Insomnia treatment

Chronic (long-term) insomnia is when you have an ongoing issue with falling asleep, staying asleep, or waking too early.

The National Institute for Health and Care Excellence considers it insomnia when you have trouble sleeping:

• on 3 or more nights a week
• for at least 3 months in a row
• and it affects how you manage when you’re awake, for example it negatively affects your mood, ability to concentrate, and energy levels

There are a few different ways you can treat your insomnia, including prescription medications, over-the-counter medications, and therapy.

Prescription treatments for insomnia that need to be approved by a doctor include:

Quviviq

Quviviq is a medication that can be prescribed by Asda Online Doctor, with the active ingredient daridorexant. Daridorexant is a ‘dual orexin receptor antagonist’. This means it blocks the pathways in your brain that keep you awake.

Quviviq takes about 30 minutes to start working, so it’s best to take it at least 30 minutes before you want to sleep. Quiviq’s effects last about 7 to 8 hours. It’s been proven to help over 50% of people get better sleep. If Quviviq works well for you and does not cause severe or ongoing side effects, it can be taken for up to 1 year.

Melatonin

Melatonin tablets are a hormone that helps set your body clock, signalling to your body that it’s time to sleep. It is licensed for short-term use in people over the age of 55.

Z-drugs

Z-drugs help you get to sleep and avoid waking up, and include zopiclone and zolpidem. They may be used for short-term sleep problems. Tolerance and dependency can develop, as well as withdrawal symptoms when stopped, which is why they are only given for the short term.

Benzodiazepines

Benzodiazepines are used for short-term sleep problems that are usually anxiety-related and include temazepam, lormetazepam, and nitrazepam. Like z-drugs, tolerance and dependency can develop, as well as withdrawal symptoms when stopped.

Over-the-counter insomnia treatments

The only over-the-counter treatments for insomnia are antihistamines, which are not meant to be used long-term. They are normally used for allergies like hay fever, but they also act like sedatives, which means they can make you drowsy and help promote sleep.

These treatments can be bought in a pharmacy without a prescription, if a pharmacist approves, and include:

• promethazine
• diphenhydramine

Therapy for insomnia

The first-line treatment for sleeping problems offered on the NHS is cognitive behavioural therapy for insomnia (CBT-i). You can access CBT-i by being referred by your GP, referring yourself online, or using a digital app. You would normally need to try CBT-i before being prescribed insomnia medication on the NHS.

There are also other ways to access support for insomnia, including:

• finding a private therapist through the British Association of Behavioural and Cognitive Psychotherapies
• self-help techniques offered by NHS Every Mind Matters
• information and support offered by The Sleep Charity
• specialist sleep clinics like the one at University College London Hospitals which you can also self-refer for

You can get insomnia treatment online, through the NHS, or over-the-counter in pharmacies. Not all treatments are meant for long-term (chronic) insomnia, and you may not be able to access treatments right away on the NHS

Can you buy insomnia treatment online?

Yes, you can request insomnia treatment online. Using a service like Asda Online Doctor, you can submit a request for treatment and have prescription medications delivered if they’re right for you:

1. Complete a short questionnaire about your health and current medications.
2. Select your preferred treatment.
3. Choose your preferred delivery method.
4. Log in or sign up for an account.
5. Submit payment details.
6. A doctor will then check your request to make sure it’s right for you.
7. If your request is approved, your treatment will be sent to an Asda Pharmacy for collection or delivered to your preferred address.
8. If your request cannot be approved, payment will not be taken, and a doctor will contact you with advice and next steps.

Asda Online Doctor offers the prescription insomnia medication, Quviviq.

Is insomnia treatment available over the counter?

Yes, but over-the-counter treatments are only meant for short-term use. Antihistamines can be ordered in pharmacies without a prescription if a pharmacist improves. See the section on ‘over-the-counter insomnia treatments’ for more information.

All medications can cause side effects and the same goes for sleeping pills. Not everyone will get side effects and most are usually mild and go away by themselves.

Common side effects of Quviviq that affect up to 1 in 10 people include:

• headaches
• excessive sleepiness
• feeling dizzy
• feeling tired
• feeling sick (nausea)

These are usually mild and should get better as you get used to the medication, but if they are severe or long-lasting, let your doctor know.

Uncommon side effects of Quviviq that affect up to 1 in 100 people include:

• being unable to move or talk for a few minutes when either going to sleep or waking up (sleep paralysis)
• seeing or hearing things that are not real, which are vivid or disturbing (hallucinations)
• unusual dreams or nightmares
• sleepwalking
• allergic reactions, such as a rash

Tell your doctor straight away if you get any of these uncommon side effects or worsening depression symptoms.

