Initial assessment
Initial assessment
Description of sleep disturbance
Bunmi describes her current pattern of sleeping as having persisted for over 6 months, although she has had problems for several years.
She finds it hard to fall asleep in the evening, and then typically experiences fragmented sleep with one or more substantial periods of wakefulness. She feels very lethargic in the morning, and describes feeling clumsy and having problems concentrating during the daytime. As a result, she has stopped working and leaves the house only to visit her housebound mother who she cares for.
An initial assessment of Bunmi’s sleep includes metrics from a sleep diary she was advised to complete and the Epworth Sleepiness Scale (ESS) questionnaire.1
Averages from sleep diary (previous week):1
- Adequate sleep opportunity: 22.30‑09.00
- Latency to persistent sleep: 1.75 hours
- Total sleep time: 5 hours
- Sleep efficiency: ∼50%
ESS = 3 (unlikely to be abnormally sleepy)
Mental health assessment
The European Insomnia Guideline (2023) recommends a thorough evaluation of any patient presenting with insomnia with suspected physical or mental comorbidities. Mental health disorders are frequently associated with or may worsen insomnia symptoms.2
As part of the initial consultation, Bunmi’s GP carries out a mental state assessment, including the Hospital Anxiety and Depression Scale (HADS). Her results were not indicative of anxiety or depression:3
- HADS (anxiety): 4
- HADS (depression): 7
Diagnosis
In accordance with the WHO ICD-11 definition, Bunmi’s GP diagnoses her as having chronic insomnia:4
“Chronic insomnia is…
…that occurs despite adequate opportunity and circumstances for sleep…
WHO ICD‑11: World Health Organization International Classification of Diseases – 11th revision
Ready for the next step?
Initial management
CBT: cognitive behavioural therapy; CBTi: cognitive behavioural therapy for insomnia; ESS: Epworth Sleepiness Scale; HADS: Hospital Anxiety and Depression Scale; HRT: hormone replacement therapy; ICD: International Classification of Diseases; NICE: National Institute for Health and Care Excellence; OTC: over-the-counter; PRO: patient-reported outcome
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.
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
- The Epworth Sleepiness Scale. Available at: nasemso.org. Accessed August 2025
- 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
- Stern A F. The hospital anxiety and depression scale. Occup Med (Lond) 2014;64(5):393-394
- World Health Organization (WHO). International statistical classification of diseases and related health problems (ICD) 11th revision. Available at: icd.who.int. Accessed August 2025
- 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
- Riemann D, Baglioni C et al. European guideline for the diagnosis and treatment of insomnia. J Sleep Res 2017;26(6):675-700
- 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
- 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
- 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
- Prolonged-release melatonin Summary of Product Characteristics
- QUVIVIQ™ Idorsia Pharmaceuticals Ltd, Summary of Product Characteristics
- 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
- 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
- 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
- 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
- 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
- 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
- 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.
UK-DA-00657 | Date of preparation: September 2025
