Sleeping Pill Belsomra Treats Insomnia With Risks

The pharmaceutical drug suvorexant—sold under the brand name of Belsomra—is a unique prescription sleeping pill that is used to treat trouble falling or staying asleep that characterizes insomnia. Learn about how it works and some of the side effects and risks associated with the use of Belsomra.

Couple in a bed, man is sleeping, woman is awake with insomnia
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Uses of Belsomra

Belsomra is a prescription medication that acts on the brain to reduce wakefulness and enhance sleep. It causes drowsiness and is effective for initiating and maintaining sleep. It is used primarily to treat insomnia. It seems to have modest benefits for most people with research suggesting that takers fall asleep 6 minutes faster and sleep only 16 minutes longer, compared to placebo.

How Does Belsomra Work to Treat Insomnia?

Belsomra is unique among sleeping pills in how it works. Approved by the U.S. Food and Drug Administration in 2014, it is the first in a class of medications that act as orexin antagonists. Orexin is a neurotransmitter, or chemical messenger, within the brain that promotes wakefulness. When it is blocked, as occurs with antagonists, sleep can result.

Belsomra is highly selective for signal receptors called OX1R and OX2R within the brain. By engaging with these receptors, it is able to block wake-promoting substances called orexin A and orexin B, which in turn suppresses the ability to stay awake. The symptoms of narcolepsy occur due to the permanent loss of these orexin-containing cells.

Who Should Not Use Belsomra?

There are certain people who should not use Belsomra or who should use it with caution. It should not be used if you have narcolepsy. It should be taken within 30 minutes of going to sleep and it should not be used if you cannot devote more than 7 hours to sleep.

Further caution is advised if you have a history of depression, mental illness, or suicidal thoughts. It should not be used in combination with alcohol or other drugs that suppress the central nervous system or respiratory system. If you have a history of substance abuse or addiction, you should not use it.

Those with lung or liver problems should be cautious in using it. Obese people and women may require lower doses to prevent side effects. Due to a lack of information about potential harm, it is not recommended to be used by pregnant or breastfeeding women.

What Are Common or Serious Side Effects of Belsomra?

There are many potential side effects of any drug. The most common side effect of Belsomra is sleepiness. Although an individual likely won't experience most serious side effects associated with the drug – and may indeed not have any of them – some that may occur with Belsomra include:

  • Drowsiness, lethargy, or a "drugged" feeling
  • Impaired alertness and coordination, including the risk of drowsy driving
  • Abnormal thinking and behavioral changes (outgoing or aggressive behavior, confusion, agitation, memory loss, anxiety, and hallucinations)
  • Worsening depression and suicidal thoughts
  • Complex sleep-related behaviors (driving, eating, sleep sex, etc.)
  • Sleep paralysis (inability to move during sleep transitions)
  • Temporary leg weakness (similar to cataplexy without a trigger)
  • Compromised breathing

What Safety Precautions Need to Be Taken With Belsomra?

Due to the unknown risks, Belsomra should be avoided in pregnancy and with breastfeeding. Certain individuals, as mentioned above, should use the medication with caution or not at all. There is no monitoring necessary for Belsomra's use. 

If you experience any difficulties, you should be in close contact with your primary health provider. You can use our Doctor Discussion Guide below to start that conversation.

A Word From Verywell

While Belsomra and other prescription sleep aids can be useful in some cases, they should

only be used once non-pharmalogical interventions are exhausted. The great majority of cases of primary insomnia will respond to approaches like keeping a consistent sleep routine, turning off blue-light-emitting devices at the end of the day, eliminating the TV from the bedroom, decreasing intake of caffeinated beverages starting in the afternoon, and cognitive behavioral therapy.

If pharmacological assistance is warranted after these interventions fail, it is important to know that newer agents like Belsomra have not been studied in comparison with other agents that have been around for decades, such as like trazodone or gabapentin, which have been used on- and off- label for insomnia, with the advantage that—unlike Belsomra and other similar agents—carry a very low risk of dependence, and rebound insomnia after stopping the pill doesn't happen.

Insomnia Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Woman
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2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Suvorexant. Aust Prescr. 2017;40(3):116-117. doi:10.18773/austprescr.2017.040

  2. Lee-iannotti JK, Parish JM. Suvorexant: a promising, novel treatment for insomnia. Neuropsychiatr Dis Treat. 2016;12:491-5. doi:10.2147/NDT.S31495

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