Non-pharm strategies for insomnia in primary care?

Non-pharmacological strategies for managing insomnia in primary care include:

• Sleep hygiene advice: This involves educating the patient about normal sleep patterns and changes with age, maintaining a comfortable sleep environment (not too hot, cold, noisy, or bright), using the bedroom only for sleep and intimacy, avoiding clock-watching at night, minimizing bright and blue light exposure from electronic devices at least an hour before bedtime, and establishing regular sleep schedules such as going to bed when sleepy and waking at the same time every day including weekends. Patients should avoid napping during the day, limit caffeine intake after midday, avoid nicotine, alcohol, and large meals within 2 hours of bedtime, and engage in relaxation activities before bed like reading or listening to music. Vigorous exercise should be avoided within an hour of bedtime but encouraged earlier in the day.
• Addressing triggers and comorbidities: Identify and manage any stressors or illnesses contributing to insomnia, and ensure optimal management of comorbid conditions such as anxiety and depression.
• Cognitive behavioural therapy for insomnia (CBTi): This is the first-line treatment for chronic insomnia in adults and includes behavioural interventions (stimulus control, sleep restriction), cognitive therapy, and relaxation training. CBTi can be delivered face-to-face or digitally (e.g., Sleepio, a NICE-recommended digital CBTi program). It is more effective than sleep hygiene alone and should be offered if sleep hygiene measures fail or if insomnia is persistent and causing significant daytime impairment.
• Referral considerations: Refer to sleep clinics or neurology if symptoms suggest another sleep disorder or if insomnia does not improve with initial management.
• Short-term hypnotic medication: Although pharmacological treatment is generally avoided long-term, a short course (preferably less than 1 week) of hypnotics may be considered as a temporary adjunct in severe or acute exacerbations, but only alongside behavioural and cognitive treatments.