Insomnia Treatment

For long-term insomnia, NICE recommends CBT-I first, and it remains the most effective and durable treatment available. Where CBT-I has not worked, is unsuitable or is not available, Quviviq (daridorexant) is the only medicine licensed in the UK for long-term use and the only one recommended by NICE. Short-term options such as prolonged-release melatonin or promethazine can help through a rough patch but are not treatments for chronic insomnia. 'Best' depends on your sleep pattern, your health and what you have already tried, which is what the assessment is for.

Quviviq is the closest the UK has to one. In trials, including a full year of continuous use, there was no evidence of physical dependence, no withdrawal on stopping and no rebound insomnia, and unlike benzodiazepines and Z-drugs it is not a controlled drug. No sleep medicine should be taken indefinitely without review, which is why ours is built in at three months.

Yes, legally and safely, through a GPhC-registered online pharmacy after a clinician assessment. Prescription treatments such as Quviviq and melatonin require a prescriber review; promethazine is a pharmacy medicine supplied after a pharmacist check. Controlled drugs such as zopiclone should not be bought online without a prescription, and any site offering them with no consultation is operating illegally.

They are controlled drugs licensed for a maximum of four weeks, with well documented risks of dependence, tolerance and next-day impairment, and they were never intended for chronic insomnia. We think the right place for a Z-drug is a short, GP-managed course, not an online repeat. If you are already taking one, we can help you plan a safe step-down and discuss longer-term options.

Zopiclone sedates the whole brain via GABA, is licensed for a few weeks at most and is a controlled drug. Quviviq blocks orexin, the wake signal, is licensed for long-term use, preserved normal sleep architecture in trials and showed no dependence signals. Patients describe drifting off rather than being knocked out. We cover this in depth in our Quviviq vs zopiclone guide.

Yes, under NICE TA922, for adults whose insomnia has lasted three months or more and affects daytime functioning, where CBT-I has not worked, is unsuitable or is unavailable, with a stop or continue review at three months. Local access varies and many areas require documented CBT-I first. Private assessment through a registered pharmacy is usually the faster route.

Melatonin is a prescription only medicine in the UK, unlike in the US where it is sold as a supplement. Prolonged-release melatonin (Circadin) is licensed for adults aged 55 and over with short-term primary insomnia, for up to 13 weeks. It is usually prescribed by a GP, and we do not supply it. Melatonin bought as a supplement from overseas websites is unregulated and its content is unreliable. If your insomnia has lasted three months or more and affects your day, Quviviq is licensed for long-term use at any adult age and can be assessed for online.

For a few nights, in adults without other health problems, yes. Sedating antihistamines such as diphenhydramine (Nytol) and promethazine (Phenergan, Sominex) are licensed for short-term use only. Tolerance develops within days and they commonly cause morning grogginess, dry mouth and, in older adults, confusion. If you have been using them for more than two weeks, that is a sign you need a proper assessment rather than another packet.

Cognitive behavioural therapy for insomnia is a structured programme, usually six to eight weeks, that retrains the habits and thought patterns keeping you awake. It is the most effective long-term treatment for insomnia and NICE recommends it first-line. Digital versions such as Sleepio are free on the NHS in many areas. It works alongside medication, not against it, and it is what makes stopping medication realistic later on.

Often, yes. Loud snoring or pauses in breathing point to sleep apnoea; an urge to move your legs at night suggests restless legs syndrome; early morning waking with low mood can be depression; hot flushes, pain, an overactive thyroid and several common medicines all disturb sleep. Our assessment screens for these, and if one is likely we will say so and point you to the right care rather than prescribe a sleeping tablet that masks it.

Quviviq works from the first night; there is no build-up period, and most people notice faster sleep onset and fewer long wakings within the first week, with daytime benefits building over one to two months. We judge treatment properly at the three-month review with a sleep diary, not on one good or bad night.