1. Why this matters for MRCGP

• Insomnia is useful for AKT-style reasoning because the answer often depends on duration, daytime impairment, and whether medication is appropriate.
• In SCA, patients may request sleeping tablets, so the skill is explaining why tablets are limited while still taking distress seriously.
• The GP risk is unsafe hypnotic prescribing: dependence, next-day impairment, falls, respiratory depression, and missed alternative sleep disorders.
• Practical use matters because sleep diaries, sleep hygiene, Sleepio, Z-drug counselling, and driving advice are all supported GP actions.

2. GP Bottom Line

• Diagnose insomnia only when sleep difficulty occurs despite adequate opportunity for sleep and causes impaired daytime functioning.
• First GP action: assess triggers, comorbidities, medicines, substances, daytime impact, and possible alternative sleep disorders.
• CBTi is first-line for chronic insomnia, and should also be offered for short-term insomnia when sleep hygiene has failed, daytime impairment is severe and causing significant distress, and the problem is not likely to resolve soon. Sleepio is a digital CBTi-based option.
• Hypnotics are not routine. Consider a Z-drug only if sleep hygiene measures have failed, daytime impairment is severe and causing significant distress, and short-term insomnia is likely to resolve soon. In this situation, consider only a 3–7 day course.
• If a hypnotic is prescribed, use the lowest effective dose for the shortest possible time and do not continue beyond 2 weeks, preferably less than 1 week.
• Exam trap: giving a repeat Z-drug prescription without reassessment, or treating chronic insomnia with long-term hypnotics.

3. 60 Second Exam Snapshot

• Short-term insomnia: less than 3 months.
• Chronic insomnia: at least 3 nights per week for 3 months or more.
• No daytime impairment = does not meet insomnia disorder criteria.
• Sleep diary: use for around 2 weeks to identify sleep pattern and maintaining factors.
• Sleep hygiene is useful, but not sufficient as standalone treatment for chronic insomnia when CBTi is indicated.
• CBTi is first-line for chronic insomnia, and should also be offered for short-term insomnia when sleep hygiene has failed, daytime impairment is severe and causing significant distress, and the problem is not likely to resolve soon. Sleepio is a digital CBTi-based option.
• Refer to a sleep clinic, a specialist with expertise in sleep medicine, or neurology if another sleep disorder is suspected or there is doubt about the diagnosis.
• Seek specialist advice or consider referral to secondary care if treatment in primary care has failed, or if insomnia occurs in an occupational at-risk group such as a professional driver.
• Driving: advise not to drive if sleepy; Driver and Vehicle Licensing Agency must be informed if excessive sleepiness affects, or is likely to affect, driving.

4. Recognition and Diagnosis

• Insomnia is persistent difficulty getting to sleep, staying asleep or poor sleep quality, despite adequate time and circumstances for sleep, with impaired daytime functioning.
• Daytime symptoms may include fatigue, depressed mood, irritability, malaise, and cognitive impairment. Ask what the patient means by “not sleeping”: onset, waking, early waking, non-restorative sleep, frequency, and duration.
• Check confidence by asking about function: mood, work, relationships, ability to drive, and quality of life. Ask about beliefs around normal sleep, because there is no single normal amount of sleep; sleep needs vary with age and between people.
• Look for contributors: stress, shift work, jet lag, sleep environment, caffeine, alcohol, nicotine, illicit drugs, prescribed medicines, chronic pain, chronic obstructive pulmonary disease, cardiovascular disease, diabetes, neurological conditions, tinnitus, menopausal symptoms, reflux, anxiety, and depression.
• Do not miss other sleep disorders: obstructive sleep apnoea, restless legs syndrome, periodic limb movement disorder, narcolepsy, and parasomnias. Snoring, witnessed apnoea, restless legs, or sleepwalking should change the assessment.