As with any medication, there is a chance of having a serious allergic reaction. Call 999 or get to A&E straight away if you get any of these symptoms:

• difficulty breathing or swallowing
• wheezing or noisy breathing
• a swollen face, tongue, or mouth
• a widespread rash
• fainting
• dizziness

How to manage the side effects

Common side effects are usually mild and go away on their own within a few days to a few weeks. Still, if you do get them, there are things you can do to manage them, including:

• headaches – drink water to stay hydrated and take over-the-counter painkillers as needed
• sleepiness or drowsiness – take your medication up to an hour before sleeping and avoid alcohol which can make sleepiness worse
• feeling dizzy – stand up slowly when you get up from sleeping, either in the night or when you get up in the morning
• feeling sick – eat a dinner earlier in the evening, which includes blander foods and ginger tea

Symptoms of insomnia include:

• trouble falling sleep
• waking up often during the night
• waking up too early in the morning and not being able to get back to sleep
• not feeling well-rested when you wake up
• finding it hard to nap during the day, even though you’re tired
• feeling tired and irritable during the day
• finding it hard to concentrate during the day due to tiredness

If these symptoms occur at least 3 days a week for at least 3 months, then they count as chronic insomnia.

Long-term impact of insomnia

If insomnia goes on for a long time without successful treatment, it can lead to an increased risk of:

• dementia
• heart disease
• type 2 diabetes
• high blood pressure
• stroke
• death from all causes

There are a few different factors that might be causing your insomnia. They can include lifestyle factors, as well as health conditions and medications.

Lifestyle factors that can cause insomnia include:

• stress
• noise
• your bedroom being too hot or cold
• an uncomfortable sleeping arrangement
• substances like alcohol, caffeine, nicotine, and illegal drugs like cocaine or ecstasy
• jet lag
• working shifts

Health conditions and medications that can cause insomnia include:

• chronic pain
• sleepwalking
• snoring and stopping breathing when asleep (sleep apnoea)
• nightmares
• a condition where you suddenly fall asleep (narcolepsy)
• restless legs syndrome
• an overactive thyroid
• menopause
• mental health conditions, including anxiety, depression, schizophrenia, and bipolar disorder

Options for improving insomnia include lifestyle changes to help promote sleep and medical treatment for insomnia.

Lifestyle changes to improve insomnia

When it comes to lifestyle changes that you can try to improve sleep, try:

✓ going to bed and waking up at the same time every day

✓ relaxing before bed by taking a bath or shower, reading, or anything else that does not involve using a screen

✓ making sure the room you’re sleeping in is dark and quiet, and your bed, pillows, mattress, and sheets are comfortable

✓ exercising during the day

Do not:

✗ smoke, drink alcohol, or have caffeine 6 hours before bed

✗ eat a big meal later in the evening

✗ exercise 4 hours before bed

✗ watch anything on a screen before bed

✗ nap during the day

Medical treatment to improve insomnia

For chronic insomnia, the best medical treatment available includes cognitive behavioural therapy (CBT-i) and prescription sleeping pills. Cognitive behavioural therapy can help how you think about and approach sleeping to improve habits.

Sleeping pills can help promote sleep by improving your body's natural sleep mechanisms. See the section on ‘where to get insomnia treatment’ for more information.

Remember that you can use a combination of lifestyle changes, medication, and therapy to help improve your insomnia.

Are natural sleeping tablets effective?

No. ‘Natural’ sleeping tablets usually refer to herbal or over-the-counter remedies that are not medications. This means that they have not been studied or proven to work the same way that actual sleeping medications have.

While some people may believe they help them get better sleep, it’s not always clear whether they’re effective or safe as they can have side effects and interact with real medications. If you do decide to use ‘natural’ products, make sure to check whether they have a traditional herbal registration.

Can you take antihistamines to help sleep?

Yes. Antihistamines are available over the counter to help with short-term sleeping problems. They can have a sedative effect, meaning they can help promote sleep. See the section on ‘over-the-counter insomnia treatments’ for more information.

What vitamins can help you fall asleep?

Vitamins may help with insomnia, but only if you’re deficient. Certain vitamins like magnesium and vitamins D, B12, and C are important for sleep. If you do not get enough of these vitamins and minerals in your diet, it might cause insomnia. However, if you are not deficient, then adding extra supplements to your diet is unlikely to improve your insomnia.

If I wake up in the middle of the night, is it too late to take a pill?

Yes, it’s probably not a good idea. Sleeping pills are meant to be taken before you want to start sleeping for the night. Taking them partway through the night when you wake up means they can still have an effect in the morning when you’re awake. This can lead to excessive sleepiness and drowsiness, and make it unsafe to drive or operate machinery.

Will my GP be notified if I order sleeping pills privately online?

Yes. Government regulations issued by the General Pharmaceutical Council require online doctor services to inform your GP of any treatments you receive. Any service that claims not to inform your GP is doing so illegally and will not be safe to order treatment from.

Can I take painkillers with sleeping tablets?

Only over-the-counter painkillers, like paracetamol and ibuprofen. Taking stronger painkillers with some sleeping pills can cause an increased risk of side effects and even a risk of dangerous side effects. Quviviq, which can be prescribed by Asda Online Doctor, is safe to take with paracetamol and ibuprofen. For stronger painkillers like codeine or tramadol, or other sleeping pills like benzodiazepines, you should speak to your doctor first.