The patient journey

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Treating chronic insomnia: the patient journey

The patient journey

Chronic insomnia has a detrimental impact on patients’ quality of life. Effective treatment can help improve symptoms including daytime functioning.1 However, despite its high prevalence, insomnia remains under‑recognised and under‑treated.2

The typical journey that a patient with chronic insomnia will experience may consist of seven distinct phases, although this varies between countries and between individuals and is not always linear.2 Some patients may also be referred to specialist care.2

Insomnia - current patient journey2

Onset of sleep problems
  • Insomnia trigged by specific stressor and sleep behaviour does not recover
  • Life-long sleep issues that may worsen for periods

Positive behaviours:2

  • Sleep hygiene
  • Altering diet/ caffeine intake
  • Active relaxation
  • Exercise

Negative behaviours:

  • Alcohol or drug abuse2
  • Daytime napping3
  • Over compensatory bed times or rise times3

According to personal research, pharmacist or peer recommendations2

May not provide lasting relief and are often associated with anticholinergic side effects1,2

Note that OTC products are not recommended by NICE for the treatment of chronic or acute insomnia.3,4

Often driven by reaching ‘crisis point’ with significant daytime impairment

Patient may feel desperate and may expect medication prescription

After evaluation of needs, HCPs may:

  • offer sleep hygiene education2
  • refer to cognitive therapy2

HCP considers benefit/ risk to patient

Patient’s feelings may fluctuate between relief/ hopefulness and failure for succumbing to prescription treatment

Medication use should be minimised with the aim to restore natural, good quality sleep

Management is usually handled in primary care

Referral may be required for further investigations or for management of associated conditions including mental health issues

Pharmacological treatment is a compromise between sleep benefit and:

  • risk/ fear of dependency or tolerance
  • residual daytime effects
  • stigma/ feelings of failure

QUVIVIQ™ is licensed for chronic insomnia in the UK and recommended by NICE* in adults with symptoms lasting for 3 nights or more per week for at least 3 months and whose daytime functioning is considerably affected.6

Treatment duration should be as short as possible and should be assessed within 3 months.5

Many patients develop coping mechanisms and individual behaviour patterns, alongside or without medication.

* For adults with chronic insomnia with symptoms lasting for 3 nights or more per week5 for at least 3 months and whose daytime functioning is considerably affected, only if CBTi has been tried but not worked or is unavailable or unsuitable. The length of treatment should be as short as possible.6

Adapted from O’Regan E et al, 20232

Treatment options

For the treatment of chronic insomnia, the BAP consensus statement as well as the NICE and ESRS/EIN guidelines recommend:1,7,8

  • first-line treatment with cognitive behavioural therapy for insomnia (CBTi)
  • if CBTi is unavailable, fails or the patient cannot engage with CBTi, evidence-based pharmacological treatment should be offered

For patients with severe symptoms or an acute exacerbation of chronic insomnia, NICE recommends a short course (<1 week) of a hypnotic drug in addition to CBTi.7

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CBTi and traditional pharmacological treatments

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BAP: British Association for Psychopharmacology; EIN: European Insomnia Network; ESRS: European Sleep Research Society; GABA: gamma-aminobutyric acid; NICE: National Institute for Health and Care Excellence; OTC: over-the-counter

QUVIVIQ™ is indicated for the treatment of adult patients with insomnia characterised by symptoms present for at least 3 months and considerable impact on daytime functioning.5

This information is intended for UK healthcare professionals.

▼This medicine is subject to additional monitoring.

Adverse events must be reported. Healthcare professionals are asked to report any suspected adverse reactions via www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in Google Play or Apple App Store. Adverse events should also be reported to ds.safety.uk@idorsia.com

References

  1. Wilson S, Anderson K et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: an update. J Psychopharmacol 2019;33(8):923-947
  2. O’Regan D, Garcia-Borreguero D et al. Mapping the insomnia patient journey in Europe and Canada. Front Public Health 2023;11:1233201
  3. National Institute for Health and Care Excellence (NICE). Clinical knowledge summary. Insomnia. Scenario: managing short-term insomnia (less than 3 months duration), May 2025. Available at: cks.nice.org.uk. Accessed August 2025
  4. National Institute for Health and Care Excellence (NICE). Clinical knowledge summary. Insomnia. Scenario: managing long-term insomnia (more than 3 months duration), May 2025. Available at: cks.nice.org.uk. Accessed August 2025
  5. QUVIVIQ™ Idorsia Pharmaceuticals Ltd, Summary of Product Characteristics
  6. National Institute for Health and Care Excellence (NICE). Technology appraisal guidance 922. Daridorexant for treating long-term insomnia, 18 October 2023. Available at: nice.org.uk. Accessed August 2025
  7. National Institute for Health and Care Excellence (NICE). Clinical knowledge summary. Insomnia, May 2025. Available at: cks.nice.org.uk. Accessed August 2025
  8. Riemann D, Espie C A et al. The European Insomnia Guideline: an update on the diagnosis and treatment of insomnia 2023. J Sleep Res 2023;32(6):e14035
  9. Prolonged-release melatonin Summary of Product Characteristics
  10. British National Formulary (BNF). Melatonin. Available from bnf.nice.org.uk, Accessed August 2025
  11. Roch C, Bergamini G et al. Nonclinical pharmacology of daridorexant: a new dual orexin receptor antagonist for the treatment of insomnia. Psychopharmacology (Berl) 2021;238(10):2693-2708
  12. Robbins R, Quan S F et al. A nationally representative survey assessing restorative sleep in US adults. Front Sleep 2022;1:935228
  13. Mignot E, Mayleben D et al. Safety and efficacy of daridorexant in patients with insomnia disorder: results from two multicentre, randomised, double-blind, placebo-controlled, phase 3 trials. Lancet Neurol 2022;21:125-139
  14. Kunz D, Dauvilliers Y et al. Long-term safety and tolerability of daridorexant in patients with insomnia disorder. CNS Drugs 2023;37:93-106
  15. Chaput J P, Dutil C, Sampasa-Kanyinga H. Sleeping hours: what is the ideal number and how does age impact this? Nat Sci Sleep 2018;10:421-430
  16. Di Marco T, Djonlagic I et al. Effect of daridorexant on sleep architecture in patients with chronic insomnia disorder – a pooled post hoc analysis of two randomized phase 3 clinical studies. Sleep 2024:zsae098
  17. Watson N F, Benca R M et al. Alliance for sleep clinical practice guideline on switching or deprescribing hypnotic medications for insomnia. J Clin Med 2023;12(7):2493

© NICE 2023 Daridorexant for treating long-term insomnia. Available from www.nice.org.uk/guidance/ta922. All rights reserved. Subject to Notice of rights.

NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/ publication.

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UK-DA-00653 | Date of preparation: September 2025

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