5. AKT Essentials: What Changes the Answer

Diagnosis / recognition

• Sleep difficulty without daytime impairment is not insomnia disorder.
• Short-term versus chronic changes management.
• Normal sleep varies; avoid prescribing for unrealistic sleep expectations alone.

Investigations / interpretation

• A 2-week sleep diary should record bed/wake times, time to sleep, night waking, daytime tiredness/naps, meals, alcohol, caffeine, exercise/stress, and sleep quality rated 1–5.
• Insomnia Severity Index scores 0–28: 8–10 subclinical, 15–21 moderate, 22–28 severe; change of 8.4 or more indicates moderate improvement.
• Named tools include: PHQ-9 and GAD-7 for depression/anxiety screening, STOP-Bang for obstructive sleep apnoea screening, and the Insomnia Severity Index for grading insomnia severity, and the Sleep Condition Indicator.

Management / next best step

• Address triggers and optimise comorbidities.
• Offer sleep hygiene advice to all.
• CBTi is first-line for chronic insomnia, and should also be offered for short-term insomnia when sleep hygiene has failed, daytime impairment is severe and causing significant distress, and the problem is not likely to resolve soon. Sleepio is a digital CBTi-based option.
• Consider a Z-drug only if sleep hygiene measures have failed, daytime impairment is severe and causing significant distress, and short-term insomnia is likely to resolve soon. In this situation, consider only a 3–7 day course. If a hypnotic is prescribed, use the lowest effective dose for the shortest possible time and do not continue beyond 2 weeks, preferably less than 1 week.
• Do not recommend over-the-counter treatments for insomnia.

Medicines / safety

• Z-drugs named: zopiclone, zolpidem, eszopiclone.
• If no response to the first hypnotic, do not prescribe another.
• Do not issue further hypnotic prescriptions without seeing the person again.

Special groups

• Older people: Avoid Z-drugs if possible.
• Pregnancy: Do not prescribe routinely; seek specialist advice from a psychiatrist with pregnancy prescribing expertise or an obstetrician if pharmacological treatment is being considered.
• Breastfeeding: Avoid a blanket rule; use specialist medicines advice and individual risk assessment, and monitor the infant for sedation, feeding problems, or poor weight gain where treatment is used.

Follow-up

• Arrange review, for example 2–4 weeks, depending on the clinical situation.

6. SCA Consultation Essentials

• Likely SCA task: tired, distressed adult asks for sleeping tablets.
• Gather: exact sleep pattern, duration, daytime effect, work/driving risk, mood, anxiety, pain, snoring/witnessed apnoea, restless legs, sleepwalking, caffeine, alcohol, nicotine, illicit drugs, prescribed medication, and previous hypnotic use.
• Communication pivot: validate distress, then shift from “make me sleep tonight” to “identify what is keeping this going and avoid treatments that create a new problem”.
• Explain CBTi plainly: it helps change thoughts and behaviours that maintain insomnia; Sleepio is a digital CBTi-based self-help programme with a sleep test, weekly sessions, and sleep diary entries.
• If a Z-drug is being considered, first confirm the prescribing threshold: sleep hygiene measures have failed, daytime impairment is severe and causing significant distress, and short-term insomnia is likely to resolve soon.
• Before prescribing a Z-drug, check medicine-specific contraindications, previous complex sleep behaviours, alcohol use, opioid use, other central nervous system depressants or sedatives, and interacting medicines.
• If prescribing a Z-drug, explicitly discuss: 3–7 day course only, no routine repeats, no alcohol, no re-dosing in the night, next-day drowsiness, driving/skilled task risk, dependence, tolerance, withdrawal, and what to do if side effects occur.
• If sleepwalking, sleep-driving or another complex sleep behaviour occurs, stop/review urgently; discontinue zopiclone immediately if this occurs.

7. Red Flags / Escalation / Referral

Refer to a sleep clinic, a specialist with expertise in sleep medicine, or neurology if:

• another sleep disorder is suspected, such as parasomnia, narcolepsy, or obstructive sleep apnoea
• there is doubt about the diagnosis.

