Initial management

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Initial management

Use of a sleep diary can aid diagnosis of chronic insomnia, as it allows the evaluation of unsatisfactory sleep, in terms of onset, maintenance and early waking, over time.6,7 Tools such as the Insomnia Severity Index (ISI) can be used for assessing changes once a diagnosis has been made.6 Non‑pharmacological therapy is recommended prior to pharmacological treatments for insomnia, in the form of sleep hygiene advice and CBTi.6,8 Due to Steve’s history of a TIA, screening for obstructive sleep apnoea (OSA) using a valid clinical screening tool is recommended.9

From Steve’s history and an assessment of his sleep behaviour over recent weeks, and having excluded an alternative sleep disorder, Steve’s clinician diagnoses chronic insomnia.

Average metrics from sleep diary:

  • Sleep opportunity: (23.00-07.30)
  • Latency to persistent sleep: average 3h
  • Total sleep time (at night): average 3h 20m
  • Sleep efficiency: 39%
  • ISI: 24 (clinical insomnia – severe)10

Steve is referred to a sleep clinic for assessment of OSA by a respiratory sleep study.

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Non-pharmacological treatment

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ACE: angiotensin-converting enzyme; CBTi: cognitive behavioural therapy for insomnia; CKD: chronic kidney disease; CPAP: continuous positive airway pressure; ISI: Insomnia Severity Index; OSA: obstructive sleep apnoea; OTC: over-the-counter; SGLT2i: sodium glucose cotransporter-2 inhibitor; TIA: transient ischaemic attack

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.18

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. Sleep Foundation. Aging and sleep, 19 September 2023. Available at: sleepfoundation.org. Accessed August 2025
  2. National Institutes of Health (NIH): National Institute on Aging. A good night’s sleep. Available at: nia.nih.gov. Accessed August 2025
  3. Patel D, Steinberg J, Patel P. Insomnia in the elderly: a review. J Clin Sleep Med 2018;14(6):1017-1024
  4. Cohen Z L, Eigenberger P M et al. Insomnia and other sleep disorders in older adults. Psychiatr Clin North Am 2022;45(4):717-734
  5. Duffy J F, Scheuermaier K, Loughlin K R. Age-related sleep disruption and reduction in the circadian rhythm of urine output: contribution to nocturia? Curr Aging Sci 2016;9(1):34-43
  6. 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
  7. 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
  8. 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
  9. National Institute for Health and Care Excellence (NICE). Clinical knowledge summary. Stroke and TIA. Scenario: secondary prevention following stroke and TIA, May 2025. Available at: cks.nice.org.uk. Accessed August 2025
  10. Morin C M, Belleville G et al. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep 2011;34(5):601-608
  11. Solikhah F K, Nursalam N, Ulfiana E. The effect of sleep hygiene on the sleep quality in elderly. Proceedings of the 8th International Nursing Conference on Education, Practice and Research Development in Nursing (INC 2017) 2017;doi: 10.2991/inc-17.2017.26
  12. National Institute for Health and Care Excellence (NICE). Clinical knowledge summary. Obstructive sleep apnoea syndrome. Scenario: management of sleep apnoea, May 2025. Available at: cks.nice.org.uk. Accessed August 2025
  13. Prolonged-release melatonin Summary of Product Characteristics
  14. 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
  15. Zolpidem Summary of Product Characteristics
  16. Zopiclone Summary of Product Characteristics
  17. National Institute for Health and Care Excellence (NICE). Clinical knowledge summary. Insomnia. Prescribing information: Z-drugs, May 2025. Available at: cks.nice.org.uk. Accessed August 2025
  18. QUVIVIQ™ Idorsia Pharmaceuticals Ltd, Summary of Product Characteristics

© 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-00657 | Date of preparation: September 2025

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