This site is intended for health professionals only

NICE recommends GPs prescribe insomnia drug if CBT fails

NICE recommends GPs prescribe insomnia drug if CBT fails

NICE has published draft guidance recommending a new drug for GPs to prescribe to patients with long-term insomnia

Today’s new guidance said that daridorexant, produced by the company Idorsia, should be used to treat adults if they have tried cognitive behavioural therapy for insomnia (CBTi) and it has not worked, or if this therapy is not available. 

Daridorexant is a pill that is taken half an hour before going to sleep every night, and clinical trial evidence has shown that it improved insomnia symptoms compared with a placebo over a 12-month period.

Its effectiveness was shown by a reduction in the total number of minutes that a person is awake after initially falling asleep as well as the time it takes to fall asleep after going to bed.

The drug works by blocking the action of two types of orexins, the chemicals that help the body stay awake. 

The length of treatment should be ‘as short as possible’, stressed NICE, with GPs to assess patients within three months of starting the drug.

The independent appraisal committee noted that daridorexant is new to GPs, as the ‘first medicine available’ for longer-term treatment of long-term insomnia. 

‘The clinical experts highlighted that, if daridorexant were recommended, support and training of GPs would be key for its implementation because people’s experience of the condition is subjective,’ the draft guidance said.

The committee also emphasised that GPs should always offer CBTi before daridorexant, but accepted that access to this service is not consistent across the country. 

One clinical expert argued that GPs ‘should be encouraged to explore reasons why CBTi is not available’.

However, the committee said ICBs should be responsible for ensuring CBTi is available in their area, given GPs are under capacity pressures and may not have time to address the lack of services. 

NICE estimated that just over 20,000 people in England could be prescribed the drug in the first year. 

GPs are advised to diagnose insomnia in adults who have symptoms lasting for at least three nights per week for at least three months, and whose daytime functioning is considerably affected.

Last year, NICE recommended a £45 app that GPs can prescribe as an effective alternative to sleeping pills for people suffering from insomnia. 


Visit Pulse Reference for details on 140 symptoms, including easily searchable symptoms and categories, offering you a free platform to check symptoms and receive potential diagnoses during consultations.


Please note, only GPs are permitted to add comments to articles

fareed bhatti 15 September, 2023 5:22 pm

I see absolutely no reason to suspect this will be a problem for GPs as all the dots seem to be joined up in this well-oiled machine between NICE, ICBs, secondary, primary care, and mental health teams. There is a ubiquitous availability and seamless flow of all the psychological therapies that work flawlessly, and GPs have all the time in the world to sit and spend 45 mins with each patient dissecting the rare problem we hardly see in primary care called insomnia.
This new medication I’m sure is cheap as chips, and nobody has read about it in the news so won’t be asking for it next week along with their modified-release opioids, antidepressants and muscle relaxants, and ICB prescribing teams undoubtedly won’t be doing the audits to get patients off it.
After all, if I don’t prescribe it they can always invoke Martha’s law and seek a second opinion and then second opinion to the second opinion and so on….
It was certainly a strong coffee….I feel quite optimistic.

Not on your Nelly 15 September, 2023 8:06 pm

Nice living again in their ivory towers in cloud cuckooland not seeing any patients or having any idea of lack of services for anything. Thank you for your wise guidance.

Matthew Jamrozek 15 September, 2023 8:47 pm

So when will this drug enter the BNF?

Turn out The Lights 15 September, 2023 11:00 pm

I detect another drug of addiction.

Janine O'Kane 15 September, 2023 11:13 pm

Are nice getting worse or is it just me

Sujoy Biswas 16 September, 2023 10:54 am

Sir would one like a side order of Daridorexant with their sertraline pregaba modafinil and THC.
Ooh yes suits you sir.
Utter numpties.

John Graham Munro 16 September, 2023 11:42 am

N.I.C.E guidelines on anything are enough to put me to sleep

Dave Haddock 17 September, 2023 12:04 pm

Please could Dr Bhatti replace whoever is currently in charge at NICE.

A Non 18 September, 2023 11:35 pm

This new sleeping tablet is ‘perfectly safe’ and recommended by the medical establishment.

Excuse me I’ve heard this before – more than once

Truth Finder 22 September, 2023 2:26 pm

More dreamland “guidance”. We’ll be lucky if there is not a shortage of insomnia drugs.