Abstract: Sleep is crucial for human physical and mental health. However, insomnia is one of the most prevalent sleep disorders worldwide and significantly increases the risk of cardiovascular and cerebrovascular diseases, mental illnesses, and neurodegenerative disorders. Researches suggested that hyperarousal may be the final common pathway in the pathophysiology of insomnia. Current intervention strategies for insomnia mainly include cognitive-behavioral therapy and pharmacological treatment. Commonly used medications primarily consist of benzodiazepines and non-benzodiazepine sedative-hypnotics. However, limitations such as tolerance, dependence, and next-day residual effects make these drugs unable to meet clinical treatment needs. Orexin receptor antagonists inhibit the hyperarousal state by blocking orexin receptors, prolonging both rapid eye movement (REM) and non-REM sleep, and promoting natural sleep. With fewer side effects and no addictive potential, they offer new hope for the treatment of insomnia. This article aims to summarize the pathophysiological mechanisms of insomnia and current pharmacological treatment strategies, providing a reference for clinical insomnia management.

Key words: sleep, hyperarousal, benzodiazepines, sedative-hypnotics, orexin system, dual orexin receptor antagonists, antidepressants, cognitive-behavioral therapy