Insomnia treatment

Insomnia is a sleep disorder that can prevent you from falling or staying asleep. As a result, it can stop you from getting the sleep you need that is restorative for your body. Types of insomnia include short-term (acute) and long-term (chronic).

Short-term insomnia

Otherwise known as acute insomnia, short-term insomnia is common and usually temporary. It typically lasts from a few days up to no more than 3 months. Causes of short-term insomnia include:

• life changes – such as bereavement or trauma
• emotional stress – like anxiety or depression
• jet lag
• substances, food or drink – alcohol, caffeine, or eating too late
• physical illness – pain, illness, or medications
• bad sleep habits – napping too much, irregular sleep schedules (due to shift work, for example), or too much stimulation before bed

Acute insomnia usually goes away once one of the underlying issues listed has settled or been addressed. If it does not go away and lasts longer than 3 months, you may have chronic insomnia.

Long-term insomnia

Also known as chronic insomnia, long-term insomnia is when you have sleeping difficulties that last longer than 3 months. The treatment for this kind of insomnia is more complex because the causes of it vary from person to person. It can affect your mood, ability to concentrate, and your energy levels.

NICE (National Institute for Health and Care Excellence) outlines that chronic insomnia often happens alongside other medical conditions, such as:

• anxiety
• depression
• chronic obstructive pulmonary disease (COPD)
• cardiovascular disease
• neurological conditions
• diabetes
• musculoskeletal conditions
• chronic pain

Trauma and post traumatic stress disorder (PTSD) can also cause chronic insomnia, with insomnia being a core, persistent PTSD symptom – with 90% of patients experiencing insomnia of some kind.

Women in the UK are 1.5 to 2 times more likely to have chronic insomnia than men, often related to menopause and changes in hormones.

Chronic insomnia can go away, but you may need treatment. You may require medication, psychotherapy, or Talking Therapies, or either of the 3.

Available treatments for insomnia at ZAVA include:

• Quiviviq
• melatonin

Quiviviq

Quiviviq is a prescription-only oral tablet taken daily, 30 minutes before you go to sleep. It contains the active ingredient daridorexant, which works to:

• regulate your body clock (sleep-wake cycle)
• reduce night-time alertness

It is usually taken for up to 3 months at first. If your doctor thinks it is suitable, they may recommend you take it for longer, for up to another 9 months. You cannot take Quiviviq for more than 1 year, as safety and effectiveness have not been studied beyond this point.

In clinical trials, within 3 months patients saw a significant improvement in how:

• alert they are in the daytime
• long it took to fall asleep
• long they stayed asleep

At ZAVA, Quiviviq is available in 25mg and 50mg doses.

Melatonin (prolonged release)

Melatonin PR (prolonged release) is a prescription-only oral tablet taken as 1 tablet daily for up to 13 weeks, 1 to 2 hours before you go to sleep.

It contains a synthetic form of melatonin, mimicking a natural hormone that is produced by the pineal gland in the brain that usually regulates your sleep cycle, or ‘body clock’. It is typically prescribed for a maximum of 13 weeks in adults (around 3 months).

According to new studies, melatonin is highly effective at improving sleep quality as well as restoring the biological clock. Melatonin is also an effective treatment for jet lag.

At ZAVA, Melatonin PR for insomnia is available in 2mg tablets.

Over-the-counter medication

There are many over-the-counter sleeping medications available, some are made from natural, herbal ingredients.

A lot of these work as great short-term treatments for acute insomnia, or if you are allergic to ingredients in prescription-only treatments. You should always check with your pharmacist or doctor if over-the-counter sleep medication is suitable for you before taking it. Some of these treatments may cause morning drowsiness and can only be taken for 1 to 2 weeks, so if your symptoms persist, you may need a prescription for insomnia.

Here are a few examples of over-the-counter UK sleeping medications and how they work:

Nytol

Nytol contains diphenhydramine, which is a popular sedative antihistamine. It works by blocking histamine receptors in the brain, which makes you drowsy, less alert, and tired. It usually takes effect within 20 to 30 minutes. It should generally be taken for up to 2 weeks.

Kalms Night

Kalms Night contains natural ingredients, a dry extract of Valerian Root. It is commonly used for temporary relief of sleep disturbances by causing drowsiness, helping you to fall asleep. They are typically taken 30 to 60 minutes before you are due to go to sleep. Patients find they are most effective 2 weeks after starting to take them regularly.

