Reasons and countermeasures for Lemborexant failure on the third day after taking it

When some patients with insomnia take Lemborexant, they will experience a situation where "it is effective on the first night but begins to feel ineffective on the third day." This is a common phenomenon in the field of sleep medicine and does not mean that the drug is ineffective. The root causes are often related to circadian rhythm adjustment, fluctuations in psychological expectations, differences in drug metabolism, and irregular sleep behavior. In the early days of taking the drug, the body's waking system is suppressed, and the experience of falling asleep may be significantly improved. However, as the self-regulation ability of the nervous system is activated, fluctuations occur on the third and fourth days, which is a typical adaptation process.

The mechanism of orexin antagonists is not to force sedation but to gradually reduce wakefulness drive, so it takes days to weeks to fully match the individual sleep cycle. If the patient has long-term sleep irregularities, such as strong light stimulation, frequent use of electronic devices, persistently high anxiety thoughts, etc., it will take longer for the drug to show a stable effect. Some patients may misjudge a slight delay in falling asleep as a "failure" due to their high initial expectations, thereby aggravating their anxiety and making it more difficult to fall asleep.

Drug metabolism factors may also contribute to the decreased experience on the third day. Leborex is metabolized by the liver. If used together with drugs that affect metabolic enzymes, such as some antibiotics, herbal preparations, or mood-treating drugs, the effective concentration in the body may fluctuate, thus affecting sleep quality. Such situations require a professional doctor to check whether there is any interaction between the drugs and adjust the medication time or dosage if necessary.

In view of the "third day failure" phenomenon, countermeasures include extending the observation period, maintaining a fixed medication time, avoiding long naps during the day, and reducing bright light and stimulation before going to bed. Deep breathing or mild relaxation training can be used before going to bed to reduce nervous system tension and make the drug effect more stable.

Reference materials:https://medlineplus.gov/druginfo/meds/a620039.html