Seek specialist advice or consider referral to secondary care if:

• treatment in primary care has failed
• insomnia occurs in an occupational at-risk group, such as a professional driver.

Do not routinely refer adults with insomnia, jerks on falling asleep, or isolated brief episodes of sleep paralysis.

Medication-related escalation:

• overdose or serious allergic reaction advice is medication-specific; patients should seek urgent help as directed in the patient information
• before prescribing a Z-drug, check alcohol use, opioid use, other central nervous system depressants or sedatives, and interacting medicines
• CYP inhibitors may increase Z-drug exposure and sedation; CYP inducers may reduce effect
• avoid alcohol
• avoid opioid co-use where possible; if co-prescribing is unavoidable, use the lowest effective doses for the shortest duration and monitor for sedation and respiratory depression
• if methadone is involved, monitor for at least 2 weeks after initiation or prescribing changes.

8. What the GP Should Do Today

• Assess: confirm insomnia criteria, duration, daytime impairment, driving risk, occupational risk, and patient expectations.
• Look for causes: stressors, sleep environment, substances, medicines, and comorbid physical/mental health problems.
• Check for other sleep disorders: snoring, witnessed apnoea, restless legs, sleepwalking, sudden daytime sleep, or collapse/weakness triggered by emotion.
• Examine/investigate where relevant: targeted examination or investigations if comorbidity or another sleep disorder is suspected.
• Use a sleep diary: ask for 2 weeks if pattern or maintaining factors are unclear.
• Advise: sleep hygiene and not driving if sleepy.
• Treat: offer CBTi/Sleepio where indicated; avoid routine hypnotics.
• Review: 2–4 weeks; reassess if not improving, including alternative diagnoses, CBTi if not already offered, and whether specialist advice or referral is needed.

9. Practical Use in GP: How to Apply This Topic

Before use

• Before Sleepio referral in higher-risk people, pregnancy, or comorbidity, do a medical assessment.
• Before any hypnotic, establish cause and treat underlying factors where possible.
• Before a Z-drug, confirm that sleep hygiene measures have failed, daytime impairment is severe and causing significant distress, and short-term insomnia is likely to resolve soon. In this situation, consider only a 3–7 day course.

Starting / advising

• Sleep diary: 2 weeks, recording sleep timing, waking, naps, caffeine, alcohol, meals, stress/exercise, and sleep quality.
• Sleep hygiene: wake and get out of bed at the same time every morning, including weekends and after a poor night’s sleep; avoid naps; avoid screens/bright light for at least an hour before bed; avoid clock-watching; keep the bedroom comfortable, dark and quiet; avoid caffeine after midday; avoid nicotine, alcohol and large meals within 2 hours of bedtime; avoid vigorous exercise within an hour of bedtime.

Patient instructions for Z-drugs

• Take only as prescribed at bedtime.
• Do not re-administer during the same night.
• Do not drink alcohol.
• Do not drive if sleepy.

Z-drug prescribing safety checks

• Before prescribing a Z-drug, check alcohol use, opioid use, other central nervous system depressants or sedatives, and interacting medicines.
• CYP inhibitors may increase Z-drug exposure and sedation; CYP inducers may reduce effect.
• Avoid opioid co-use where possible; if co-prescribing is unavoidable, use the lowest effective doses for the shortest duration and monitor for sedation and respiratory depression. If methadone is involved, monitor for at least 2 weeks after initiation or prescribing changes.

Review / monitoring

• Review insomnia in 2–4 weeks.
• For dependence-forming medicines, monitor benefit, adverse effects, dose escalation, early refill requests, loss of effect, and patient preference.