Phenergan Night Time

Phenergan Night Time contains promethazine hydrochloride. This is an antihistamine that causes drowsiness to help with short-term sleeplessness. It is a strong over-the-counter medication. You can use it for no longer than 10 days. They are taken 30 to 60 minutes before bed. They last 12 hours, so may cause drowsiness when you wake up.

Sominex

Sominex contains promethazine hydrochloride, like Phenergan Night Time. So, it is a sedating antihistamine which makes you drowsy so you can fall asleep easier. It contains 20mg, whereas Phenergan contains 25mg. You may find this a suitable alternative if you find Phenergan too strong. You can also take Sominex 20 minutes before you go to sleep. You should not take Sominex for longer than 7 days.

We do not offer over-the-counter sleeping aids at ZAVA. If you have tried these medications and still are having trouble falling asleep, you can start an online consultation for Quiviviq or Melatonin (PR).

Clinical studies have found that insomnia medications are effective in the short-term for sleepless nights, however in the long-term, Talking Therapies or psychotherapy may be required.

At ZAVA, you can request melatonin, which can enhance sleep quality in the short term. Or Quiviviq, which has been clinically recognised to help 53% of people get better sleep. However, you cannot take either medication long-term. For example, the maximum duration recommended is 12 months for Quiviviq, and around 3 months (13 weeks) for melatonin, if this is approved by your doctor.

The National Institute of Care and Excellence (NICE) recommends that in the long-term, insomnia should be treated (first-line) with Cognitive Behavioural Therapy for Insomnia (CBT-i). This is a structured, session-based talking therapy treatment recognised as a first-line non-drug treatment for the sleep disorder. This may work for you if your insomnia may be caused by prolonged stress, grief, anxiety, phobias, depression, PTSD, or other psychological disorders.

Insomnia is a complex condition. You may find that insomnia medications like Quiviviq (daridorexant) may be suitable if CBT-i is not available or is unsuitable for you. You may find this treatment line more suitable if you have physical condition-related insomnia, which is chronic or musculoskeletal.

You may even find that using insomnia medication works for you in the short-term, while maintaining CBT-i works for you in the long-term. Other options are available for insomnia, and you may need a referral from your GP to a sleep clinic or neurology specialist.

What is the best medication for insomnia?

The best treatment for insomnia varies from person to person. At ZAVA, we offer melatonin and Quiviviq (daridorexant).

Melatonin is a short-term insomnia medication, which you should only take for up to 13 weeks. Whereas, you can take Quiviviq for up to 12 months if your doctor finds it suitable.

Quiviviq contains daridorexant, which is a part of a class of drugs referred to as dual orexin receptor agonists (DORA). These work to improve sleep-wake cycles by turning off wakefulness in your brain by blocking the chemical called orexin that keeps you alert. Quiviviq is the first dual orexin receptor agonist medication to be authorised for treatment of insomnia in the UK.

To help you consider which treatment may be suitable for you to request, here is an overview of alternative DORA treatments to Quiviviq which is offered by ZAVA and how they compare:

The best non-prescription sleeping pills in the UK are antihistamine-based medications like:

• Nytol (diphenhydramine hydrochloride)
• Phenergan (promethazine)
• Sominex (promethazine hydrochloride)

Each of these are available in different dose strengths and are taken from 20 minutes to 1 hour before bed to increase drowsiness, helping you get to sleep faster. You can find more information on these in the over-the-counter medication section.

We do not offer non-prescription sleeping pills at ZAVA, however these treatments, among others, should be available over-the-counter at your local pharmacy.

The most common causes of insomnia are:

• psychological or emotional – stress, anxiety, and depression
• noise
• substances – alcohol, caffeine, or nicotine
• illegal drugs
• jet lag
• shift work

In some cases, other health conditions can cause insomnia. This is often due to a change of hormones, neurological or physical pain. You may experience insomnia if you have:

• menopause symptoms or are going through menopause
• hyperthyroidism (overactive thyroid)
• chronic pain like fibromyalgia or arthritis
• endometriosis
• cancer
• respiratory or cardiovascular issues like sleep apnoea, asthma, or heart failure
• neurological diseases like Parkinson’s or Alzheimer’s
• respiratory conditions like COPD or asthma
• gastrointestinal reflux (GERD or GORD)
• other sleep disorders like restless legs syndrome (RLS) or periodic limb movement disorder (PLMD)
• epilepsy

If you think that your insomnia may be caused by 1 of these conditions, or you have symptoms other than difficulty with sleeping, speak to your doctor. It’s important to manage any underlying conditions that could be affecting your sleep, as well as considering treatment for your insomnia symptoms.

