Signs You May Need Medical Treatment for Insomnia

Occasional difficulty sleeping is common. Stress, illness, travel, bereavement, shift work or a temporary change in routine can all lead to a few restless nights.

However, insomnia becomes more concerning when it continues for months, significantly affects daytime life or does not improve despite reasonable changes to your sleep habits.

At this point, professional assessment may be appropriate.

Medical treatment for insomnia does not always mean taking sleeping tablets. Depending on your symptoms and medical history, treatment may involve cognitive behavioural therapy for insomnia, addressing an underlying health condition, reviewing existing medicines or considering a prescription treatment such as QUVIVIQ▼ (daridorexant) where clinically appropriate.

This guide explains the signs that you may need medical treatment for insomnia, what chronic insomnia means, how prescription treatment may help and how 24 HR Pharmacy supports eligible patients through a clinically supervised online service.

What Is Insomnia?

Insomnia is a sleep disorder characterised by persistent difficulty:

• falling asleep;

• staying asleep;

• returning to sleep after waking;

• waking earlier than intended; or

• getting sleep that feels refreshing and restorative.

The problem occurs despite having enough time and a suitable environment in which to sleep.

Insomnia may be short term, lasting days or weeks, or chronic, continuing for three months or longer.

For a diagnosis of chronic insomnia, the sleep problem usually needs to be having a considerable effect on daytime functioning. This may include tiredness, poor concentration, irritability, reduced productivity or difficulty managing everyday responsibilities.

Signs You May Need Medical Treatment for Insomnia

1. Your Insomnia Has Lasted for Three Months or More

One of the clearest signs that you may need professional assessment is when sleep problems have continued for at least three months.

This may involve:

• regularly taking a long time to fall asleep;

• waking several times during the night;

• lying awake for extended periods;

• waking too early;

• or sleeping for several hours but still feeling unrefreshed.

QUVIVIQ▼ is specifically licensed for adults whose insomnia symptoms have been present for at least three months and are having a considerable effect on daytime functioning.

It is not intended for the occasional poor night or a brief period of sleeplessness.

2. Poor Sleep Is Significantly Affecting Daytime Life

The severity of insomnia is not measured only by how many hours you sleep.

The effect it has during the day is equally important.

You may need medical assessment when poor sleep is causing:

• persistent fatigue;

• difficulty concentrating;

• memory problems;

• reduced performance at work;

• irritability;

• low motivation;

• difficulty managing family or personal responsibilities;

• reduced confidence;

• or difficulty coping with normal daily life.

When insomnia begins to affect your ability to work, drive, study, care for others or maintain relationships, it should not simply be dismissed as tiredness.

3. You Have Tried Improving Your Sleep Routine Without Success

Many short-term sleep problems improve after changes to daily habits.

These may include:

• going to bed and waking at consistent times;

• avoiding caffeine late in the day;

• reducing alcohol;

• avoiding heavy meals before bed;

• keeping the bedroom dark and quiet;

• limiting screen use in the evening;

• and avoiding long daytime naps.

However, chronic insomnia is not always caused by poor sleep habits.

When you have made consistent changes but still struggle to sleep, a clinician may need to assess whether psychological, medical, hormonal or medication-related factors are contributing.

4. Cognitive Behavioural Therapy Has Not Worked or Is Not Suitable

Cognitive behavioural therapy for insomnia, often called CBTi, is an evidence-based treatment that helps address the thoughts and behaviours that maintain long-term sleep problems.

It may involve:

• establishing consistent sleep and waking times;

• reducing time spent awake in bed;

• addressing anxiety about sleep;

• reducing clock-watching;

• challenging unhelpful beliefs about sleep;

• and building a stronger association between bed and sleeping.

Current NICE guidance recommends QUVIVIQ▼ for chronic insomnia where CBTi has already been tried without adequate improvement, or where CBTi is unavailable or unsuitable.

For this reason, a responsible insomnia assessment should ask whether you have already tried CBTi and what effect it had.

5. Anxiety About Sleep Is Making the Problem Worse

After several weeks or months of poor sleep, many people begin to fear bedtime.

You may find yourself:

• worrying throughout the day about whether you will sleep;

• checking the clock repeatedly;

• calculating how many hours remain before morning;

• going to bed much earlier than usual;

• staying in bed long after waking;

• or cancelling plans because you expect to be exhausted.

This can create a cycle in which anxiety increases alertness, making sleep even more difficult.

Medical assessment can help determine whether CBTi, mental health support, an insomnia medicine or a combination of approaches may be appropriate.

6. You Are Relying on Alcohol or Unregulated Products to Sleep

Some people begin using alcohol, sedating antihistamines, borrowed medicines or unregulated online products because they feel desperate for sleep.

