- Indication
- Insomnia
- RAG rating
- Green
- Document type
- NICE technology appraisal
- Place
- Hertfordshire and West Essex ICB
- Output type
- Pharmacy / Prescribing
Daridorexant
NICE Technology Appraisal 922 recommends
daridorexant as an option for treating insomnia in adults with symptoms lasting
for 3 nights or more per week for at least 3 months, and whose daytime
functioning is considerably affected, only if:
- cognitive behavioural therapy for insomnia (CBTi) has
been tried but not worked, or
- CBTi is not available or is unsuitable*.
Before considering daridorexant ensure:
- Any circumstances/stressors associated with onset of
insomnia have been addressed
- Insomnia related to other conditions such as sleep
apnoea, restless legs have been explored
- Information has been provided to patients on insomnia
and sleep hygiene - Prescribers should refer to NICE Clinical Knowledge Summary on insomnia for
further information about the assessment, diagnosis, and management of
insomnia.
- Sleep hygiene measures have been implemented and failed
- Patients are asked to keep a sleep diary to help
identify what is keeping them awake. This is a useful tool which will help
to pinpoint if there are any patterns affecting sleep. This is best
completed over a two-week period and can be used as evidence of patient’s
sleep-wake pattern which can help with diagnosis. An example can be found
here sleepdiary.pdf (www.nhs.uk)
- Digital CBTI has been tried
The length of treatment should be as short as possible. Treatment with daridorexant should be assessed within 3 months of starting and should be stopped in people whose long-term insomnia has not responded adequately. If treatment is continued, assessment should be undertaken to determine whether it is still working at regular intervals.
*Digital CBTi (Sleepio®) availability
A digital cognitive behavioural therapy for insomnia (CBTi) programme, Sleepio® is available for residents in England on the NHS at no cost to the GP practice, or patient, and without the need for a prescription. Sleepio® is a NICE-recommended digital treatment for insomnia and poor sleep. It delivers clinically proven CBT for insomnia in 10 minute sessions over six weeks and is free for patients. CBTi must be tried or be unsuitable before consideration for daridorexant (see further information below).
Patients can start using Sleepio® via www.sleepio.com/nhs. Patients will need to create an account and answer a few short questions to customise for them. This can be accessed via the app or on the website.
Locally developed resources are available on the website:
- Prescribing support document for
prescribers,
- Frequently asked questions (FAQs) document for patients on
daridorexant,
- Frequently asked questions (FAQs) document for patients on long
term insomnia