You may have insomnia if you often:

• feel tired after waking up
• lie awake at night, ‘clock-watching’
• have trouble staying awake and concentrating during the day due to tiredness
• find it difficult to get to sleep
• wake up early and cannot go back to sleep
• find it difficult to nap during the day, even though you are tired

Like all medications, insomnia treatments can cause side effects but not everyone will experience them.

Both prescription and over-the-counter sleeping medications may cause:

• next-day drowsiness
• dizziness
• headache
• dry mouth

Most medications are short-term or only safe to use for up to 1 year, depending on the treatment. You should tell your doctor if you drive or operate machinery if you are going to take insomnia medications.

Uncommon side effects of prescription insomnia medication include:

• sleepwalking
• nightmares
• abnormal dreams
• sleep paralysis (a temporary inability to move or talk while you are asleep, or upon waking up)
• anxiety
• dizziness
• high blood pressure
• stomach upset and pain
• changes in liver blood tests
• rash
• itching
• weight gain

If you experience any of the following rare symptoms, which may be signs you are having a serious allergic reaction, call 999 or go to the nearest A&E:

• rash or hives
• swelling in your face or throat
• difficulty breathing and wheezing
• fainting
• chest pain

Insomnia treatment is for you if you are having trouble sleeping often and a doctor or pharmacist has prescribed or recommended treatment.

Insomnia treatments should not be taken if you:

• are under 18 or over 75
• have severe liver problems
• are allergic to any of the ingredients in the medication
• are pregnant or breastfeeding

Quiviviq (daridorexant) should also not be taken if you have:

• narcolepsy
• alcohol or drug dependency
• depression or thoughts of harm to yourself
• severe COPD
• ever had serious changes in mood whilst taking hypnotic medication

Melatonin is also not suitable if you have:

• galactose intolerance, LAPP lactase deficiency, or glucose-galactose malabsorption
• epilepsy
• kidney disease
• autoimmune disease

You should speak to your doctor before taking melatonin if you are taking:

• certain antidepressants
• medications that lower blood pressure
• anti-inflammatory drugs like ibuprofen, naproxen, or diclofenac
• oestrogens in contraceptive pills or hormone replacement therapy
• opiates for pain control like codeine or morphine
• psoralens for psoriasis
• antibiotics like quinolones or rifampicin
• carbamazepine for epilepsy
• thioridazine for schizophrenia
• cimetidine for ulcers in the stomach
• warfarin to prevent blood clots
• givosiran, leniolisib, mexiletine, osilodrostat, rucaparib or vemurafenib
• zaleplon, zolpidem, or zopiclone for insomnia or any medication that makes you sleepy

You should speak to your doctor before taking Quiviviq (daridorexant) if you are taking:

• antifungals
• HIV treatment
• antibiotics
• cyclosporin
• medication for your heart such as diltiazem or verapamil
• St. John's wort
• nefazodone, mifepristone, nirmatrelvir/ritonavir (Paxlovid), ombitasvir/paritaprevir/ritonavir
• medication that makes you tired or drowsy, too tired to function, or that affects your balance

It’s also important to avoid grapefruit juice (and other citrus juices) and noni juice while taking Quiviviq (daridorexant).

You can treat insomnia without medication in a range of ways that involve physical activity and psychotherapy or Talking Therapies. For example, try:

Cognitive Behavioural Therapy

Otherwise known as CBT. There is a short programme specified for insomnia that lasts 6 to 8 weeks, known as CBT-I. This is usually the first treatment recommended for insomnia and the NHS will refer you for this before prescribing medications, unless there is a reason it’s not suitable for you. CBT-I can help with:

• adjusting thought patterns around sleep
• challenging anxiety around sleep
• finding calming techniques like deep breathing or progressive muscle relaxation
• retraining the brain and its associations to sleep

CBT-I can be helpful because insomnia is a complex condition and varies from person to person.

Sleep hygiene

Changing your sleeping habits can positively impact your sleep pattern and potentially help your insomnia. For example, you may find it helpful to go to bed at a set time and wake up at a set time.

Consider your environment when you sleep, too. If you are affected by light or noise, try:

• using blackout curtains, or eye masks
• ear plugs, white noise, or heavy curtains to shut out noise
• avoiding screens (phones and TV) before bed

Take time to get comfortable and develop a bedtime routine.

