Sleeping tablets are not the answer. What actually works is well established and rarely offered.
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Insomnia is difficulty falling asleep, staying asleep, or waking too early — together with daytime consequences. That second half matters: if you sleep six hours and feel fine, you do not have insomnia. You are a short sleeper, which is a normal variant.
It affects around a third of adults at some point, and about one in ten persistently. The most important thing on this page is that the treatment with the best evidence is not a tablet.
Cognitive behavioural therapy for insomnia — CBT-I — is the recommended first-line treatment, and it outperforms sleeping tablets in the long term by a considerable margin. Tablets work while you take them and the problem returns when you stop. CBT-I retrains the sleep system, and the improvement persists after it ends.
It is also more available than most people realise: digital CBT-I programmes can be used at home, and several are available free through the NHS in some areas.
The second important thing: most persistent insomnia is maintained by what happens after it starts. Spending longer in bed to catch up, going to bed early, lying awake trying — these are entirely logical responses that make insomnia worse and keep it going.
Insomnia usually persists long after the original trigger has resolved, maintained by the responses to it:
Insomnia is diagnosed from the history. There is no test, and sleep studies are used only where sleep apnoea or another sleep disorder is suspected.
Two weeks of recording: what time you went to bed, roughly when you fell asleep, waking during the night, final waking time, when you got up, naps, alcohol and caffeine.
It does two things nothing else does. It shows the real pattern rather than the remembered one — people substantially over-estimate how long they lie awake. And it allows sleep efficiency to be calculated: time asleep as a proportion of time in bed. That figure is what drives effective treatment.
Thyroid function, ferritin — which should be well above the usual cut-off in restless legs — full blood count, vitamin D and HbA1c where fatigue is prominent.
Insomnia is well suited to a longer remote consultation, because the treatment is a structured behavioural plan rather than a prescription.
Two components do most of the work, and neither is what people expect from "sleep hygiene":
Sleep restriction. Counter-intuitively, you spend less time in bed — matched initially to how much you are actually sleeping — which concentrates sleep, raises sleep pressure and rebuilds the association between bed and sleeping. Time in bed is then extended gradually as efficiency improves. It is uncomfortable for the first week or two and it is the most effective single intervention available.
Stimulus control. Bed is for sleep and sex only. If you are awake more than about 20 minutes, get up, go to another room, do something quiet in dim light, and return only when sleepy. Lying in bed awake is what maintains the problem.
Alongside those: challenging the catastrophic thoughts about sleep loss that keep the system aroused, and a wind-down routine.
Digital CBT-I programmes are available and effective, and free through the NHS in some areas. We will point you to them.
We do not start sleeping tablets — z-drugs such as zopiclone, or benzodiazepines — at a remote consultation, and we do not prescribe them for ongoing use. They are controlled or dependence-forming, tolerance develops within weeks, and stopping causes rebound insomnia worse than the original. In older people they substantially increase falls and confusion.
This applies to everyone; it is not a judgement about any individual. Where a short course is genuinely appropriate, that is a decision for a clinician who can review you in person and follow you up.
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Worry time. Fifteen minutes in the early evening, on paper, listing what is on your mind and one next action for each. It is remarkably effective at stopping the 2am version.
Stop trying. Sleep is the one thing effort makes worse. Aiming to rest quietly rather than to fall asleep removes the performance pressure, and people frequently fall asleep as a result.
Sleep need varies between people, and the eight-hour target causes a great deal of unnecessary anxiety. Some adults function well on six. What matters is how you feel in the day, not the number on a tracker — and sleep-tracking devices are a recognised cause of sleep anxiety in their own right.
The most effective treatment for long-term insomnia is not a tablet, and it is free.
CBT for insomnia — CBT-I — is first-line in UK and international guidance, outperforms sleeping tablets in the long term, and unlike medication its benefits persist after treatment ends. Sleepstation is available free on the NHS in many areas, and NHS-endorsed digital programmes exist. NHS Talking Therapies also takes self-referrals.
That is genuinely the answer, and it is the one people are least often offered — because prescribing a tablet takes two minutes and explaining CBT-I takes longer.
Sleep hygiene advice alone is not CBT-I and is much less effective, which is worth knowing if you have tried it and concluded nothing works. The active ingredients are sleep restriction and stimulus control, which are counterintuitive and need proper instruction.
What we will not prescribe is zopiclone, zolpidem or benzodiazepines. They work for a fortnight, cause dependence and rebound insomnia, increase falls and confusion in older people, and we never initiate them remotely. Any service that will is not acting in your interest.
Where a consultation genuinely helps is identifying what is actually causing it — sleep apnoea, restless legs, perimenopause, pain, alcohol, depression, or medication. Insomnia is frequently a symptom rather than the diagnosis.
NICE Clinical Knowledge Summary, Insomnia, is the principal reference. It recommends cognitive behavioural therapy for insomnia (CBT-I) as first-line treatment for long-term insomnia, ahead of pharmacological options.
NICE MTG70 recommends Sleepio, a digital CBT-I programme, as a cost-saving option for adults with insomnia in the NHS.
CKS advises that hypnotics should be reserved for short-term use — typically no more than two weeks — in severe insomnia causing extreme distress, and warns of tolerance, dependence and rebound insomnia.
CKS specifically cautions against hypnotics in older adults, given increased risks of falls, cognitive impairment and daytime sedation.
CKS recommends identifying and treating underlying causes — including obstructive sleep apnoea, restless legs syndrome, depression, chronic pain, menopause and substance use — which underpins the point above.
Not remotely, and not as a first step. Z-drugs and benzodiazepines lose effectiveness within weeks, cause rebound insomnia worse than the original on stopping, and substantially raise the risk of falls and confusion in older people. What we can do is set up the treatment that actually works long-term, and treat any underlying cause.
Yes — not immediately, but decisively over time. Tablets work while taken and stop working when stopped. CBT-I takes a few weeks and the improvement persists for years afterwards. It is recommended as first-line treatment for exactly that reason, and digital versions are available to use at home.
Because sleep works on pressure and association. Nine hours in bed for six hours of sleep spreads sleep thinly and teaches your brain that bed is a place you lie awake. Restricting time in bed concentrates sleep, deepens it, and rebuilds the association — then the window is widened again. It is uncomfortable for a week or two and it is the most effective thing available.
Not necessarily. Sleep need genuinely varies, and some adults do well on six. The eight-hour figure causes real anxiety, and anxiety about sleep is itself a major cause of insomnia. Judge by how you function in the day, not by a number.
Probably not if you have insomnia. They are not accurate at distinguishing sleep stages, and checking a score each morning reliably increases anxiety about sleep — which worsens it. There is a recognised pattern of people made worse by their own data.
It helps you fall asleep and damages everything after that. Alcohol suppresses REM sleep and causes fragmented waking in the second half of the night as it clears. People who drink to sleep are usually sleeping worse, not better.
Sleep does change with age — lighter, more fragmented, shifted earlier — and that is normal. But insomnia is not an inevitable part of ageing, and in older adults it very often has a treatable cause: pain, prostate symptoms, medication, or sleep apnoea. It is worth investigating rather than accepting.
Useful for body-clock problems — jet lag, shift work, and a sleep phase shifted later — rather than for ordinary insomnia, where it is not particularly effective. In the UK it is prescription-only and licensed for short-term use over 55. Products bought abroad or online vary considerably in what they actually contain.
August 23, 2026
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It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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