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Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

The main aim of insomnia management is to improve sleep quantity and quality, improve daytime function (greater alertness and concentration), and cause minimal adverse drug effects

Acute insomnia

  • address the trigger factors which might have resulted in insomnia e.g. – ill health, stress, medication, change in time zone etc.
  • provide with or review sleep hygiene practices
  • educate and reassure the patient that the symptoms are usually self limiting and are usually caused by a precipitant factor
  • short term hypnotic can be considered if symptoms are severe and causes distress about lack of sleep
  • if there is no improvement consider comorbid conditions

Chronic insomnia

  • healthcare professionals should address any relevant, underlying problems :
    • prescribed drugs (eg some antidepressants, withdrawal of sedatives) and non-prescribed drugs (eg caffeine, alcohol)
    • physical - pain, respiratory and cardiovascular disorders, neurological disorders, movement disorders, restless leg syndrome and other sleep disorders)
    • psychiatric disorders - depression, anxiety, dementia and substance misuse)
    • disruption of circadian rhythm - shift work)
  • first-line therapy should be non-drug therapy - cognitive behavioural therapy (CBT)
  • in patients with significant distress and impact on waking function due to insomnia consider pharmacological treatment (should be used in parallel with non drug treatment and need regular review of medication)
  • manage comorbid conditions and refer to a specialist if indicated

Secondary insomnia is treated via treatment of the primary condition.

Whether acute or chronic insomnia, the following non-pharmacologic and pharmacologic treatments can be utilised for treatment (depending on the individual patient and circumstances).

Non paharmacological therapy

  • cognitive behavioural therapy (CBT)
    • sleep hygiene
    • stimulus control
    • sleep restriction
    • relaxation training
    • cognitive restructuring (4)

Pharmacological therapies include (4,5)

  • benzodiadepine and Z drugs
  • melatonin
  • antidepressants
  • antipsychotics
  • sedating antihistamines

Herbal remedies (5)

  • stated that there is insufficient evidence to support the use of herbal medicine for insomnia, though there is a clear need for further research in this area


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