Idorsia created the Alliance for Sleep just a few months ago, but the team have hit the ground running, publishing a new report with some eye-opening insights on the effects of insomnia.
The Alliance for Sleep, a sort of insomnia-focused think tank, was born while Idorsia was still awaiting approval for its sleep drug daridorexant. Now approved under the brand name Quviviq, the drug is rolling out in the U.S.—and so is the alliance's new report, aimed at raising awareness about chronic sleep problems.
Based on The Wake-Up America Survey, the report says 70% of people with trouble sleeping are desperate to find a solution, spending more than $7 billion on sleep aids annually to improve their sleep.
But there's an "insomnia conversation gap" between patients and their doctors, the survey found. Sleep is seen as the third pillar of health—behind diet and exercise—by primary care physicians and psychologists,but only 66% of primary care doctors ask about sleep during routine visits, and 57% of people who have trouble sleeping have not spoken about it with their doctors.
Clearly Idorsia will want to bridge that gap and help fill it with Quiviviq—and it's working hard to get the word out. The insomnia market, however, has a tough dynamic: Idorsia will have to compete with Merck’s Belsomra and Eisai's Dayvigo, for one thing, but all three of them sit within a market awash with cheap generics. Awareness of new drugs is part of the puzzle but getting patients to take them—and doctors to prescribe them—remains a major challenge.
But Idorsia and its Alliance still see insomnia as a major medical issue—and the survey shows it's one that still needs addressing. The report found a high level of so-called “false confidence” among people who can't sleep—74% believe they are knowledgeable about sleep and insomnia—and that leads to belief in common sleep myths among about two-thirds of them.
This situation has also worsened amid the pandemic. “Studies indicate that the pandemic has contributed to a rising prevalence of insomnia symptoms and disturbed sleep in the U.S. and globally, bringing insomnia and trouble sleeping to the forefront,” said Ruth Benca, M.D., Ph.D., chair of the Wake Forest School of Psychiatry and Behavioral Medicine and co-chair of the Alliance for Sleep.
“This has accompanied an increase in psychiatric symptoms of depression, anxiety, substance abuse and suicide, all of which are also associated with insomnia and for which insomnia is a risk factor,” Benca added.
The survey was taken before the full impact of the war in Ukraine and inflation took hold, but these two global problems likely would do little to aid restful sleep.
The stigma of sleep deprivation
Benca also believes insomnia comes with a shame that is hard to shake. “There is still evidence of a stigma related to having insomnia,” she said. “Wake Up America survey results reveal various reasons why people with trouble sleeping are not talking to their doctors about sleep, including that they don’t think it’s a legitimate medical problem and that they think they should be able to solve it on their own.”
What's more, that shame affects treatment. “Most don’t want to be prescribed sleep medication,” she said, often fearing addiction, side effects/risks, or stigma.
According to the survey, 66% of patients who take or have taken sleeping medications believe there's a stigma attached to the drugs. But large numbers of people "self-medicate" with treatments that aren't proven to work and might even worsen sleep problems in the long run, Benca said, such as over-the-counter drugs, alcohol, and cannabis-related compounds.
It’s key to help patients better understand that insomnia is not their fault and is a condition “worthy of medical attention because of its significant health risks, they should feel empowered to proactively bring up sleep with their doctor,” Benca said.
And doctors need to better understand how poor sleep can cause larger health issues for their patients, she said.
In terms of the myths that perpetuate she believes that the belief that you can get used to less sleep “is particularly dangerous,” as research shows that when you’re running on less sleep, “you are not aware you’re getting more and more impaired, but objectively you are.”
The survey, report and campaign are all unbranded, with no mention of Quviviq, but clearly the idea is to boost awareness of insomnia, remove stigma and get doctors to be more aware of new meds for the condition, all in the hope that prescriptions for Quviviq will tick up.
The survey was conducted online in the U.S. by The Harris Poll on behalf of Idorsia from September to October 2021 among 300 primary care physicians, 152 psychiatrists and 1,001 U.S. adults diagnosed with insomnia or trouble sleeping.
Despite only being approved for a few months, Idorsia is already going all guns blazing on the awareness and marketing frontt. And it's not just the Alliance and its new survey: Earlier this year, Idorsia tapped A-lister actress Jennifer Aniston to head up its unbranded awareness campaign, “Seize the Night & Day”.
Idorsia sees this as an “integrated educational campaign aimed at revealing insomnia’s dual impact that affects both nights and days." Michael Moye, head of U.S. Marketing, said Idorsia is “thrilled with the work we have done so far with Jen Aniston to launch Seize the Night & Day.”
Quviviq is the first FDA-approved drug for Idorsia, a spinout that emerged from Johnson & Johnson's buyout of Actelion.
In April 2020, the drug aced a phase 3 trial in insomnia patients, turning up evidence that the dual orexin receptor antagonist (DORA) could improve daytime performance. Idorsia hopes to rival the market share of Merck’s insomnia therapy Belsomra, which shares a mechanism of action with Quviviq and was the first DORA drug to market.
Sales for the Merck drug have been sluggish, however; it brought in just $327 million in 2020, even after seven years on the market. Eisai is more optimistic its DORA—Dayvigo, launched last year in the U.S.—can hit blockbuster sales.
Merck has a long history with its insomnia campaigns, with one stretching all the way back to 2015, when it ran unbranded TV spots dubbed "Why So Awake" on national TV as well as in paid promotions on YouTube and in doctors' offices.
Print ads appeared in national magazines, while digital marketing included a WhySoAwake website, Twitter page and hashtag, and a mobile Sleep Guru app with tips for adopting healthy sleep habits. The website is still active today.
What has been holding Belsomra sales back is the extremely low cost of established, generic insomnia drugs, which have dragged down the overall value of the market for sleep medicines. All the companies with branded meds, including Idorsia, will hope a growing new market of DORA drugs and fresh campaigns can help turn the poor sales run around.
By Ben Adams