Study: Online Reviews Link Lemborexant Side Effects to Discontinuation

Patients Report Severe Sleep Disruptions in Online Reviews of Lemborexant

“Felt paralyzed to move. Wanted to scream and could not make a sound,” one reviewer noted online about lemborexant, describing a terrifying encounter with sleep paralysis. That stark account forms part of a new analysis published in the journal Sleep Medicine, in which researchers examined 260 online reviews of lemborexant posted between 2020 and 2023. Investigators from the Rutgers Brain Health Institute, Virginia Commonwealth University, and the University of Sydney found that approximately 1 in 4 reviewers stopped or planned to stop taking the prescription insomnia medication.

• High Discontinuation Rates: Roughly 25 percent of reviewers in the study stopped or planned to stop taking lemborexant, frequently citing unexpected side effects rather than simple lack of efficacy.
• Specific Adverse Experiences: Sleep paralysis was reported in 40 percent of reviews from individuals who discontinued the drug, while vivid dreams and next-day grogginess also drove patients to abandon treatment.
• Clinical Trial Discrepancies: Controlled clinical trials show sleep paralysis and nightmares occurring in fewer than 3 percent of participants, highlighting a gap between regulated trials and real-world patient experiences.

Orexin Blockade and the Pathophysiology of Insomnia Treatment

Approved in the U.S. in 2019, lemborexant belongs to the newest class of insomnia medications, sold under the brand name Dayvigo. Rather than broadly sedating the brain like traditional sleeping pills, these compounds block signals from orexin, a chemical messenger responsible for maintaining wakefulness. Insomnia itself—defined as difficulty falling or staying asleep—affects roughly 30 percent of adults, according to established sleep research. While clinical trials demonstrated that lemborexant helped patients fall asleep faster and stay asleep longer than a placebo, real-world utilization patterns captured in public forums tell a more complex story of therapeutic outcomes and tolerability.

Vivid Dreams and Sleep Paralysis Drive Treatment Cessation

Ratings across the 260 analyzed reviews split sharply, with 1 being the most common score followed closely by 10. Roughly a third of reviewers stated the medication meaningfully improved their sleep, with one noting it felt like sleeping naturally as they once did. Conversely, those who stopped or planned to stop treatment frequently highlighted specific parasomnias. Sleep paralysis emerged in 40 percent of reviews from patients who discontinued the drug, compared to 15 percent among the rest. Abanoub J. Armanious, a pharmacoepidemiologist and neuropsychiatry researcher with the Rutgers Brain Health Institute and lead author of the study, noted that what surprised researchers most was how unsettling patients found certain side effects, meaning discontinuation was not simply about the drug failing to work.

Researchers Investigate Underlying Neurobiological Mechanisms

Scientists propose that the nightmares and episodes of sleep paralysis stem from the biological mechanisms of dreaming sleep, a phase during which the brain normally switches off most of the body’s muscles. Blocking orexin activity can increase the proportion of dreaming sleep, potentially allowing vivid dreams and muscle shutdown to spill over into conscious waking moments. Ongoing work at the Rutgers Brain Health Institute is investigating the potential repurposing of orexin-based sleep medications to treat sleep disturbances across a range of psychiatric conditions, including addiction. The study was funded in part by the National Institute on Drug Abuse, National Institutes of Health, under grant numbers DA045765 and DA063103, as well as a Horizon Fellowship from the University of Sydney.

Real-World Patient Feedback Contrasts With Controlled Trials

Despite the high incidence of side effects reported in online forums, researchers emphasized that self-selected reviews do not reflect the true population-wide frequency of these events, as individuals with extreme experiences are most likely to post publicly. In lemborexant’s two main clinical trials, which tracked all enrolled participants, fewer than 2 in 100 patients experienced sleep paralysis, and roughly 1 to 3 in 100 reported nightmares or abnormal dreams. Armanious explained that while a clinical trial can quantify how often side effects occur, it is less equipped to measure how much those effects matter to the individual living through them. Morgan James, senior author of the study, adjunct Assistant Professor at the Rutgers Brain Health Institute, and senior lecturer at the Brain and Mind Centre and School of Psychology at the University of Sydney, stressed that the differences in patient experiences show why clinicians must set proper expectations. Most reviewers who discontinued the drug had used it for less than a month, and anyone taking a prescribed sleep medication should consult a clinician before stopping or altering their treatment regimen.

Disclaimer: The information provided in this article is for educational and scientific communication purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical condition, diagnosis, or treatment plan.