RAG rating
Document type
NICE technology appraisal
Hertfordshire and West Essex ICB
Output type
Pharmacy / Prescribing


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 (
  • 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.

Locally developed resources are available on the website: