About one in four people who posted online reviews of the prescription insomnia drug lemborexant said they had stopped taking it or were planning to stop, according to researchers from Rutgers and other universities who analyzed hundreds of those reviews. The team, drawing on Rutgers Brain Health Institute, Virginia Commonwealth University and the University of Sydney, found that the reviewers who walked away from the medication more often described frightening nights and groggy mornings than those who kept taking it. The findings, published in the journal Sleep Medicine, offer a rare window into how patients experience a newer class of sleep drug in everyday life, outside the controlled setting of a clinical trial, and they highlight side effects that some users found deeply unsettling even when the medication itself helped them sleep.
Lemborexant, sold under the brand name Dayvigo, belongs to the newest class of insomnia medicines. It was approved in the United States in 2019, and it works differently from many older sleeping pills. Rather than broadly sedating the brain, drugs in this class block signals from orexin, a chemical messenger that helps keep people awake. In clinical trials, lemborexant helped people fall asleep faster and stay asleep longer than a placebo. The condition it treats is far from rare: insomnia, meaning difficulty falling or staying asleep, affects roughly 30 percent of adults according to prior sleep research. Ongoing work at the Rutgers Brain Health Institute is also investigating whether orexin-based sleep medications might be repurposed to treat sleep disturbances in a range of psychiatric conditions, including addiction.
To learn how patients experience the drug in ordinary circumstances, the research team analyzed 260 online reviews of lemborexant posted between 2020 and 2023. Team members classified 70 of those 260 reviewers as having stopped the medication or as planning to stop. The reviewers who quit or intended to quit were less likely to say the drug had helped them, yet they were about as likely as everyone else to complain of poor or broken sleep. What most clearly set them apart was not whether the medication put them to sleep, but what happened while they slept and how they felt the next morning. Side effects, the analysis suggests, were the decisive factor in many decisions to discontinue treatment.
The ratings themselves split in a striking pattern. Across all reviewers, the most common score was 1 out of 10, followed closely by 10 out of 10, with little middle ground between the two extremes. Roughly a third of reviewers said the drug meaningfully improved their sleep, while half reported little or no benefit and two-thirds mentioned at least one side effect. That polarization is one of the study’s most notable features: the same medication, taken for the same condition, produced experiences that reviewers described in dramatically different terms, ranging from restorative natural sleep to nights they described with alarm.
Those extremes are visible in the reviewers’ own words. One person, rating lemborexant 10 out of 10, wrote online that it felt like sleeping naturally, the way they had once upon a time. Another reviewer gave the identical drug a 1 and described a very different night. Felt paralyzed to move, the reviewer wrote. Wanted to scream and could not make a sound. Was able to touch my husband’s arm and waken him. He said he never saw such terror in my eyes. That reviewer was describing sleep paralysis, a temporary state of being awake but unable to move or speak, an experience that recurred throughout the reviews as a reason for abandoning the medication.
Sleep paralysis appeared in 40 percent of reviews from people who stopped or planned to stop taking lemborexant, compared with 15 percent of the remaining reviewers. Vivid dreams and nightmares were also more common among those who discontinued, as was next-day grogginess. Many reviewers said side effects were what drove them to stop. The dreams, the nightmares, are very vivid, one reviewer wrote, and that is the reason I can no longer take this medication. Abanoub J. Armanious, a pharmacoepidemiologist and neuropsychiatry researcher with the Rutgers Brain Health Institute and lead author of the study, said what surprised the team most was how unsettling some patients found certain side effects. For these individuals, he said, stopping the medication was not simply about it failing to improve sleep.
There is a plausible biological explanation for why an insomnia drug might produce nightmares and sleep paralysis. One proposed mechanism involves dreaming sleep, the stage in which the brain normally switches off most of the body’s muscles, a state known as muscle atonia. Blocking orexin can increase the amount of dreaming sleep a person gets. That increase may allow the features of dreaming sleep, vivid dreams and the shutdown of voluntary muscles, to spill over into waking moments, producing the sensations of paralysis and terror that some reviewers described. The proposed explanation connects the drug’s intended mechanism, dampening the orexin signals that promote wakefulness, with the unintended intrusion of sleep-state physiology into consciousness.
The study’s senior author, Morgan James, an adjunct assistant professor at the Rutgers Brain Health Institute and a Horizon Fellow and senior lecturer at the Brain and Mind Centre and School of Psychology at the University of Sydney, emphasized that lemborexant was reported to work very well for some people. Not every dream reported in the reviews was unwelcome, either. One reviewer, who rated the drug a 9, looked forward to what they called wild crazy dreams. But the overall picture was more complicated: about one in five reviewers brought up sleep paralysis, and nearly a third described vivid dreams or nightmares. In lemborexant’s two main clinical trials, which tracked everyone enrolled, fewer than 2 in 100 participants taking the drug experienced sleep paralysis, and about 1 to 3 in 100 reported nightmares or abnormal dreams.
The researchers were careful to note the limits of what online reviews can show. The numbers cannot indicate how common any of these experiences are among all users, because people with the best or worst experiences are the most likely to post about them, a selection effect that skews the sample toward extremes. A clinical trial, Armanious explained, can tell you how often side effects occur, but it is less equipped to tell you how much that side effect matters to the person living it. A side effect can be rare, he said, and still be the reason someone discontinues treatment. That distinction between frequency and personal impact is central to the study’s contribution, since trials measure the former while patient reports illuminate the latter.
Timing also mattered in the analysis. Most reviewers, especially those who stopped or planned to stop, had used the drug for less than a month, while longer-term users generally rated it higher, though the study cannot say why that pattern exists. The researchers said they hope people will learn about these side effects without being alarmed, and they stressed that anyone taking a prescribed sleep medication should talk with a clinician before stopping or changing it. James said what really stands out is how different people’s experiences with this medication can be, which highlights the importance of setting expectations and finding the right treatment for the individual. The research was funded in part by the National Institute on Drug Abuse, part of the National Institutes of Health, through grant numbers DA045765 and DA063103, as well as by the University of Sydney through the Horizon Fellowship. The content, the authors note, is solely their responsibility and does not necessarily represent the official views of the National Institutes of Health.
Subject of Research: Patient-reported experiences and discontinuation of the insomnia medication lemborexant
Article Title: Why some patients quit a newer insomnia medication
Article References: Why some patients quit a newer insomnia medication. Original publication (Bibliographic details unavailable.)
Image Credits: AI Generated
DOI: Not provided
Keywords: lemborexant, insomnia, sleep paralysis, orexin, side effects, drug discontinuation, Sleep Medicine, Rutgers, patient reviews, nightmares, Dayvigo, pharmacoepidemiology
News Source: Ophelia Keating. (October 30, 2026). Frightening Nights and Groggy Mornings Drive Some Patients to Quit Lemborexant. Scienmag.
