CBT for insomnia vs sleeping tablets

Short-term insomnia, lasting a few nights, often follows stress, illness or a change of routine and usually settles. Chronic insomnia, with difficulty sleeping at least three nights a week for three months or more and daytime consequences, behaves differently: it becomes self-sustaining through worry about sleep, irregular routines and compensating behaviours such as long lie-ins.

The treatments compared here are aimed at that persistent form, where the right approach is less about forcing sleep and more about changing what keeps the problem going.

CBT-I is a structured programme, usually over several weekly sessions, delivered by a therapist, in groups, or through a digital programme. Components include sleep restriction (temporarily limiting time in bed to build sleep drive), stimulus control (using the bed only for sleep), relaxation methods, and challenging worries and beliefs about sleep. It is not just sleep hygiene tips.

It asks for effort and a diary, and the early weeks can leave people more tired. Benefits include improved sleep quality and confidence without medication side effects, with studies showing effects that persist after the programme ends. It is less suitable without supervision for people with bipolar disorder or untreated sleep apnoea, in whom sleep restriction needs care.

Prescribed hypnotics, such as the "Z-drugs" and benzodiazepines, act on brain receptors to promote sleep. They can help during a crisis or short episode. Risks include next-day drowsiness, falls and accidents, memory problems, tolerance (needing more for the same effect) and dependence with withdrawal symptoms on stopping.

Because of these risks, guidance advises that they are used at the lowest effective dose for the shortest possible time, and not as a long-term solution. Some medicines for other conditions also affect sleep, and over-the-counter antihistamine products have limited evidence and cause drowsiness.

NICE Clinical Knowledge Summaries on insomnia advise sleep hygiene education for all and CBT-I for persistent insomnia, with hypnotic medicines considered only in short courses when insomnia is severe and affecting daytime function. NICE technology appraisal TA77 supports short-term use of certain hypnotic medicines when non-drug approaches have been insufficient, with the lowest dose for the shortest time.

Clinicians also look for contributors: sleep apnoea, restless legs, pain, depression, anxiety, alcohol, caffeine, night shift work and medicines. Treating these often improves sleep more than any sleep-specific treatment.

• Insomnia for weeks or months with daytime effects: ask your GP about CBT-I, including digital programmes.

• Short-term crisis, such as bereavement or acute illness: a clinician may consider a brief course of tablets alongside sleep advice.

• Snoring, gasping at night or excessive daytime sleepiness: ask about sleep apnoea testing.

• Already taking sleeping tablets long term: do not stop suddenly; discuss gradual withdrawal with your prescriber.

• Low mood, panic or persistent worry alongside poor sleep: mention this, since treating it can help sleep.

Needing eight hours is not a universal rule; sleep needs vary. Lying in bed longer to "catch up" tends to worsen insomnia. Sleeping tablets are also not a safe long-term answer, and over-the-counter products are not free of risk. And CBT-I is not simply being told to relax.

Another misconception is that a few bad nights always mean a sleep disorder. Short-term sleep disruption is common and often settles.