If, after consideration of the use of non-pharmacological measures, hypnotics are considered necessary, limit their use to short periods of time only (1 to 4 weeks). Establish cause of insomnia. Be aware of drug and alcohol use and educate on realistic sleep patterns. Patient information leaflets are available from www.moodjuice.scot.nhs.uk. In most cases, hospital patients should only be discharged home with a supply of hypnotics if they were admitted on them and there is good reason to continue. This is particularly important for older patients. The use of hypnotics with a long half-life such as nitrazepam (non-Formulary) is not recommended as they often result in a hangover effect and may lead to accumulation, particularly in older people. Sedative antihistamines are not recommended.

Long-term hypnotic use is associated with falls, road traffic accidents and hip fractures. NHS Highland guidance on Insomnia is under development, for further information see: BNF: Hypnotics and anxiolytics.

Be aware or gain reassurance that the person being prescribed benzodiazepines is not diverting or purchasing/acquiring medicines privately.

NICE guidance April 2004 (www.nice.org.uk) recommends that switching from one hypnotic to another should only occur if a patient experiences adverse effects thought to be directly related to a specific agent. Patients who have not responded to one hypnotic should not be prescribed any of the others.

For information on the use of melatonin in children and adolescents see Sleep onset difficulty guidance.

Additional information is available via the following links:

ZOLPIDEM - (First line)

Important: Therapy notes

MHRA advice: Zolpidem: risk of drowsiness and reduced driving ability the next day (December 2014) (www.gov.uk)

Important: Formulation and dosage details

Formulation:

Tablets 5mg, 10mg

Dosage:

10mg at bedtime. Older or debilitated patients 5mg at bedtime.

 

ZOPICLONE

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

Tablets 3·75mg, 7·5mg

Dosage:

7·5mg at bedtime. Older or debilitated patients initially 3·75mg at bedtime increased if necessary.

 

TEMAZEPAM

Important: Therapy notes

MHRA advice: Drugs and driving: blood concentration limits to be set for certain controlled drugs in a new legal offence (December 2014) (www.gov.uk)

Important: Formulation and dosage details

Formulation:

Tablets 10mg (CD schedule 3) 

Dosage:

10 to 20mg at bedtime, exceptional circumstances 30 to 40mg. Older or debilitated patients 10mg at bedtime, exceptional circumstances 20mg.

 

Important: Formulation and dosage details

Formulation:

Oral solution 10mg/5mL (CD schedule 3)

Dosage:

10 to 20mg at bedtime, exceptional circumstances 30 to 40mg. Older or debilitated patients 10mg at bedtime, exceptional circumstances 20mg.

MELATONIN

Important: Therapy notes

Important: Formulation and dosage details

Formulation:

Tablets 3mg (specialist recommendation only)
Ceyesto brand is the cost-effective choice. It is licensed for: Insomnia in children and adolescents aged 6-17 years with ADHD, where sleep hygiene measures have been insufficient.

Dosage:

To be used for sleep onset difficulties in children as per Sleep onset difficulty guidance.
In swallowing difficulties the  tablets can be crushed and mixed with a small amount of water or soft food for administration. 

For patients with enteral feeding tubes, a polypharmacy review should be conducted and, if melatonin is to be continued, advice from the Community Paediatrician should be sought for suitable formulations. See Highland unlicensed/off-label medicines list.

Editorial Information

Last reviewed: 06/06/2024

Version: V2

Document Id: F071