Warning signs include:

• needing increasing amounts to feel sleepy;

• feeling unable to sleep without alcohol or medication;

• combining several sedating products;

• taking another person’s prescription medicine;

• or purchasing sleeping tablets from an unregulated website.

These approaches may cause side effects, interactions, tolerance or dependence.

Prescription insomnia treatment should only be supplied after assessment by a qualified prescriber through a regulated pharmacy.

7. Your Mood or Mental Health Is Being Affected

Persistent insomnia may contribute to:

• low mood;

• anxiety;

• irritability;

• reduced emotional resilience;

• poor motivation;

• and difficulty coping with stress.

Insomnia may also occur alongside depression or other psychiatric conditions.

QUVIVIQ▼ must be used cautiously in people with symptoms of depression or psychiatric conditions. Hypnotic medicines have occasionally been associated with worsening depression or suicidal thoughts in affected patients.

A prescriber will therefore review your mental health history carefully before deciding whether treatment is appropriate.

Seek urgent help if poor sleep is accompanied by thoughts of self-harm, suicidal thoughts, hallucinations, severe agitation or feeling unable to keep yourself safe.

8. You Feel Dangerously Sleepy During the Day

Insomnia commonly causes tiredness, but extreme daytime sleepiness may indicate a more serious sleep disorder.

Concerning signs include:

• falling asleep unintentionally;

• struggling to stay awake while driving;

• repeatedly nodding off at work;

• waking with headaches;

• or feeling unable to function without frequent naps.

Do not drive or operate machinery when you feel dangerously sleepy.

Symptoms such as loud snoring, gasping or pauses in breathing may suggest obstructive sleep apnoea, which requires a different assessment and treatment pathway.

9. Another Medical Condition May Be Causing the Problem

Insomnia can be a symptom of another condition rather than a standalone illness.

Possible causes include:

• anxiety or depression;

• chronic pain;

• menopause symptoms;

• acid reflux;

• breathing conditions;

• restless legs syndrome;

• thyroid disorders;

• urinary symptoms;

• and obstructive sleep apnoea.

Some prescription and over-the-counter medicines can also interfere with sleep.

A clinical assessment should therefore review your symptoms, current medicines, general health and whether another condition requires investigation.

When Might QUVIVIQ▼ Be Considered?

QUVIVIQ▼ contains daridorexant, a prescription-only medicine licensed in the UK for adults with chronic insomnia.

It may be considered for adults who:

• are aged 18 or over;

• have had insomnia symptoms for at least three months;

• experience a considerable impact on daytime functioning;

• have tried CBTi without adequate improvement;

• or cannot access or are unsuitable for CBTi;

• and do not have a contraindication identified during assessment.

Treatment is always based on individual clinical suitability.

QUVIVIQ▼ will not be appropriate for everyone.

How Does QUVIVIQ▼ Work?

QUVIVIQ▼ belongs to a class of medicines called orexin receptor antagonists.

Orexin is a naturally occurring brain chemical that helps promote wakefulness.

By blocking the action of orexin at night, daridorexant is designed to:

• help you fall asleep more easily;

• reduce waking during the night;

• help you stay asleep for longer;

• and improve daytime functioning.

This is different from older sleeping medicines such as benzodiazepines and Z-drugs, which primarily work through the GABA system.

QUVIVIQ▼ therefore offers a different mechanism of action, although it can still cause drowsiness and other side effects.

QUVIVIQ▼ Dosing Information

QUVIVIQ▼ is available as 25 mg and 50 mg film-coated tablets.

Usual dose

The usual adult dose is:

One 50 mg tablet taken once each night.

The maximum daily dose is 50 mg.

When is the 25 mg dose used?

A lower dose of 25 mg once nightly may be prescribed for some patients, including those who:

• have moderate liver impairment;

• take certain moderate CYP3A4 inhibitor medicines;

• take other central nervous system depressants;

• or require a lower dose based on the prescriber’s clinical judgement.

How should QUVIVIQ▼ be taken?

Take one tablet:

• once per night;

• in the evening;

• within approximately 30 minutes before going to bed.

If you forget the dose at bedtime, do not take it later in the night. Wait until the next scheduled evening dose.

Never take more than the prescribed dose.

How Long Is Treatment Continued?

QUVIVIQ▼ treatment should be kept as short as clinically appropriate.

Your suitability should be reassessed within three months of starting treatment and periodically after that.

Treatment may be stopped if:

• it has not improved your insomnia adequately;

• side effects outweigh the benefits;

• your circumstances change;

• or the prescriber decides that continuing treatment is no longer appropriate.

QUVIVIQ▼ is not intended to be prescribed indefinitely without regular review.

Who Should Not Take QUVIVIQ▼?

QUVIVIQ▼ is not suitable if you:

• are allergic to daridorexant or any ingredient in the tablet;

• have narcolepsy;

• or take a strong CYP3A4 inhibitor.