Stop / change / escalate if

• No response to first hypnotic: do not prescribe another.
• Symptoms persist: reassess diagnosis, consider CBTi if not offered, and consider referral.
• Z-drug withdrawal needed: use a slow, stepwise, individualised reduction; do not stop abruptly except in exceptional medical circumstances.

10. Medicines, Investigations and Intervention Safety

Z-drugs: zopiclone, zolpidem, eszopiclone

• Class supplied as non-benzodiazepine hypnotic medication.
• Consider a Z-drug only if sleep hygiene measures have failed, daytime impairment is severe and causing significant distress, and short-term insomnia is likely to resolve soon. In this situation, consider only a 3–7 day course.
• If a hypnotic is prescribed, use the lowest effective dose for the shortest possible time and do not continue beyond 2 weeks, preferably less than 1 week. Product information may state a maximum total duration of 4 weeks including tapering, but this should not be presented as a routine GP target.
• Before prescribing a Z-drug, check medicine-specific contraindications. Key exclusions include marked neuromuscular respiratory weakness, respiratory failure or severe respiratory depression, myasthenia gravis, severe hepatic impairment, and sleep-apnoea restrictions. Zopiclone is contraindicated in severe sleep apnoea syndrome and in people who have previously had complex sleep behaviours after zopiclone. For zolpidem, obstructive sleep apnoea is listed as a contraindication.
• Use caution with chronic pulmonary insufficiency, psychiatric illness including depression, drug/alcohol misuse history, and driving/skilled work.
• If sleepwalking, sleep-driving, or another complex sleep behaviour occurs, stop/review urgently; discontinue zopiclone immediately if this occurs.

Doses supplied:

• zopiclone: adult 7.5 mg at bedtime; use an initial 3.75 mg dose in older people and in renal impairment, mild–moderate hepatic impairment, or chronic pulmonary/respiratory insufficiency; avoid severe hepatic impairment
• zolpidem: adult 10 mg at bedtime; use 5 mg in older or debilitated people and in hepatic impairment; avoid severe hepatic impairment and use caution in renal impairment
• eszopiclone: 1 mg at bedtime, increasing to 2 mg or maximum 3 mg if clinically indicated; elderly 1 mg, increasing to 2 mg if clinically indicated.

Interaction checks:

• before prescribing a Z-drug, check alcohol use, opioid use, other central nervous system depressants or sedatives, and interacting medicines
• CYP inhibitors may increase Z-drug exposure and sedation; CYP inducers may reduce effect
• avoid alcohol
• avoid opioid co-use where possible; if co-prescribing is unavoidable, use the lowest effective doses for the shortest duration and monitor for sedation and respiratory depression
• if methadone is involved, monitor for at least 2 weeks after initiation or prescribing changes.

Driving:

• zolpidem: at least 8 hours before skilled tasks
• zopiclone: risk if taken within 12 hours of mental-alertness tasks.

Pregnancy & Breastfeeding:

• Pregnancy: do not prescribe routinely; seek specialist advice from a psychiatrist with pregnancy prescribing expertise or an obstetrician if pharmacological treatment is being considered.
• Breastfeeding: avoid a blanket rule; use specialist medicines advice and individual risk assessment, and monitor the infant for sedation, feeding problems, or poor weight gain where treatment is used.

Prolonged-release melatonin

• For adults aged 55 years and over with persistent insomnia: 2 mg once daily, 1–2 hours before bedtime and after food, up to 13 weeks.
• Avoid in autoimmune disease and hepatic impairment; caution in renal impairment and seizure susceptibility. Do not blur this with immediate-release melatonin for jet lag.
• Also check interactions. Avoid fluvoxamine. Use caution with alcohol, opioids, and other central nervous system depressants. Quinolones and oestrogens may increase melatonin exposure; carbamazepine and rifampicin may reduce melatonin levels. Benzodiazepines and Z-drugs may enhance sedation and side effects. Check lactose-related product cautions where relevant.
• Pregnancy and breastfeeding cautions apply as above.

