What is the recommended management of primary insomnia in adults in primary

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MSt MRCGP.

Posted: 2 August 2026Updated: 2 August 2026 Guideline-Aligned (High Confidence) Clinically Reviewed

Assessment and first steps: Confirm insomnia as difficulty initiating or maintaining sleep, or poor sleep quality, despite adequate opportunity, with impaired daytime functioning; sleep disturbance without daytime impairment is not insomnia disorder.

Assess symptom pattern, duration, frequency, functional impact, sleep schedule and environment, triggers, substance use, medicines, and physical or mental-health comorbidity.

Ask about snoring, witnessed apnoea, restless legs and parasomnias, and consider obstructive sleep apnoea screening where appropriate.

Use a 1–2 week sleep diary to identify sleep patterns and perpetuating lifestyle factors.

Non-pharmacological management: Offer sleep-hygiene advice to everyone, addressing behavioural, environmental and timing factors that can impair or improve sleep.

Offer cognitive behavioural therapy for insomnia (CBTi) as first-line treatment for both short-term and chronic insomnia in adults of all ages; its benefits persist after treatment ends.

Sleepio, a digitally delivered CBTi programme, can be offered.

Pharmacological management: Avoid hypnotics where possible because of their potential for significant adverse effects, and avoid pharmacological therapy for long-term management.

For short-term insomnia that is likely to resolve soon but causes severe daytime impairment and significant distress, consider a 3–7 day course of a non-benzodiazepine hypnotic (z-drug), avoiding these where possible in older people.

For short-term insomnia that is unlikely to resolve soon, offer CBTi first line; short-term adjunctive treatment with a z-drug, or prolonged-release melatonin for people aged over 55 years, may be appropriate.

If prescribing zopiclone, use the lowest effective dose and do not use it continuously long term.

Review and referral: Refer to a sleep clinic or neurology if another sleep disorder is suspected, the diagnosis is uncertain, or long-term insomnia has not responded to primary-care management.

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