It can be difficult for patients to take in such a large amount of information, so pharmacy teams may want to signpost them to the Every Mind Matters section on the NHS website. Keeping a sleep diary is often a good first step in terms of identifying any modifiable issues as well as symptoms.

More formal programmes include Sleepstation, which is funded by the NHS in certain areas. This starts with an evaluation of symptoms and habits, and includes cognitive behavioral therapy. Similar is the Sleepio programme, which costs up to £200 per year and has been assessed by NICE. 

"Sleepio may save costs by avoiding face-to-face CBT… there is some evidence of good user engagement and experience… cost savings may also result from reduced hypnotic drug prescribing," says NICE.

OTC sleep aids

In terms of medication, OTC sleep aids have a place but also have drawbacks, according to the Royal College of Psychiatrists. Antihistamine-based products may cause next day drowsiness and tolerance, so restrictions should be carefully adhered to.

Herbal remedies such as those containing valerian are best taken nightly for two to three weeks rather than occasionally, with warnings around next day drowsiness and the risk of dependence. Anyone asking about these products should be signposted to resources about sleep hygiene such as those available on the NHS website. 

Cannabidiol (CBD) products are often heralded as a sleep aid – and there are grounds for this in theory, given the involvement of the endocannabinoid system in maintaining several body functions, including sleep. However, there is little good quality evidence supporting the use of the cannabinoid for this purpose, although there is emerging evidence that it can help anxiety, which can play a significant role in insomnia.

Hypnotics

The Royal College of Psychiatrists discourages the use of hypnotics, stating that they do not work for very long, can cause tiredness and irritability the next day, and are likely to cause dependence.     

This applies equally to the newer Z-drugs (zopiclone, zaleplon and zolpidem) as it does benzodiazepines. For this reason, the college advises using such medication at the lowest possible dose for less than two weeks (ideally under a week) and only in situations of insomnia, such as that caused by acute distress that is severely impairing daytime functioning. 

Patients on long-term sleep medication should be assisted in gradual withdrawal. While anti-depressants may be helpful to some, they are not without their own potential issues. Melatonin is often heralded as a sleep aid but is only available on prescription in the UK and pharmacists should be aware that it has licensing restrictions.