IMO: Forget the antihistamines and CBT. Just get some lemborexant. Lemborexant is no more likely to damage your brain than CBT. It is usually not hard to get a doctor to prescribe it; if not, use our usual India sources. The price is about $180 for 280 Lemborexant 5 mg tablets (10 boxes). So about $231 a year from India.
Gemini said
When comparing lemborexant (a Dual Orexin Receptor Antagonist or DORA) to antihistamines (such as diphenhydramine or doxylamine) for sleep, the differences in mechanism, efficacy, and long-term safety—particularly for older adults—are significant.
Mechanism and Efficacy
- Lemborexant (e.g., Dayvigo): This medication works by blocking the orexin system, which is the brain’s “wakefulness” switch. Rather than forcing the brain into sedation, it dampens the signals that keep you awake.
- Sleep Onset: Clinical trials (such as SUNRISE 1 and 2) show it significantly reduces the time it takes to fall asleep.
- Sleep Maintenance: It is specifically effective at reducing WASO (Wake After Sleep Onset), meaning it helps you stay asleep and get back to sleep faster if you do wake up.
I want to start another ad nauseam battle about CBT. I think it is mostly BS; it is also very time-consuming and expensive compared to drug interventions. Older people almost always have sleep problems. We are not going to send them to CBT. If you are young and have sleep problems, you probably need a doctor’s diagnosis. My main objection is the cost and time involved. I don’t dismiss the fact that CBT may work for some people.
“Lemborexant response rate: ~60–70%, works essentially as long as you take it”
CBT-I remission rate: ~36–54% depending on population, with effects that can persist long-term but require active maintenance of behavioral habits. For someone who won’t or can’t sustain the behavioral changes — and the dropout and adherence data suggest that’s a substantial proportion — the remission rates look considerably less impressive in practice than in controlled trials."
“Several meta-analyses have found that when CBT is compared not just to no-treatment controls, but to credible placebo therapies (e.g., supportive listening structured to look like a real treatment), the advantage for CBT narrows considerably — particularly for depression and some anxiety disorders. The specific techniques appear to matter more for some conditions”
CBT explicitly works through belief change — identifying and restructuring maladaptive cognitions. A person who is more absorptive and suggestion-responsive might:
- More readily internalize the therapist’s reframing of their thoughts
- More fully commit to the behavioral experiments
- Experience stronger expectancy effects from the treatment rationale
Responsive people are placebo-prone; they may also extract more from any meaning-rich, expectancy-generating intervention, including psychotherapy.
Psychotherapy history is essentially a graveyard of formerly confident treatments. A partial list of past darlings:
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Psychoanalysis — dominant for decades, enormously influential culturally, now largely abandoned as a primary treatment in evidence-based settings
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Primal scream therapy — briefly seized serious attention in the 1970s
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Recovered memory therapy — caused genuine harm before being largely discredited
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EMDR — still used, but whether the eye movement component does anything beyond exposure remains contested
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Rebirthing therapy — resulted in actual deaths
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Power therapies of the 1990s (Thought Field Therapy, etc.) — came with grandiose claims that evaporated under scrutiny"
“The pharmaceutical route offered something psychoanalysis conspicuously lacked: measurable, replicable, relatively rapid results. When the evidence base for analysis was being publicly questioned at exactly the moment that drugs were demonstrably working for schizophrenia and severe depression, the institutional and economic momentum shifted decisively toward biological psychiatry. That shift has never fully reversed.”
Yes, **I believe in DuPont’s “Better Things for Better Living… Through Chemistry.” ** 