Examples of strong CYP3A4 inhibitors may include certain medicines such as itraconazole, clarithromycin or ritonavir.

Your prescriber will review all current medicines before approving treatment.

When Is Extra Caution Needed?

QUVIVIQ▼ may require extra caution if you:

• have moderate liver impairment;

• take other sedating medicines;

• are over 75;

• have depression symptoms;

• have another psychiatric condition;

• have severe chronic obstructive pulmonary disease;

• have a history of alcohol or substance misuse;

• are pregnant;

• or are breastfeeding.

Small amounts of daridorexant may pass into breast milk. A clinician may recommend stopping breastfeeding or choosing an alternative treatment, depending on individual circumstances.

The medicine is not recommended for people with severe liver impairment.

Possible Side Effects of QUVIVIQ▼

Like all medicines, QUVIVIQ▼ can cause side effects, although not everyone will experience them.

Common side effects

These may affect up to 1 in 10 people:

• headache;

• sleepiness or drowsiness;

• dizziness;

• nausea;

• and fatigue.

Drowsiness can sometimes persist into the following day, particularly during the first few days of treatment.

Uncommon side effects

These may affect up to 1 in 100 people:

• sleep paralysis;

• hallucinations;

• vivid or unsettling perceptions while falling asleep or waking.

Sleep paralysis is a temporary inability to move or speak while falling asleep or waking up.

Contact your prescriber if side effects are severe, persistent or concerning.

Driving and Operating Machinery

Because QUVIVIQ▼ reduces wakefulness, it may impair driving ability.

You should allow approximately nine hours between taking QUVIVIQ▼ and driving or operating machinery, particularly during the first few days of treatment.

Only drive when you feel fully alert.

Do not drive if you feel drowsy, dizzy, confused or unable to concentrate.

Alcohol, Grapefruit and Other Medicines

Alcohol

Do not drink alcohol while taking QUVIVIQ▼.

Alcohol can increase sedative effects, making drowsiness, dizziness or impaired coordination more likely.

Grapefruit

Avoid grapefruit and grapefruit juice in the evening while taking QUVIVIQ▼ because they may affect the way the medicine is processed.

Other sedating medicines

QUVIVIQ▼ may interact with other central nervous system depressants.

These can include certain:

• sleeping medicines;

• anxiety medicines;

• strong painkillers;

• sedating antihistamines;

• and psychiatric medicines.

Your prescriber will check for potential interactions before treatment is approved.

Benefits of Medical Treatment for Chronic Insomnia

When used in an appropriate patient, medical treatment may help:

• reduce the time taken to fall asleep;

• reduce waking during the night;

• improve sleep duration;

• improve daytime functioning;

• reduce distress around bedtime;

• and make it easier to maintain a healthier sleep routine.

However, no medicine can guarantee a full night’s sleep, and individual responses vary.

Treatment works best when combined with appropriate sleep habits and ongoing clinical review.

Advantages of QUVIVIQ▼

Potential advantages include:

• a mechanism that targets the brain’s wakefulness system;

• licensed use specifically for chronic insomnia;

• once-nightly dosing;

• availability in 25 mg and 50 mg strengths;

• potential improvement in both sleep and daytime functioning;

• and an alternative mechanism to older benzodiazepine or Z-drug sleeping tablets.

Limitations and Possible Disadvantages

QUVIVIQ▼ may not be appropriate for everyone.

Potential disadvantages include:

• next-day sleepiness;

• dizziness or fatigue;

• interactions with other medicines;

• the need to avoid alcohol;

• caution in older adults and some medical conditions;

• uncommon sleep paralysis or hallucinations;

• and the need for ongoing clinical review.

It is also only recommended in the NICE pathway after CBTi has not worked or is unavailable or unsuitable.

What to Expect During an Insomnia Assessment

A responsible insomnia service should not simply supply sleeping medication on request.

Your assessment may ask about:

• how long you have had insomnia;

• how often symptoms occur;

• whether daytime functioning is affected;

• whether you have tried CBTi;

• your mental and physical health;

• symptoms of sleep apnoea or narcolepsy;

• alcohol or substance use;

• pregnancy or breastfeeding;

• liver problems;

• and all prescription, over-the-counter and herbal medicines you take.

Based on this information, the prescriber may:

• approve treatment;

• recommend a lower dose;

• request further information;

• recommend CBTi;

• advise you to speak to your GP;

• or decline treatment because another pathway is safer.

How 24 HR Pharmacy Can Help

At 24 HR Pharmacy, we understand that chronic insomnia can affect your work, relationships, concentration, mood and overall quality of life.

Our insomnia service provides a structured clinical pathway for eligible adults seeking professional support.

