Insomnia treatment at our clinic

First, understand your sleep difficulties

Please consult us if difficulty falling asleep, repeated waking during the night or waking too early continues and affects your energy, concentration or daytime activities.

We review your sleep schedule, stress, alcohol, caffeine and medicines. Snoring or pauses in breathing, restless legs and low mood may point to other conditions. We assess these and arrange specialist referral when needed.

CBT-I-based app treatment with Medcle

Cognitive behavioral therapy for insomnia (CBT-I) addresses habits and thoughts that can maintain sleep difficulties, such as worrying that you must sleep or spending long periods awake in bed.

Our clinic provides SUSMED Medcle under Japan’s health-insurance system for eligible patients. With medical supervision, you record your sleep on a smartphone and work through a program based on CBT-I.

• Use a sleep diary to review time in bed and time asleep.
• Adjust time in bed and your waking schedule under medical supervision.
• Strengthen the connection between bed and sleep, and address unhelpful worries about sleep.

The course lasts 9 weeks: one week of sleep recording and sleep-hygiene guidance, followed by an eight-week program, with medical follow-up.

Eligibility and insurance coverage

Coverage is subject to Japanese insurance criteria, including mild-to-moderate insomnia, not currently taking medication for a sleep disorder, and medication being unsuitable or not agreed to. We also check other conditions, work schedules and ability to use a smartphone. We explain suitability and costs at your consultation. The Japanese text is the reference for this local insurance arrangement.

Daytime sleepiness can increase early in treatment. Tell us about driving or hazardous work. Do not independently restrict your sleep or stop prescribed medication. Medcle’s treatment content is currently available in Japanese.

What are orexin and its receptors?

Orexin is a substance in the brain that helps maintain wakefulness. Orexin receptors on nerve cells receive this wakefulness signal.

There are two receptor types, OX1 and OX2. Dayvigo and vornorexant block orexin’s action at both types, reducing wakefulness signaling to help with falling asleep and staying asleep.

Insomnia is not always caused by excessive orexin. Your sleep schedule and overall health also matter when choosing treatment.

Medication: Dayvigo and vornorexant

Both are dual orexin receptor antagonists. We consider difficulty falling asleep or staying asleep, next-day activities, age and other medicines when selecting treatment.

Dayvigo (lemborexant)

Approved in Japan in 2020, Dayvigo helps with sleep onset and maintenance. Sleepiness and reduced alertness can persist into the next morning or later. Do not drive or operate hazardous machinery during treatment.

Vornorexant hydrate (ボルズィ)

Approved in Japan in 2025, vornorexant has relatively rapid elimination from the body. This does not mean next-day sleepiness cannot occur. Your doctor must carefully assess whether driving is appropriate; never drive when sleepy or less alert.

Taking these medicines safely

• Take the prescribed dose immediately before going to bed. Avoid taking it with or just after a meal.
• Avoid alcohol. Do not take it when you will need to get up during the night for work or other activities.
• Sleepiness, dizziness and nightmares can occur. Tell us about all medicines, including nonprescription products, so we can check interactions.
• Tell your doctor before treatment if you are pregnant or breastfeeding, or have liver disease or breathing problems.

We review the response, next-day effects and ongoing need for treatment. Neither medicine is the right choice for everyone.

A discovery involving Japanese researchers

Orexins were discovered in 1998 by a research group including Masashi Yanagisawa and Takeshi Sakurai, working at the University of Texas Southwestern Medical Center in the United States.

An independent group reported the same peptides that year as “hypocretins.” Initially studied for their link with feeding, they were later shown to play an important role in maintaining wakefulness. This basic research paved the way for insomnia medicines that target orexin receptors.

Common questions