Mindfulness and meditation

Increasing evidence backed by data has shown that mindfulness meditation can be a great form of therapy for insomnia.

There are a range of online resources on mindfulness and meditation which can help to add to your bedtime routine, which may help you relax so that you can go to sleep.

You can try:

• breathing techniques
• guided meditation videos or podcasts
• progressive muscle relaxation

Exercise

Several studies on different types of exercise on insomnia patients have found that it is beneficial in the treatment of insomnia. One study found that jogging, yoga, and Tai Chi in particular helped patients to get to sleep faster, and stay asleep. These low-impact exercises can also be done gently and can help with physical or chronic pain which can cause insomnia too.

You can access these exercises by simply going for a walk around the block, or finding resources through videos online which are accessible for free on yoga or Tai Chi moves. You could wind down with light yoga before bedtime as a way to relax your muscles, for example.

Regular physical activity can lead to improved sleep quality overall, helping your sleep health and overall health.

If you can, try adding exercise, whether this is light, aerobic, or more cardio-based, to see if it makes a difference to your sleep schedule.

Natural sleep aids

Try natural sleep aids before bed time like:

• herbal teas
• warm milk, or hot chocolate, or warm malted milk drinks
• valerian root based herbal teas

Getting yourself ‘cosy’ before bedtime may make it easier for you to go to sleep.

Acupuncture

Acupuncture has been clinically proven to be a safe, effective and evidence-based treatment for insomnia with minimal side effects. It can help with sleep quality through relaxation, as well as reducing anxiety.

You can get acupuncture therapy at acupuncture clinics. It is also available via some local GP clinics through physiotherapists on the NHS.

You can access medication-based treatment for insomnia from your local GP on the NHS or from online doctor services.

Can you buy insomnia treatment online?

Yes. You can access insomnia treatment from online doctor services like ZAVA. For insomnia at ZAVA, we currently offer:

• Quiviviq
• melatonin

To request treatment with ZAVA:

1. Fill in a short online health questionnaire.
2. One of our online doctors will review your questionnaire and approve if suitable.
3. If approved, you can receive your treatment to your door.

Is insomnia treatment available on the NHS?

Yes. Insomnia treatment is available on the NHS at some local GP surgeries. Insomnia is a complex condition, medication is often prescribed for short-term use, whereas in some cases your GP may suggest CBT-I for managing your sleep habits long-term.

Can you buy sleeping tablets online?

Yes. Over-the-counter and prescription-only sleeping tablets are available to request from a range of licensed providers. At ZAVA we currently offer:

• melatonin
• Quiviviq (daridorexant)

To request treatment with ZAVA you simply fill in a short online health questionnaire, and one of our online doctors will review your questionnaire and approve if it is suitable for you. If it is approved, your treatment will be delivered to your door.

Can you cure insomnia?

Yes. In most cases, insomnia can be treated. It is a complex condition and ways of treating it vary from person to person. For example, short-term (acute) insomnia treatments are different from long-term (chronic) insomnia. Note that there is no ‘quick-fix’ fast way to cure insomnia, a variation of medication-based treatment in the short-term and therapeutic treatments for the long-term can help you treat insomnia.

Can sertraline cause insomnia?

Yes. Insomnia is a very common side effect of sertraline. Although not everyone experiences side effects of sertraline. However, insomnia can also be caused by depression which is treated with sertraline. If you are unsure whether your insomnia may be caused by other conditions like depression or your medication, you should speak to your doctor.

Can vaping cause insomnia?

Yes, especially if your vape contains nicotine. Clinical studies have found that e-cigarettes (vapes) may be linked to disturbances of sleep. Nicotine is a stimulant which can reduce the quality of your sleep and increase how many times you wake up at night.

Will insomnia eventually go away?

Yes, it can. Insomnia is a complex condition but it can be treated and can eventually go away.

Short-term (acute) insomnia usually goes away on its own. Acute insomnia is often caused by emotional stress, anxiety, or things like shift work and jet lag, life changes or illness. Once these things go away, insomnia can too. Acute insomnia typically lasts from a few weeks up to 3 months.

Long-term (chronic) insomnia can also go away, however it takes longer treatment and needs specific strategies, sometimes involving Talking Therapy or CBT-I in addition to medication.

If you have been struggling sleeping for longer than 3 months, it is likely that you may have chronic insomnia. You should speak with your doctor and they may suggest a suitable treatment for you.