Benzodiazepines and hypnotics

Insomnia can result in impaired daytime functioning and reduced quality of life. Effective treatment is important to reduce suffering. Cognitive behavioural therapy for insomnia is efficacious both in-person and digitally and should be the first-line option in either short-term or long-term insomnia. Hypnotics or sedatives can be offered if non-drug treatments are ineffective or unsuitable but should be kept to short-term use because of associated adverse effects. Treatment should be withdrawn gradually to reduce risks of rebound anxiety, other distressing symptoms, confusion and convulsions. Melatonin is an alternative hypnotic for the short-term management of insomnia in individuals aged >55 years. Orexin receptor antagonists are an option in chronic insomnia where cognitive behaviour approaches are not an option.