Daridorexant

• For chronic insomnia with symptoms at least 3 nights per week for at least 3 months and considerably affected daytime function, only if CBTi has failed, is unavailable or unsuitable.
• Dose supplied: 50 mg once daily within 30 minutes before bedtime, or 25 mg in some patients.
• Assess within 3 months; stop if inadequate response; review regularly if continued.
• Avoid in narcolepsy and severe hepatic impairment. Caution with depression, psychiatric illness, severe obstructive sleep apnoea, severe chronic obstructive pulmonary disease, age over 75, abuse/addiction history, driving, or heavy machinery.
• Leave about 9 hours before skilled tasks.
• Check CYP3A4 interactions. Strong CYP3A4 inhibitors are contraindicated/should not be co-prescribed; use 25 mg with moderate CYP3A4 inhibitors; CYP3A4 inducers may reduce efficacy.
• Avoid grapefruit or grapefruit juice in the evening.
• Use caution with alcohol or other central nervous system depressants.
• Daridorexant may increase digoxin exposure, so use caution and monitor.
• Avoid in pregnancy unless essential and seek specialist advice if considering use in pregnancy or breastfeeding.
• Unlike Z-drugs, daridorexant can be stopped without down-titration.

11. How to Explain it to the Patient

• “Insomnia is not just short sleep; it is sleep difficulty that is affecting how you function in the day.”
• “The first step is to understand your sleep pattern and what may be keeping the problem going.”
• “A sleep diary for two weeks can show patterns that are hard to spot from memory.”
• “Sleeping tablets can help some people briefly, but they can cause next-day drowsiness, falls, dependence, and withdrawal.”
• “CBT for insomnia works on the thoughts and behaviours around sleep, and its benefits can last after treatment finishes.”
• “If you feel sleepy, please do not drive.”

12. When the Plan Changes

• If symptoms are present for less than 3 months.
  • Why this changes the plan: short-term insomnia may resolve if the trigger resolves.
  • What the GP does now: address stressor, sleep hygiene and review. If sleep hygiene measures have failed, daytime impairment is severe and causing significant distress, and short-term insomnia is likely to resolve soon, consider only a 3–7 day Z-drug course. If the problem is not likely to resolve soon, offer CBTi/Sleepio.
• If symptoms are at least 3 nights per week for 3 months or more.
  • Why this changes the plan: this is chronic insomnia.
  • What the GP does now: offer CBTi/Sleepio first-line; avoid long-term hypnotics.
• If snoring, witnessed apnoea, restless legs or sleepwalking is present.
  • Why this changes the plan: another sleep disorder may explain symptoms.
  • What the GP does now: assess further and refer if another sleep disorder is suspected or there is doubt about the diagnosis.
• If the patient is pregnant.
  • Why this changes the plan: pharmacological treatment needs specialist advice.
  • What the GP does now: do not prescribe routinely; seek specialist advice from a psychiatrist with pregnancy prescribing expertise or an obstetrician if medication is being considered.
• If hypnotic treatment has not helped.
  • Why this changes the plan: prescribing another hypnotic is not supported.
  • What the GP does now: reassess diagnosis, consider CBTi if not already offered, and seek specialist advice or consider referral if primary-care treatment has failed.
• If the patient is a professional driver.
  • Why this changes the plan: occupational risk changes safety and escalation decisions.
  • What the GP does now: advise on sleepiness/driving and seek specialist advice or consider referral.

13. Common AKT / SCA Traps

• Calling it insomnia when there is no daytime impairment.
• Ignoring duration: short-term and chronic insomnia are managed differently.
• Offering sleep hygiene alone when CBTi is indicated.
• Prescribing Z-drugs routinely, repeatedly, or beyond the restricted short-term threshold.
• Using the product-information maximum duration as a routine GP prescribing target.
• Missing obstructive sleep apnoea, restless legs syndrome, narcolepsy, or parasomnia clues.
• Missing complex sleep behaviour safety with Z-drugs.
• Missing opioid, alcohol, central nervous system depressant, or CYP-interaction risk.
• Mixing up drug-specific driving timings.
• Giving detailed CBTi, STOP-Bang, PHQ-9, or GAD-7 instructions not supplied in the source text.

