The NICE CKS insomnia guidelines, revised in January 2020, distinguish between acute and chronic insomnia in the approach to managing the condition but offering advice on good sleep hygiene is common to both. This covers aspects such as:3

·       the sleeping environment (comfort with no disturbances)

·       having a regular sleep schedule, avoiding daytime napping

·       relaxing before bedtime

·       avoiding stimulants or alcohol

·       no large meals within two hours of bedtime

·       exercising during the day, but not in the four hours before bedtime.

Patients should also be advised that the Driver and Vehicle Licensing Agency (DVLA) requires drivers to inform them if they experience excessive sleepiness.3,21

For acute insomnia, if sleep hygiene measures do not work and daytime impairment is causing severe distress, NICE says a short 3-7 day course of a non-benzodiazepine hypnotic may be considered if the insomnia is likely to resolve soon, for example with a known stressor out of the way. If the insomnia is unlikely to resolve soon, then CBTi can be offered, possibly with a short-term hypnotic.3

For chronic insomnia, NICE recommends CBTi as a first line treatment for adults of any age, and to generally avoid pharmacological therapy in the long-term management, but with exceptions:3

·       those with severe insomnia or an acute exacerbation, ideally limiting any sleep medication to under a week

·       those aged 55 and over with persistent insomnia may benefit from melatonin.