- Consider non pharmacological treatments first e.g. sleep hygiene (Principles of sleep hygiene below, Leicestershire Partnership patient leaflet available here)
- Prescribe a hypnotic only if severe insomnia is interfering with normal daily life
- Limit to short period of time and review BNF advice.
- If treatment with one of the recommended hypnotic medicines does not work, the doctor should not prescribe one of the others available.
Principles of sleep hygiene
- Avoid excessive use of caffeine, alcohol or nicotine. A hot milky drink at bedtime may help promote sleep.
- Do not stay in bed if not asleep.
- Avoid daytime naps or periods of inactivity.
- A warm bath or exercise a few hours before bedtime may promote sleep.
- Avoid strenuous physical or mental activity near to bedtime.
- Make sure the bed and bedroom are comfortable; avoid extremes of noise and temperature.
- Rise at the same time every morning, regardless of sleep duration.
In patient use: recommendations
- All PRN hypnotic prescriptions should be endorsed with a maximum frequency of 5 nights out of 7
- PRN hypnotics should not be offered before 11pm
- All regular hypnotic prescriptions should be assigned a review date of 2 weeks to ensure usage does not become long-term
- All prescriptions for hypnotics on discharge should be queried unless the patient was a regular user of hypnotics prior to admission