Daridorexant and Menopause

Poor sleep is incredibly common during perimenopause and menopause.

Hot flushes and night sweats can wake you. Hormonal changes may affect sleep. Anxiety or mood changes can contribute.

But sometimes insomnia becomes a problem in its own right.

And that's an important distinction.

When does poor sleep become chronic insomnia?

Chronic insomnia isn't simply having an occasional bad night.

Daridorexant (Quviviq) is licensed for adults with insomnia symptoms present for at least three months where poor sleep has a considerable impact on daytime functioning.

That may include:

• difficulty falling asleep
• repeatedly waking
• waking too early
• daytime tiredness
• concentration problems
• impaired functioning.

What does menopause have to do with insomnia?

Sleep disturbance is common during the menopause transition.

Sometimes treating symptoms such as night sweats with appropriate menopause treatment improves sleep considerably.

But not every woman with persistent insomnia has poor sleep solely because of hot flushes.

The British Menopause Society includes CBT-I among the important treatments for chronic insomnia and recognises daridorexant as a potential option where chronic insomnia is appropriately diagnosed.

What does the new daridorexant research show?

This is particularly interesting because new research was published in 2026 specifically examining women of menopausal-transition age.

Researchers analysed women aged 47–55 from a randomised controlled daridorexant trial.

The analysis suggested that daridorexant 50mg may provide benefits in sleep outcomes and daytime functioning in women in this age group, with tolerability broadly consistent with the overall trial population.

There is an important caveat:

This was a subgroup analysis involving 117 women, not a trial designed specifically to prove daridorexant treats menopause-related insomnia.

So it should not be interpreted as evidence that daridorexant treats menopause itself.

Should HRT be considered instead?

That depends on what's causing the sleep problem.

If night sweats, hot flushes or other menopause symptoms are repeatedly disrupting sleep, assessing and treating the underlying menopausal symptoms may be more appropriate.

If someone meets criteria for chronic insomnia disorder, then CBT-I and other insomnia treatments may also need consideration.

The answer may not always be:

HRT OR insomnia treatment.

Good clinical care means working out why you're awake in the first place.

Where does CBT-I fit?

NICE recommends daridorexant for qualifying adults with chronic insomnia when CBT-I has been tried but not worked, is unavailable or is unsuitable.

That remains relevant during menopause.

Medication should sit within a broader assessment rather than replacing investigation of sleep habits, hormonal symptoms, mood, restless legs, sleep apnoea or other possible causes.

How Pharmulous can help

This is an area where Pharmulous has a useful advantage.

Our services cover both women's health and clinician-led insomnia assessment, allowing us to consider the wider picture rather than assuming every middle-aged woman's poor sleep has one cause.

Persistent insomnia during menopause deserves to be taken seriously. Treat the woman, not just the sleepless night.

References

1. Schaedel Z et al. Efficacy and safety of daridorexant for the treatment of insomnia disorder in women of menopausal transition age. Maturitas. 2026;206:108821.
2. British Menopause Society. Managing sleep disturbance during the menopause transition. 2025.
3. NICE. Daridorexant for treating long-term insomnia. TA922.
4. Idorsia Pharmaceuticals UK Ltd. QUVIVIQ SmPC.
5. Mignot E et al. Safety and efficacy of daridorexant in insomnia disorder. Lancet Neurology. 2022.