Hypnotic Z-drugs e.g. zopiclone, zolpidem, zaleplon are inappropriate to use in patients aged 65 years and older if they have a history of falls (may cause protracted daytime sedation, ataxia).
Non-drug management of insomnia should be advised before initiating pharmacotherapy
All hypnotics have abuse and addiction potential. Tolerance can develop within 3 to 14 days of continuous use and long term efficacy cannot be assured
Benzodiazepines should be used to treat insomnia only when it is severe, disabling, or causing the patient extreme distress
Short term insomnia should be treated for a maximum of 3 weeks (preferably only 1 week)
Chronic insomnia is rarely benefited by hypnotics
NICE TA77 Guidance on the use of z-drugs for the short-term treatment of insomnia
NICE Key Therapeutic Topic KTT6 Hypnotics
