Suvorexant for Insomnia to Prevent Delirium in Hospitalized Cancer Patients

Inclusion Criteria: * Presence of advanced active malignancy and insomnia despite nonpharmacologic management * Anticipated hospital course of at least 3 days post randomization as judged by the patient's primary inpatient team * One or more of the following risk factors of delirium: * Age 75 or above * Hearing impairment * Vision impairment * Initiation of 8 or new medications since start of hospitalization * Chronic kidney disease III or greater * Congestive heart failure * Hospitalization for 14 or more days * Dehydration requiring ongoing use of intravenous (IV) hydration * Electrolyte imbalance requiring ongoing correction Exclusion Criteria: * Inability to consent * Current pregnancy * Women of childbearing potential (defined as women under age 55 without a personal history of surgical or chemotherapy-induced sterility) * Current or prior delirium in the active hospitalization * Concurrent use of strong/moderate CYP3A4 inducers and inhibitors (including but not limited to -azole antifungals, amiodarone, phenytoin, carbamazepine, etc.) * Use of any benzodiazepine, benzodiazepine receptor modulator, or first generation antihistamine class medication within 72 hours prior to enrollment * Personal history of narcolepsy * Personal history of other primary sleep disorders including obstructive sleep apnea * Personal history of alcohol use disorder * Personal history of substance use disorder * Personal history of cirrhosis * Transaminitis more than 3 tim…