism of action as a dual orexin receptor antagonist is thought to reduce the risk of abuse and tolerance compared with conventional hypnotic agents. Aims & Objectives To assess the effectiveness of Daridorexant in reducing Insomnia Severity Index (ISI) scores in adults with comorbid mental health disorders under the care of a Community Mental Health Team (CMHT) over a 12-week treatment period. Method Data was collected prospectively between October 2024 and May 2025 within Vale Royal Community Mental Health Team (CMHT) as part of a clinical audit. Seventeen adults with secondary mental health diagnoses were included (13 females, 4 males). Patients had a range of mental health diagnoses including mood disorders, anxiety disorders, personality disorders and psychotic disorders. ISI scores were obtained during consultation when Daridorexant was prescribed. Follow-up ISI assessments were conducted after four weeks via telephone. Data were anonymised and summarised descriptively as part of routine clinical care. Results Baseline ISI scores ranged from 17 to 27. Five patients (29%) discontinued treatment before the four-week review; three due to perceived lack of efficacy and two because of side effects. Of the 12 patients who completed follow-up, all demonstrated improvement in ISI scores, with reductions ranging from 3 to 25 points. Eleven patients achieved a reduction of 7 points or more, representing a clinically meaningful improvement in insomnia severity (92% of completers; 65% of the total sample). Discussion & Conclusions Daridorexant was well tolerated and effective amongst patients with a variety of mental health diagnoses in a natural community setting. It produced clinically meaningful reduction in insomnia severity for those who completed follow-up. Improvement in sleep appeared to correlate with better mental health, daily functioning, and overall wellbeing, highlighting the value of sleep optimisation within mental health care. The small fraction of patients reporting lack of perceived efficacy might reflect expectation of rapid onset of action typically associated with traditional hypnotics. Daridorexant remains a promising option for managing insomnia in patients with complex mental health needs, particularly where traditional hypnotics may be less suitable. Further evaluation in larger cohorts and over longer periods will help clarify durability of benefit and allow for profiling patient groups most likely to respond.