Why sleeping tablets are the wrong first move.

If you've had insomnia for more than three months, every major clinical guideline — NICE in the UK, the AASM in the US, the European Sleep Research Society — says the same thing: the first treatment you should be offered is cognitive behavioural therapy for insomnia (CBT-I), not medication.

Most patients have never heard of it. Many have been taking sleeping tablets for years.

CBT-I works because chronic insomnia is rarely sustained by whatever started it. The original trigger — stress, illness, a new baby — usually passes. What remains is a learned pattern: the bed becomes associated with wakefulness, the sleep schedule fragments, and the harder you try to sleep, the more alert you become. Tablets sedate you through that pattern; CBT-I dismantles it.

• Sleep restriction rebuilds the pressure to sleep by matching time in bed to actual sleep.
• Stimulus control re-teaches your brain that bed means sleep, not worrying.
• Cognitive work defuses the 3am arithmetic — “if I fall asleep now I'll get four hours” — that keeps the system on alert.

Around 70–80% of patients respond, and unlike medication the gains hold after treatment ends, because you've changed the system rather than sedated it. A typical programme at Halcyon runs four to six sessions, in clinic or by video.

Tablets still have a place — short-term, for acute crises. But if your insomnia has a postcode and a routine, it deserves treatment, not just sedation.