Suvorexant for the Treatment of Insomnia for Women with Breast Cancer

Inclusion Criteria

• Diagnosis of breast cancer and no more than 10 years from initial diagnosis
• At least 6 weeks beyond completion of definitive treatment
• Female
• Greater or equal to 18 years old
• Currently taking selective estrogen modulator or aromatase inhibitor use without a planned stop during the 28-day study intervention
• Participants cannot be on maintenance therapy except endocrine therapy as stated above
• Participants should have no residual disease based on recent clinical assessment from the oncologist
• Insomnia Severity Index Score (ISI) assessed during screening is greater than or equal to 15
• Has provided study informed consent
• Currently menopausal (participant has not had a menstrual period within 12 months)

Exclusion Criteria

• Male. Due to limited sample size, we will limit participation to women with a diagnosis of breast cancer
• Less than 6-month life expectancy
• Current receipt of hospice care
• Known severe depression or anxiety. Individuals with a Patient Health Questionnaire-9 score of greater than 20 or General Anxiety Disorder-7 score greater than 15 will be excluded from participation
• Pregnant
• Medical history of severe mental illness
• Known hepatic impairment with elevation of aspartate aminotransferase (AST), alanine aminotransferase (ALT), or bilirubin over twice the normal limit
• Diagnosis of severe obstructive sleep apnea or untreated moderate sleep apnea
• Medical history of narcolepsy or other sleep related illness other than insomnia
• Concurrent use of moderate or strong CYP3A inhibitors
• Current steroid use
• Current use of greater than 40 morphine milligram equivalents daily. Participants taking less than 40 morphine equivalents daily should be on a stable medication regimen for two weeks prior to enrollment
• Treatment with alternate pharmacotherapy for insomnia. Participants may be enrolled if they have discontinued any of these medications 2 weeks prior to trial initiation. Eligible patients on these medications interested in trial participation can discuss appropriate medication tapering under physician supervision with the current prescribing physician
• Individuals with previous intolerance or allergy to suvorexant
• Individuals with a disability that precludes completion of study activities (e.g. severe cognitive impairment per patient report or as documented in the medical record) will be limited from participating