Which non-pharmacological interventions are recommended for managing chronic insomnia in adults?

Non-pharmacological interventions recommended for managing chronic insomnia in adults include:

• Cognitive behavioural therapy for insomnia (CBTi) as the first-line treatment, which typically includes behavioural interventions such as stimulus control and sleep restriction, cognitive therapy, and relaxation training. CBTi can be delivered face-to-face or digitally, with digital options like Sleepio recommended by NICE.
• Sleep hygiene advice to improve behavioural, environmental, and temporal factors affecting sleep. This includes maintaining a comfortable sleep environment, avoiding bright and blue light exposure before bedtime, establishing regular sleep schedules, avoiding caffeine after midday, nicotine, alcohol, and large meals within 2 hours of bedtime, and engaging in relaxation activities before sleep.
• Addressing and managing comorbidities such as anxiety or depression that may contribute to insomnia.
• Reviewing and modifying lifestyle factors and triggers associated with insomnia, including stressors and illness.
• Referral to specialist services such as sleep clinics or neurology if other sleep disorders are suspected or if insomnia does not improve with initial interventions.

Pharmacological treatments are generally avoided long-term and only considered short-term adjuncts if severe symptoms persist despite non-pharmacological measures ¹.