14. Common Exam Angles

• Angle: Adult requests zopiclone after 2 weeks of stress-related insomnia.
  • Hidden challenge: severe distress versus routine prescribing.
  • What the candidate must not miss: consider a Z-drug only if sleep hygiene measures have failed, daytime impairment is severe and causing significant distress, and short-term insomnia is likely to resolve soon; 3–7 days only, no routine repeats, review.
• Angle: Older adult with months of insomnia and daytime fatigue.
  • Hidden challenge: chronic insomnia plus Z-drug risk.
  • What the candidate must not miss: CBTi/Sleepio first-line; avoid Z-drugs if possible.
• Angle: “Insomnia” with snoring and witnessed apnoea.
  • Hidden challenge: alternative sleep disorder.
  • What the candidate must not miss: refer if another sleep disorder is suspected or there is doubt about the diagnosis; do not default to hypnotic prescribing.
• Angle: Patient on long-term sleeping tablets wants more.
  • Hidden challenge: dependence, tolerance, and withdrawal.
  • What the candidate must not miss: review benefits/harms, avoid escalation, plan careful reduction.

15. 90 Second Audio Summary Script

Insomnia in adults is diagnosed when sleep difficulty happens despite enough opportunity to sleep and causes daytime impairment. No daytime impairment means it does not meet insomnia disorder criteria.

Separate short-term insomnia (under 3 months), from chronic insomnia, which is at least 3 nights per week for 3 months or more. In the consultation, ask about onset, waking, early waking, daytime function, driving, work, mood, sleep environment, stress, caffeine, alcohol, nicotine, drugs, medicines, and comorbidities.

A 2-week sleep diary is useful. Sleep hygiene should be offered. CBTi is first-line for chronic insomnia, and should also be offered for short-term insomnia when sleep hygiene has failed, daytime impairment is severe and causing significant distress, and the problem is not likely to resolve soon. Sleepio is a digital CBTi-based option.

Hypnotics are the danger zone. Consider a Z-drug only if sleep hygiene measures have failed, daytime impairment is severe and causing significant distress, and short-term insomnia is likely to resolve soon. In this situation, consider only a 3–7 day course. If a hypnotic is prescribed, use the lowest effective dose for the shortest possible time and do not continue beyond 2 weeks, preferably less than 1 week.

Counsel on alcohol, opioids, sedatives, interacting medicines, driving, dependence, withdrawal, and not re-dosing overnight. Do not prescribe another hypnotic if the first fails.

Refer if another sleep disorder is suspected or the diagnosis is uncertain. Seek specialist advice or consider referral if primary-care treatment fails, or if the patient is in an occupational at-risk group such as a professional driver.

