Suvorexant and Trauma Related Insomnia

GHUCCTS2015-1333

Problems sleeping are common after exposure to highly threatening experiences and can occur with and without a diagnosis of posttraumatic stress disorder (PTSD). Established treatments for PTSD are limited for addressing insomnia and many insomnia treatments appear to be limited in the context of PTSD. Suvorexant is FDA approved for insomnia and among approved drugs has a unique mechanism of action that may be well suited for targetting arousal at night dysregulated by trauma. The investigators will evaluate the efficacy of suvorexant for insomnia that developed in relation to trauma exposure, utilizing a placebo control, and polysomnography to identify biomarkers of response, in a six week trial.

2016-05-01

2021-04-30

2021-04-30

Completed

Early phase I

41

Inclusion Criteria: * Physically healthy adults age 18-55 who meet DSM-5 criteria for insomnia and Criterion A (exposure to a traumatic event) for PTSD. The index trauma must have occurred within the past 5 years and at least 3 months before enrolling, and insomnia symptoms must have started or worsened after the exposure to the index trauma Exclusion Criteria: * Psychiatric disorders other than insomnia, PTSD and specific phobias; including bipolar and psychotic disorders and meeting criteria for DSM-5 moderate alcohol or drug use disorders within the past year. * Diagnosis of a sleep disorder other than insomnia including PSG findings of apnea/hypopnea or periodic limb movement indices \> 10/hour; * Medical conditions that require consistent use of medication or compromise sleep; * History of moderate to severe traumatic brain injury or mild traumatic brain injury with ongoing post-concussive symptoms; * Suicidal ideation with intent to act or with specific plan and intent in the past 6 months (Type 4 - 5 ideation on the Columbia Suicide Severity Rating Scale) or a concerning history of prior suicidal behavior. * Caffeine use exceeding 5 cups of coffee per day or its equivalent; * Habitual bedtimes after 3 AM, habitual rise times after 10 AM, or habitual napping \> 1hour/day; * Pregnancy or breastfeeding, or expecting to conceive while in study; * Positive urine toxicology.

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2023-02-15