1. Complete an Online Assessment

You complete a confidential questionnaire covering:

• your sleep history;

• how long symptoms have been present;

• the impact on daytime functioning;

• previous treatments, including CBTi;

• current medicines;

• and your wider medical history.

2. Review by a UK-Registered Prescriber

A qualified UK prescriber reviews your answers to determine whether QUVIVIQ▼ is safe and suitable.

The review includes checks for:

• contraindications;

• medicine interactions;

• narcolepsy symptoms;

• mental health concerns;

• liver impairment;

• alcohol or substance misuse;

• and other sleep conditions requiring referral.

3. Prescription and Dispensing

If QUVIVIQ▼ is clinically appropriate, a prescription is issued and the medicine is dispensed by a GPhC-registered pharmacy.

Your treatment is supplied with the full patient information leaflet and clear instructions on how to take it safely.

4. Discreet Delivery

Approved treatment can be delivered in discreet packaging to your chosen UK address.

5. Ongoing Review

Treatment is not simply prescribed and forgotten.

24 HR Pharmacy can support you with:

• treatment reviews;

• monitoring of effectiveness;

• side-effect advice;

• dose review;

• medicine-interaction checks;

• and decisions about whether treatment should continue.

Suitability should be reassessed within three months of starting and periodically afterwards.

When to Seek Urgent Help

Seek urgent medical support if insomnia occurs alongside:

• suicidal thoughts or thoughts of self-harm;

• severe confusion;

• hallucinations while fully awake;

• extreme agitation;

• symptoms of mania;

• severe breathing problems;

• chest pain;

• or dangerous sleepiness that makes driving unsafe.

QUVIVIQ▼ should also be stopped and urgent advice sought if you experience signs of a severe allergic reaction.

Frequently Asked Questions

Is QUVIVIQ▼ the same as traditional sleeping tablets?

No.

QUVIVIQ▼ works by blocking orexin, a brain chemical involved in wakefulness. Older medicines such as benzodiazepines and Z-drugs generally work through the GABA pathway.

Your prescriber will decide whether its mechanism and safety profile are suitable for you.

How long does insomnia need to last before QUVIVIQ▼ is considered?

QUVIVIQ▼ is licensed for adults whose insomnia symptoms have lasted at least three months and are having a considerable effect on daytime functioning.

What dose of QUVIVIQ▼ is normally prescribed?

The usual dose is 50 mg once nightly, taken within 30 minutes before bed.

A 25 mg dose may be used in people with moderate liver impairment, those taking certain interacting medicines or patients who need a lower dose based on clinical judgement.

Can I take QUVIVIQ▼ after waking during the night?

No.

If you forget your bedtime dose, do not take it later during the night. Wait until the following evening.

Can I drink alcohol while taking QUVIVIQ▼?

No.

Alcohol should be avoided because it can increase sedation and impair alertness.

Can I drive the morning after taking QUVIVIQ▼?

Allow approximately nine hours between taking the medicine and driving or operating machinery.

Only drive when you feel fully alert.

Do I need to try CBTi first?

Current NICE guidance recommends QUVIVIQ▼ where CBTi has already been tried without adequate success, or where CBTi is unavailable or unsuitable.

The 24 HR Pharmacy assessment will ask about previous insomnia treatment.

Is QUVIVIQ▼ suitable for occasional sleeplessness?

No.

It is licensed for chronic insomnia lasting at least three months with a considerable effect on daytime functioning.

Can I buy QUVIVIQ▼ online in the UK?

QUVIVIQ▼ is a prescription-only medicine.

It should only be supplied by a regulated UK pharmacy following an appropriate clinical assessment by a qualified prescriber.

Final Thoughts

Occasional poor sleep does not always require medical treatment.

However, professional help may be appropriate when insomnia:

• has continued for three months or more;

• significantly affects daytime functioning;

• has not improved with lifestyle changes;

• has not responded to CBTi;

• is damaging your mood, concentration or ability to cope;

• or is leading you to rely on alcohol or unregulated products.

For eligible adults, QUVIVIQ▼ may offer a licensed treatment option that works by reducing the brain’s wakefulness signal at night.

The usual dose is 50 mg once nightly, although a 25 mg dose may be used in certain circumstances. Treatment requires careful screening, interaction checks and regular review.

Through its online insomnia service, 24 HR Pharmacy provides clinical assessment, prescriber review, regulated dispensing, discreet delivery and ongoing treatment support.

Additional Monitoring

▼ QUVIVIQ is subject to additional monitoring.

This allows new safety information to be identified quickly. Patients and healthcare professionals are encouraged to report suspected adverse reactions through the MHRA Yellow Card Scheme.

This article is intended for general information and does not replace the patient information leaflet, Summary of Product Characteristics or advice from a qualified healthcare professional.