References

• Aurobindo Pharma–Milpharm Ltd (2026a) Zopiclone 7.5 mg film-coated tablets: Summary of Product Characteristics. Electronic Medicines Compendium. Available at: https://www.medicines.org.uk/emc/product/10590/smpc (Accessed: 2 May 2026).
• Aurobindo Pharma–Milpharm Ltd (2026b) Zopiclone 3.75 mg and 7.5 mg tablets: Patient Information Leaflet. Electronic Medicines Compendium. Available at: https://www.medicines.org.uk/emc/product/10590/pil (Accessed: 2 May 2026).
• Davidson, J.R., Dickson, C. and Han, H. (2019) ‘Cognitive behavioural treatment for insomnia in primary care: a systematic review of sleep outcomes’, British Journal of General Practice, 69(686), pp. e657–e664. doi: 10.3399/bjgp19X705065.
• Driver and Vehicle Licensing Agency (2025) Assessing fitness to drive: a guide for medical professionals. Available at: https://www.gov.uk/government/publications/assessing-fitness-to-drive-a-guide-for-medical-professionals (Accessed: 2 May 2026).
• Driver and Vehicle Licensing Agency (2025) Miscellaneous conditions: assessing fitness to drive. Available at: https://www.gov.uk/guidance/miscellaneous-conditions-assessing-fitness-to-drive (Accessed: 2 May 2026).
• Driver and Vehicle Licensing Agency (n.d.) Excessive sleepiness and driving. Available at: https://www.gov.uk/excessive-sleepiness-and-driving (Accessed: 2 May 2026).
• Hirshkowitz, M., Whiton, K., Albert, S.M., Alessi, C., Bruni, O., DonCarlos, L., Hazen, N., Herman, J., Katz, E.S., Kheirandish-Gozal, L., Neubauer, D.N., O’Donnell, A.E., Ohayon, M., Peever, J., Rawding, R., Sachdeva, R.C., Setters, B., Vitiello, M.V., Ware, J.C. and Hillard, P.J.A. (2015) ‘National Sleep Foundation’s sleep time duration recommendations: methodology and results summary’, Sleep Health, 1(1), pp. 40–43. doi: 10.1016/j.sleh.2014.12.010.
• Idorsia Pharmaceuticals UK Ltd (2025) QUVIVIQ 50 mg film-coated tablets: Summary of Product Characteristics. Electronic Medicines Compendium. Available at: https://www.medicines.org.uk/emc/product/15360/smpc (Accessed: 2 May 2026).
• Joint Formulary Committee (2026a) British National Formulary: Daridorexant. Available at: https://bnf.nice.org.uk/drugs/daridorexant/ (Accessed: 2 May 2026).
• Joint Formulary Committee (2026b) British National Formulary: Daridorexant interactions. Available at: https://bnf.nice.org.uk/interactions/daridorexant/ (Accessed: 2 May 2026).
• Joint Formulary Committee (2026c) British National Formulary: Hypnotics and anxiolytics. Available at: https://bnf.nice.org.uk/treatment-summaries/hypnotics-and-anxiolytics/ (Accessed: 2 May 2026).
• Joint Formulary Committee (2026d) British National Formulary: Melatonin. Available at: https://bnf.nice.org.uk/drugs/melatonin/ (Accessed: 2 May 2026).
• Joint Formulary Committee (2026e) British National Formulary: Melatonin interactions. Available at: https://bnf.nice.org.uk/interactions/melatonin/ (Accessed: 2 May 2026).
• Joint Formulary Committee (2026f) British National Formulary: Zolpidem tartrate. Available at: https://bnf.nice.org.uk/drugs/zolpidem-tartrate/ (Accessed: 2 May 2026).
• Joint Formulary Committee (2026g) British National Formulary: Zolpidem interactions. Available at: https://bnf.nice.org.uk/interactions/zolpidem/ (Accessed: 2 May 2026).
• Joint Formulary Committee (2026h) British National Formulary: Zopiclone. Available at: https://bnf.nice.org.uk/drugs/zopiclone/ (Accessed: 2 May 2026).
• Joint Formulary Committee (2026i) British National Formulary: Zopiclone interactions. Available at: https://bnf.nice.org.uk/interactions/zopiclone/ (Accessed: 2 May 2026).
