Cognitive behavioural therapy for insomnia, built on sleep restriction, stimulus control and addressing unhelpful beliefs about sleep, is the recommended first-line treatment for chronic insomnia and its effects outlast those of hypnotics. It can be delivered in person, in groups, by telephone or through structured digital programmes.
Where a hypnotic is used, it should be short term with a plan to stop. For patients already on long-term benzodiazepines or Z-drugs, a slow, agreed taper alongside behavioural support succeeds more often than abrupt withdrawal.
- Offer CBT for insomnia, in person or digital, as first-line treatment for chronic insomnia.
- Give simple sleep restriction and stimulus control advice in the consultation while awaiting therapy.
- Agree an end date when prescribing a hypnotic.
- Taper long-term benzodiazepines or Z-drugs gradually, with behavioural support.
Why it matters
Hypnotic prescriptions started for a bad month often become years of dependence.
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