Case Report: Dual Orexin Receptor Antagonists (DORAs) as a Target Mitigation Strategy for Tirzepatide-Induced Insomnia in a Patient with Historical Neuroleptic Exposure and Complex Neurodivergence

Post-market clinical utilization of the dual GLP-1/GIP receptor agonist tirzepatide (Zepbound) has revealed an unexpected incidence of treatment-resistant insomnia. This case report documents a 61-year-old neurodivergent male veteran who experienced stable metabolic success on the pure GLP-1 agonist semaglutide (Wegovy) from January 2025 to August 2025, losing 25 pounds, before being transitioned to tirzepatide. The addition of the GIP agonist pathway initiated a progressive, unrecognized sleep degradation that was misattributed to preexisting Traumatic Brain Injury (TBI) and Complex Post-Traumatic Stress Disorder (C-PTSD). Attempts to resolve the insomnia via upward dosage titrations of clonidine and prazosin, alongside dietary modifications, exacerbated a systemic somatic regression, leading to severe spinal fusion instability and loss of employment. The patient hypothesized an underlying hyper-arousal of the orexinergic system linked to remote neuroleptic exposure (aripiprazole, olanzapine) ceased in 2010. Discontinuation of tirzepatide and the eventual introduction of the Dual Orexin Receptor Antagonist (DORA) lemborexant successfully restored restorative sleep. Furthermore, this report highlights a monumental economic paradigm shift: transitioning the patient from a model of intensive psychiatric intervention ($40,000/year) to a model of precise, non-invasive neurodivergent sensory management ($4,000/year). This deposit includes a JSON companion file encoding the paper's argument architecture, epistemic grades, and inference chain for machine readers. The prose article is the canonical work; the JSON exposes its reasoning structure so the case can be evaluated as argument rather than parsed as narrative.