• Medicines and Healthcare products Regulatory Agency (2014) Zolpidem: risk of drowsiness and reduced driving ability. Drug Safety Update. Available at: https://www.gov.uk/drug-safety-update/zolpidem-risk-of-drowsiness-and-reduced-driving-ability (Accessed: 2 May 2026).
• Medicines and Healthcare products Regulatory Agency (2020) Benzodiazepines and opioids: reminder of risk of potentially fatal respiratory depression. Drug Safety Update. Available at: https://www.gov.uk/drug-safety-update/benzodiazepines-and-opioids-reminder-of-risk-of-potentially-fatal-respiratory-depression (Accessed: 2 May 2026).
• Medicines and Healthcare products Regulatory Agency (2026) Improving information supplied with gabapentinoids (pregabalin/gabapentin), benzodiazepines and Z-drugs. Drug Safety Update. Available at: https://www.gov.uk/drug-safety-update/improving-information-supplied-with-gabapentinoids-pregabalin-slash-gabapentin-benzodiazepines-and-z-drugs (Accessed: 2 May 2026).
• National Institute for Health and Care Excellence (2022a) Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults. NICE guideline NG215. Available at: https://www.nice.org.uk/guidance/ng215 (Accessed: 2 May 2026).
• National Institute for Health and Care Excellence (2022b) Sleepio to treat insomnia and insomnia symptoms. HealthTech guidance HTG624. Available at: https://www.nice.org.uk/guidance/htg624 (Accessed: 2 May 2026).
• National Institute for Health and Care Excellence (2023) Daridorexant for treating long-term insomnia. Technology appraisal guidance TA922. Available at: https://www.nice.org.uk/guidance/ta922 (Accessed: 2 May 2026).
• NHS (2022) Zopiclone. Available at: https://www.nhs.uk/medicines/zopiclone/ (Accessed: 2 May 2026).
• NHS (2023) Zolpidem. Available at: https://www.nhs.uk/medicines/zolpidem/ (Accessed: 2 May 2026).
• NHS (2024) Insomnia. Available at: https://www.nhs.uk/conditions/insomnia/ (Accessed: 2 May 2026).
• NHS (n.d.a) Fall asleep faster and sleep better. Every Mind Matters. Available at: https://www.nhs.uk/every-mind-matters/mental-wellbeing-tips/how-to-fall-asleep-faster-and-sleep-better/ (Accessed: 2 May 2026).
• NHS (n.d.b) Sleep problems. Every Mind Matters. Available at: https://www.nhs.uk/every-mind-matters/mental-health-issues/sleep/ (Accessed: 2 May 2026).
• Riemann, D., Benz, F., Dressler, A.Y., Espie, C.A., Johann, A.F., Blanken, T.F., Leerssen, J., Wassing, R., Henry, A.L., Kyle, S.D., Spiegelhalder, K. and Van Someren, E.J.W. (2023) ‘The European Insomnia Guideline: an update on the diagnosis and treatment of insomnia 2023’, Journal of Sleep Research, 32(6), e14035. doi: 10.1111/jsr.14035.
• Specialist Pharmacy Service (2024) Treating insomnia during breastfeeding. Available at: https://www.sps.nhs.uk/articles/treating-insomnia-during-breastfeeding/ (Accessed: 2 May 2026).
• Watson, N.F., Badr, M.S., Belenky, G., Bliwise, D.L., Buxton, O.M., Buysse, D., Dinges, D.F., Gangwisch, J., Grandner, M.A., Kushida, C., Malhotra, R.K., Martin, J.L., Patel, S.R., Quan, S.F. and Tasali, E. (2015) ‘Recommended amount of sleep for a healthy adult: a joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society’, Sleep, 38(6), pp. 843–844. doi: 10.5665/sleep.4716.
• Wilson, S., Anderson, K., Baldwin, D., Dijk, D.J., Espie, A., Espie, C., Gringras, P., Krystal, A., Nutt, D., Selsick, H. and Sharpley, A. (2019) ‘British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: an update’, Journal of Psychopharmacology, 33(8), pp. 923–947. doi: 10.1177/0269881119855343.
• Zentiva (2025) Zolpidem Tartrate 10 mg Tablets: Summary of Product Characteristics. Electronic Medicines Compendium. Available at: https://www.medicines.org.uk/emc/product/3975/smpc (Accessed: 2 May 2026).

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