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Dear Pharmacist,

I can't sleep well and have taken Ambien for years. What else do you recommend?

--F.T., Bradenton, Florida

Answer:If you can't sleep on Ambien, I'd try something different. Another novel sleep drug is coming to the market called "Suvorexant" and so far, I like it. The Food and Drug Administration (FDA) is evaluating it right now.

Merck & Co is manufacturing the new drug, which supposedly does not induce memory loss, daytime fatigue or attention difficulties, all common side effects with benzodiazepines and Z drugs, which dominate the multi-billion dollar insomnia market. You know them by names like Ambien, Lunest, Sonata, Xanax, Valium and Halcion.

The drugs increase GABA levels, a neurotransmitter that induces sleep. Tickle those GABA receptors, and you will fall asleep, and likely have cognitive problems, full-body muscle relaxation, daytime fatigue and bizarre hypnotic events. Anything's possible. Suvorexant doesn't affect GABA at all, it reduces a hormone called orexin (a.k.a. hypocretin). This drug doesn't induce sleep, rather it turns off the switch that keeps you awake.

Interestingly, elevated orexin are common in those prone to panic attacks (Nature Medicine, 2010), but that is not Suvorexant's focus, it's marketed as a prescription sleep aid and will do very well. There are well-designed unbiased clinical trials to show orexin blockers improve sleep (and reduce panic). If you have sleep deprivation, it increases risk of depression, heart disease and infection so sleep any way you can.

Orexins keep you awake. If orexin levels suddenly drop, so do you, meaning you go to sleep! People with narcolepsy have swinging orexin levels. Contrarily, if orexin is high, you might feel panicky, anxious, wired or have insomnia. That's where Suvorexant works, it reduces orexin, and remember orexin keeps you awake. It's categorized as a "dual orexin receptor antagonist" or a "DORA blocker" for short. Dual because it blocks both OX1 and OX2 receptor sites.

How do you feel if you wake at 4 a.m. on your sleep medication? Researchers compared conventional GABA blockers to DORA blockers to find out. Monkeys given popular GABA blockers were much foggier, confused and slower to respond as compared to monkeys given a DORA blocker. We're not monkey's though the point is made.

Is Suvorexant the next best amazing sleep drug? Time will tell. So far, headache is the most commonly reported side effect. Always use the lowest effective dose and for short-terms. Never combine sleep drugs with sedatives or alcohol. Clean your bedroom, turn off lights and implement healthier sleep hygiene practices; go to my website to read about natural remedies if those interest you. One theoretical concern is narcolepsy. If you reduce orexin levels you will go to sleep. That's the point of the drug. Fortunately, late-stage clinical trials have not reported this side effect. More adverse reactions may trickle after the medication is launched. Sleep aids are for short-term use, they are not a forever thing.

Suzy Cohen

Suzy Cohen, is known as America’s Pharmacist. She has been a licensed pharmacist for 24 years and is a Functional Medicine practitioner. She’s the author of 6 books, including her most recent Amazon #1 best-seller, “Thyroid Healthy: Lose Weight, Look Beautiful and Live the Life You Imagine.”

She was the host of The Thyroid Summit which broadcast worldwide in June 2014. Suzy has been a syndicated columnist for 19 years reaching 20 million in circulation each week. She is a Huffington Post writer, and also hosts her own syndicated medical minute on TV. Suzy has been featured on The Dr OZ Show 6 times, and has appeared on The View, Good Morning America Health, The Doctors and hundreds of other networks. She is a member of The Institute of Functional Medicine, also the American Academy of Anti-Aging Medicine, The American Pharmacists Association and ILADS, the International Lyme and Associated Diseases Society. You can read free articles and receive your free newsletter by visiting her website,

Books authored by Suzy Cohen include:

  • Thyroid Healthy
  • Headache Free
  • Drug Muggers
  • Diabetes Without Drugs
  • The 24-Hour Pharmacist
  • Eczema: Itchin’ for a Cure (kindle only)
  • Understanding Pancreatitis & Pancreatic Cancer (kindle only)