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Home > Formulary : Adult > Chapters > 4. Central Nervous System >

BNSSG Adult Joint Formulary

4.7 Sleep disorders

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Last edited: 06-09-2024

4.7.1 Insomnia

First line drugs Second line drugs Specialist drugs Secondary care drugs

 

  • Before a hypnotic is prescribed, the underlying cause should be identified and addressed, and realistic sleep requirements should be discussed with the patient
  • All hypnotics should be used for the minimum length of time due to the risk of dependence
  • If required on a hospital discharge prescription, a maximum of 14 days should be dispensed
  • See BNSSG Benzodiazepine and Z-drug Prescribing (including withdrawal) Support Document

 

Benzodiazepines

Recommended: (TLS Green)

Temazepam

 

CNS depressants 

Recommended: (TLS Green)

Zopiclone

 

Other

Melatonin modified-release and immediate-release (TLS Amber 3 months)

  • Intrinsic sleep disorder with one of:
    • Autism Spectrum Disorder (ASD) diagnosis,
    • Learning Disability (LD) diagnosis,
    • a neurodevelopmental disorder / disability (e.g. cerebral palsy) (excluding those with Attention Deficit Hyperactivity Disorder as a standalone diagnosis)
  • REM sleep disorder
  • Shared Care Protocol

Melatonin (TLS Red)

Melatonin modified-release (TLS Red)

  • For use in the Intensive Care Unit for the prevention of delirium in at risk patients. Local protocol to be developed
  • For Consultant Neuro-psychiatrist initiation only for short term use of insomnia at NBT only. To be reviewed by Joint Formulary Group

Melatonin for all other indications are non-formulary.

Specific Cohort:

Daridorexant (TLS - Blue)

  • NICE TA922 Daridorexant for treating long-term insomnia

BNSSG Insomnia Pathway Final 2024

 

4.7.2 Narcolepsy

Dexamfetamine (TLS Amber 3 months) (SCP click here)

Methylphenidate (TLS Red)

Modafinil (TLS Amber 3 months) (SCP click here)

Solriamfetol (TLS Red)

  • NICE TA758 for treating excessive daytime sleepiness caused by narcolepsy 

Sodium oxybate (TLS Red)

  • For symptom control of narcolepsy with cataplexy under the care of a sleep specialist

 

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