Outsmarting Sleepless Nights: A Veteran’s Guide to the New Class of Sleep Meds—DORAs
- Matthew Feehan
- Oct 23
- 7 min read
If you’re a veteran struggling with insomnia, nightmares, or just plain hyperarousal at night, you’re not alone. PTSD-related sleep problems are one of the most common and stubborn issues facing post-9/11 veterans. But what if there was a new class of medications that didn’t just knock you out cold—but actually targeted the brain's overactive wakefulness system? And what if your doctor—even your VA pharmacist—had never heard of them?
Welcome to the era of DORAs: dual orexin receptor antagonists.
These medications are changing the game—and the VA is finally taking notice.
AUTHOR'S NOTE: Matthew Feehan, J.D., is not a medical doctor, and the information provided in this article is for general informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult your physician or qualified healthcare provider regarding any medical condition or treatment options. This is not a sponsored post; the author has received no compensation, financial or otherwise, from any pharmaceutical company, manufacturer, or third party in connection with the content of this article.
What Are DORAs?
DORAs work differently than old-school sleep drugs. Instead of sedating your entire nervous system, they block the brain chemicals (orexins) that keep you wired and hyper-alert. For veterans with PTSD, that means potentially better sleep, fewer side effects, and less next-day grogginess. Why potentially? because DORAs are still being studied.
There are three main FDA-approved DORAs:
Suvorexant (Belsomra), developed and manufactured by Merck & Co., Inc. It was the first DORA approved by the U.S. Food and Drug Administration (FDA) for the treatment of insomnia, receiving FDA approval in August 2014.
Lemborexant (Dayvigo), developed by Eisai Co., Ltd., a Japanese pharmaceutical company. It was approved by the U.S. Food and Drug Administration (FDA) in December 2019 for the treatment of insomnia, specifically for difficulties with sleep onset and/or sleep maintenance.
Daridorexant (Quviviq), was developed by Idorsia Pharmaceuticals, a Swiss biopharmaceutical company based in Allschwil, Switzerland. It received FDA approval in January 2022 for the treatment of insomnia characterized by difficulties with sleep onset and/or sleep maintenance. Daridorexant is the most recent dual orexin receptor antagonist (DORA) to enter the U.S. market.
Why Haven’t Veterans Heard About These?
One.
Because they’re new. The newest, Daridorexant, was approved in 2022 and because the VA formulary is often slow to update. Some VA pharmacists can be overly cautious gatekeepers (or "badge protectors" as some veterans know them as)—especially when a new med isn’t widely known, is costly, or has prescribing criteria attached. Even many primary care docs and psychiatrists haven’t gotten formal training in this class of medicine yet, which is odd—as many psychiatrists within the U.S. Department of Veterans Affairs (VA) system are well known for jumping straight to off-label use of anti-psychotics and anti-depressants for treatment of conditions other than their intended use. (Cohen BE et al.), “Antipsychotic Prescriptions in Iraq and Afghanistan Veterans with PTSD,” Journal of Clinical Psychiatry (2015). DOI: 10.4088/JCP.13m08857
Two.
Because they're expensive. According to Drugs.com, a month of 20 mg Belsomra tablets come out to $462.70, compared to a month of 150 mg Trazadone tablets (an antidepressant often prescribed off-label for insomnia) at just $11.39. In other words, it's cheaper for the VA to prescribe an anti-depressant for insomnia than a DORA for insomnia.
Likewise, thirty rounds of 40 mm M781 training grenades could cost the Department of Defense (DoD) approximately $150 on the low end (more likely about $400) and would only qualify two shooters through an M203 or M320 day-fire. Scaling up, getting an infantry company through a single day-and-night qualification with their grenade launchers could cost the U.S. government roughly the same amount it would take to treat 24 veterans’ insomnia with a month’s supply of Belsomra.
Bottom line: to a non-MD analyst staring at an Excel screen in D.C. (and not the veteran patient in front of them), $462.70 is a larger number than $11.39.
Three.
Because the VA’s bureaucratic culture rewards risk avoidance (the "easy button"), not innovation. When a new drug hits the market, it must survive multiple layers of approval—pharmacy, formulary, and regional VISN review—before most veterans will ever hear about it. Many clinicians know that prescribing outside of those lanes invites extra paperwork and scrutiny, so they default to the “safe” choice: another round of trazodone or quetiapine, even when better potentially 'better' options exist.
Still, every large system has its innovators and champions. Some of the most forward-thinking and compassionate researchers in the country work within those same walls—scientists who refuse to accept “good enough” when it comes to veterans’ health. One of them is Dr. Sabra Inslicht, a VA principal investigator whose groundbreaking research is helping veterans reclaim what PTSD too often steals: the ability to sleep.
The Groundbreaking Scientist Who’s Restoring Peace to Veterans, One Night at a Time.
Dr. Inslicht has been conducting human clinical research on the psychobiology of PTSD for the past 20 years, serving as Principal Investigator on projects sponsored by the Departments of Defense, Veterans Affairs, and the National Institute of Health.
Her research goals are:
to identify psychobiological causes and consequences of traumatic stress symptoms;
to characterize sex differences in the biology of PTSD; and
to develop drug treatments that have potential for facilitating fear extinction and improving the treatment of PTSD.
