This document discusses two case studies where the drug Lemborexant was used to treat insomnia. In the first case, a 23-year-old male patient was experiencing sleep disturbances like sleep talking and limb movements. Lemborexant reduced his symptoms and improved his insomnia. In the second case, a 63-year-old female developed insomnia after a stroke, and Lemborexant significantly improved her sleep initiation and maintenance. The document questions whether Lemborexant could be useful for other conditions like parasomnias and whether it is superior to melatonin for sleep maintenance.

1. Clinical experience of
Lemborexant
Dr. Balaji B S
Sakra World Hospital, Bellandur

2. Case 1
• 23 years male patient
• Diagnosed as Anxiety disorder/ Depression
Jun 2021
• Started on Desvenlaflexine 75 mg od.
• Complaints-
 difficulty in falling asleep (2-3 hours)
Frequency –almost every single day. Waking
up early morning.

3. • Started with melatonin 3 mg and clonazepam
0.25 mg at night.
• Taken for two months but symptoms
persisted.
• Neurology referral: (Aug,2021)
• Detailed discussion about the sleep
disturbances and symptoms with the parents -

4. • Sleep disturbances-sleep talking, involuntary
limb movements in sleep. Frequency -3 to 4
times a week.
• Daytime: tiredness, difficulty in concentration
• Medical : No h/o aches and pains
• No h/o drug/ alcohol abuse
• No significant past or family history

5. • Possibilty of
Periodic limb movements in sleep
Parasomnia.
• Polysomnography was advised for this
patient.
• PSG- no event suggestive of parasomnia/
PLMS during this recording.

6. • Tab lemborexant 10 mg once in night was
started( Melatonin was discontinued)
• After a month during follow up patient
reported
Sleep talking – significantly reduced
PLMS- reduced
Insomnia- better. Reduced time to fall
asleep(30- 45 minutes).

7. • He complained of mild drowsiness in the
morning.
• Discussed with the psychiatrist to stop
Clonazepam and observe.
• Patient is due to follow up after that

8. • Nil or very few reports about the use of
Lemborexant in Parasomnias.
• Should there be further research to expand
the clinical utility of Lemborexant for
Parasomnias or REM-BD.

9. Case 2
• 63 years female patient
• Left posterior circulation infarction
• MRI showed multiple embolic infarcts in left
cerebellar hemisphere, left midbrain,
hypothalamus.
• Was managed conservatively and recovered
well.

10. • about a month after recovery she developed
insomnia.
• Her complaints included difficulty to fall
asleep, on some days difficulty to maintain
sleep- she would wake up at around 2or 3 am
following which she had difficulty to fall
asleep again and on some days waking up very
early in morning 4 or 5 am.

11. • the cause of these sleep disturbances could
possibly be the hypothalamic infarct.
• She was started on lemborexant 10 mg. She
on follow up a month later reported that
though initial two weeks she did not
experience much benefit
• later- her insomnia is better. In terms of sleep
initiation and sleep maintenance; she had a
significant improvement.

12. • Melatonin is effective for sleep initiation
difficulty but its efficacy in sleep maintainence
is a bit less.
• Is Lemborexant superior to Melatonin , at
least theoretically.

13. Thank you