CBTi follow-up appointment 1 (3 months later)

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CBTi follow-up appointment 1 (3 months later)

Bunmi’s CBTi course finished 6 weeks ago. However, she says she struggled to engage with the course and skipped some of the lessons. She reports applying some of the sleep hygiene advice, including restricting time in bed, and trying some of the active relaxation techniques at bedtime.

Adherence to CBTi7

of participants do not complete their CBTi course

 

of patients consistently adhere to the recommendations from CBTi

Sleep assessment

Bunmi’s GP asks her to repeat the ESS questionnaire and complete the Insomnia Severity Index (ISI) to evaluate Bunmi’s treatment response. Results from her sleep diary indicate a slight improvement in sleep metrics, with total sleep time increasing from an average of 5 hours to 5.5 hours. However, she remains very dissatisfied with her sleep and continues to struggle with daytime impairment.

From sleep diary (previous week):1,8

  • Restricted sleep opportunity: 23.30‑06.30
  • Latency to persistent sleep: 1.5 hours (from 1.75 hours)
  • Total sleep time: 5.5 hours (from 5 hours)
  • Sleep efficiency: ∼75% (from ∼50%)

  • ISI = 21 (moderate)
    ESS = 3 (unlikely to be abnormally sleepy) (from 3)

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Considerations for use of QUVIVIQ™

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ESS: Epworth Sleepiness Scale; HRT: hormone replacement therapy; ISI: Insomnia Severity Index; 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.21

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. The Epworth Sleepiness Scale. Available at: nasemso.org. Accessed August 2025
  2. 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
  3. Stern A F. The hospital anxiety and depression scale. Occup Med (Lond) 2014;64(5):393-394
  4. World Health Organization (WHO). International statistical classification of diseases and related health problems (ICD) 11th revision. Available at: icd.who.int. Accessed August 2025
  5. 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
  6. Riemann D, Baglioni C et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res 2017;26(6):675-700
  7. Koffel E, Bramoweth A D, Ulmer C S. Increasing access to and utilization of cognitive behavioral therapy for insomnia (CBT-I): a narrative review. J Gen Intern Med 2018;33(6):955-962
  8. 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
  9. 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
  10. Prolonged-release melatonin Summary of Product Characteristics
  11. QUVIVIQ™ Idorsia Pharmaceuticals Ltd, Summary of Product Characteristics
  12. 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
  13. Muehlan C, Roch C et al. The orexin story and orexin receptor antagonists for the treatment of insomnia. J Sleep Res 2023;32(6):e13902
  14. Janto K, Prichard J R, Pusalavidyasagar S. An update on dual orexin receptor antagonists and their potential role in insomnia therapeutics. J Clin Sleep Med 2018;14(8):1399-1408
  15. 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
  16. National Institute for Health and Care Excellence (NICE). Clinical knowledge summary. Benzodiazepine and z-drug withdrawal. Scenario: benzodiazepine and z-drug withdrawal, May 2025. Available at: cks.nice.org.uk. Accessed August 2025
  17. National Institute for Health and Care Excellence (NICE). Clinical knowledge summary. Benzodiazepine and z-drug withdrawal. Prognosis, May 2025. Available at: cks.nice.org.uk. Accessed August 2025
  18. 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(2):125-139

© 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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