"She has led clinical studies using a human laboratory paradigm to examine fear conditioning in PTSD and has examined complex steroid pathways, reproductive hormones, and immune function. Her ultimate goal is to use the knowledge gained on the neurobiology of PTSD to inform novel interventions for ameliorating prolonged posttraumatic stress responses. The possibility that there may be sex differences in the neurobiology of PTSD may lead to more tailored treatments for men and women." University of California San Francisco.
That drive to bridge neuroscience and veteran care has led Dr. Inslicht to partner with Dr. Robin Hurley of the VA’s Salisbury research program on a landmark bi-coastal study exploring new treatments for PTSD and insomnia. Building on that mission, their collaboration—uniting the San Francisco VA Health Care System and the W.G. (Bill) Hefner VA Medical Center—represents one of the most promising efforts yet to translate decades of laboratory research into real-world relief for veterans battling the invisible wounds of war.
The DORA Trial: VA Researchers Explore a New Frontier in PTSD Treatment
For far too many combat veterans, the war doesn’t end when the uniform comes off—it just moves to the bedroom. Post-traumatic stress disorder (PTSD) often brings with it a relentless mix of hyperarousal, nightmares, and broken sleep. The result is more than exhaustion—it’s a chain reaction that hits concentration, memory, and physical health, fueling everything from inflammation to cardiovascular disease.
At the heart of this new VA study is a simple but groundbreaking question: what if improving sleep could also heal PTSD itself?
Dr. Sabra Inslicht of the San Francisco VA Health Care System and Dr. Robin Hurley of the W.G. (Bill) Hefner VA Medical Center in North Carolina are leading the first-ever VA clinical trial testing suvorexant, a medication that targets the brain’s orexin system—the same system that regulates both wakefulness and stress. Suvorexant, already FDA-approved for insomnia in civilians, blocks the wake-promoting orexin neuropeptide. Early data suggest it helps people fall asleep faster, stay asleep longer, and wake feeling more rested—all without the heavy side effects or dependency risks of traditional sedatives.
This multi-site, double-blind, placebo-controlled clinical trial will test whether suvorexant can safely reduce trauma-related insomnia and, over time, ease broader PTSD symptoms. Veterans enrolled in the 12-week study will be randomly assigned to suvorexant or placebo, with dosages gradually increased during the first two weeks and maintained for the following ten. Researchers will track changes in sleep patterns, nightmare frequency, and PTSD symptom severity using validated clinical measures like the Insomnia Severity Index (ISI) and the Clinician-Administered PTSD Scale (CAPS-5).
Beyond the data points, the goal is profound: to determine whether restoring healthy sleep might also quiet the hyperactive fear circuits that keep trauma alive. If the results are positive, this study could set the stage for a safer, non-stigmatized treatment—one that works through biology, not sedation.
Study Timeline and Status
Study Start: August 30, 2019 (Actual)
Record Verification: July 2025
Overall Status: Recruiting
Primary Completion (Estimated): December 31, 2025
Study Completion (Estimated): December 31, 2025
First Submitted: August 20, 2018
First Posted: August 22, 2018
Last Update Posted: July 18, 2025
The study is currently in its final recruitment and data-collection phase, with results expected in early 2026. If successful, this trial could become the cornerstone for how the VA approaches PTSD-related insomnia nationwide. National Library of Medicine, Clinical Trials.
Where Veterans Can Participate in the Study (CA, NC, SC)
Long Beach, California, United States, 90822
Status:
Recruiting
Facility:
VA Long Beach Healthcare System, Long Beach, CA
Contact:
Contact
Michael Hollifield, MD
562-967-0115
San Francisco, California, United States, 94121-1563
Status:
Recruiting
Facility:
San Francisco VA Medical Center, San Francisco, CA
Contact:
Contact
Sabra S Inslicht, PhD
415-221-4810, 3341
Principal Investigator
Sabra S Inslicht, PhD
Salisbury, North Carolina, United States, 28144
Status:
Recruiting
Facility:
Salisbury W.G. (Bill) Hefner VA Medical Center, Salisbury, NC
Contact:
Contact
Robin Hurley, MD
704-638-9000, 14455
Contact
Amy Morris
7046389000, 14392
Charleston, South Carolina, United States, 29401-5703
Status:
Recruiting
Facility:
Ralph H. Johnson VA Medical Center, Charleston, SC
Contact:
Contact
Zhewu Wang, MD
843-252-3586
Contact
Lisa McTeague, PhD
8435775011
About the Author
Matthew Feehan, J.D. is a U.S. Army National Guard veteran and former infantry officer with more than a decade of combined military, legal, and federal contracting experience. A former Department of Justice Honors Law Clerk and U.S. Army Corps of Engineers Law Clerk and Operations Officer, Feehan has served across nearly every corner of the federal system—as a contractor, civil servant, and soldier—working on matters that span regulatory policy, administrative law, and complex federal procurement. His firsthand experience navigating the same statutes and rulemaking processes that govern veterans’ benefits gives his writing a uniquely practical edge.
Today, Feehan serves as a Senior Policy Advisor with the Veterans Education Project (VEP), a Board Member and Sergeant-at-Arms of Combat Veterans of America (CVA), and an independent consultant specializing in ethics, compliance, and veterans’ policy. His work explores how law and regulation collide with the lived experience of those who serve—bridging the gap between policy intent and on-the-ground impact for veterans, families, and the public institutions charged with supporting them.
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