Efficacy of Suvorexant in the Treatment of Hot Flash-associated Insomnia

Inclusion Criteria: * Peri- or postmenopausal women * DSM-5 criteria for Insomnia disorder, with onset of symptoms attributed to hot flashes * Some awakenings co-occur with a hot flash * Score on the Insomnia Severity Index (ISI) measure ≥15 * Hot flashes present, including at night Exclusion Criteria: * Diagnosis of other primary sleep disorders * Shift workers * Current or expected use of hypnotic medications * Current major depressive episode * Lifetime history of bipolar disorder, psychosis, or other serious mental health problem * Current alcohol/substance use disorder * Obesity * Renal or hepatic disease * Pregnancy or breastfeeding * Recent malignancy * Recent surgery * Neurological disorder or cardiovascular disease raising safety concerns * Medical instability considered to interfere with study procedures * Concomitant medications with drug interaction or co-administration concerns * Contraindications or allergic responses to suvorexant * Recent or planned travel across time zones * Excessive coffee or cigarette use