The attraction to this new med is pretty much nothing indicated for long-term insomnia other than Ramelteon and this med are safe with long-term use, and while Ramelteon has some differences with Melatonin I've never seen any strong data showing it's superior to it especially to the degree where it's worth taking at hundreds of dollars a month vs OTC Melatonin that's about $10/month or less.
Before Ramelteon and Suvorexant came out what I used to do was place patients on rotating sleep-med schedules. E.g. 2 weeks Zolpidem, then 2 weeks Trazodone, etc. Of course this was after I had them try sleep-hygiene and other non-prescription med approaches such as Melatonin.
But at more and more time passed by and I gained more knowledge and experience I came to realize many of my patients with insomnia had OSA and that they really needed to treat the OSA with a CPAP. This is something not taught in training that I caught on later. With so many people overweight these days and suffering from insomnia, it's frustrating that sleep studies are so expensive. Then add on top of that often times the sleep doctor doesn't communicate to me at all even after I've send him the umpteenth request for the patient's sleep report with the patient's permission.
Another insomnia factor I learned of later on in melatonin can work better if used for several days straight instead of just in one night. It resets the brain's circadian rhythms. Again not taught in usual training and much better alternative to taking Zolpidem long-term as many are doing these days despite that the data shows doing so isn't helpful and even potentially dangerous.
