If you have long-term insomnia, there are four main prescription options you are likely to hear about. They are z-drugs (zopiclone, zolpidem), low-dose trazodone, orexin receptor antagonists (daridorexant and others) and prescribed melatonin (Circadin). Each works differently, and each has real limits. Z-drugs are meant for a few weeks at most and carry dependence and sleepwalking-type risks. Trazodone is an antidepressant used off-label, with thin evidence for sleep. Daridorexant is newer, licensed for insomnia lasting three months or more, with a review built in. Prescribed melatonin is a modest option, licensed in Ireland and the UK for people aged 55 and over. Before any of them, guidelines in the UK, Europe and the US put one treatment first: cognitive behavioural therapy for insomnia (CBT-I). The HSE in Ireland also points people towards it.
This guide explains what each medicine is, what the evidence shows, and how availability differs between Ireland, the UK and the US. It is not a guide to choosing or dosing a medicine. That is a conversation for you and your GP or prescriber.
The guidelines we checked put CBT-I ahead of medication for chronic insomnia:
Both the NHS and the HSE say GPs now rarely prescribe sleeping pills for insomnia. When they do, it is usually for a few days or weeks. We cover what CBT-I involves, and what its trials do and don't show, in CBT-I: the sleep treatment with better evidence than any supplement. Why tips alone rarely fix chronic insomnia is in sleep hygiene tips vs real treatment.
Zopiclone and zolpidem are the two z-drugs covered here; both have UK product information. Chemically they are not benzodiazepines, but they act on the same receptor system. We explain the mechanism, and why dependence works the same way, in what benzodiazepines actually do.
How long they are meant to be used. The UK product information for both is explicit. Treatment should be as short as possible and should not exceed four weeks, including the time spent tapering off. The European guideline also limits these drugs to short-term use of four weeks or less. It notes longer use may be considered in some cases. NICE's 2004 guidance says hypnotics should be prescribed for short periods only, and only after non-drug measures have been considered.
Dependence and stopping. The zopiclone product information says it can cause physical and psychological dependence. It adds that the risk rises the longer treatment goes on. Stopping can bring rebound insomnia, where the original sleep problem returns in a stronger form for a while. Withdrawal symptoms can also include anxiety, tremor, sweating and confusion.
The NHS advises not to stop zopiclone or zolpidem suddenly. Your doctor will usually reduce the dose gradually. If you take one now, do not change how you take it without your prescriber.
Complex sleep behaviours: the FDA boxed warning. In April 2019 the US Food and Drug Administration (FDA) added a boxed warning to the labels of three insomnia medicines. It covers eszopiclone (Lunesta), zaleplon (Sonata) and zolpidem (Ambien and others). The warning is about "complex sleep behaviours": sleepwalking, sleep driving and other activities done while not fully awake.
The FDA said these events are rare but have caused serious injuries and deaths. It told prescribers not to prescribe these drugs to anyone who has had such an episode before. Anyone who has one should stop the medicine and contact their doctor.
UK product information carries similar warnings. It describes sleep driving, preparing and eating food, making phone calls or having sex, with no memory afterwards. The zolpidem information says alcohol and other sedatives, and doses above the maximum, appear to increase the risk.
Next-day effects and who should be careful. The NHS advises not to drive, cycle or use machinery for 12 hours after taking zopiclone. It also says zopiclone may not be suitable for people with sleep apnoea or breathing problems. If you snore heavily or wake unrefreshed, the STOP-BANG screening questions are worth a look before any sleep medicine.
Trazodone is an antidepressant. In the US it is approved for major depressive disorder. In the UK, the NHS describes it as a treatment for depression and anxiety. Prescribers sometimes use a low dose at bedtime for sleep, because it can make people drowsy. That use is off-label.
The best summary of the evidence is a 2018 Cochrane review of antidepressants for insomnia. It notes that none of these drugs is licensed for insomnia. For trazodone, it found:
The reviewers concluded there "may be a small improvement in sleep quality" with short-term, low-dose trazodone. They found no evidence for long-term use.
Guidelines split on it. The American Academy of Sleep Medicine's 2017 drug guideline suggests clinicians not use trazodone for insomnia, a weak recommendation. The 2023 European guideline allows low-dose sedating antidepressants for short-term use, with a lower evidence grade than for other options.
Two safety points matter. The NHS lists priapism, a long-lasting painful erection, as a rare serious side effect. And in the US, trazodone's label carries a boxed warning. It says antidepressants increased suicidal thoughts and behaviours in children and young adults in short-term studies.
Orexins are brain chemicals that help keep you awake. Orexin receptor antagonists block the receptors they act on. The aim is to turn down the brain's "stay awake" signal.
Daridorexant (Quviviq) in Ireland and the UK. Daridorexant was authorised across the EU on 29 April 2022, which includes Ireland. UK product information is also published. It is licensed for adults whose insomnia has lasted at least three months and considerably affects daytime functioning.
In one main trial of 930 people, those on 50 mg cut their night-time waking by 29 minutes on average, after three months. Those on placebo cut it by 11 minutes. Trial data cover up to 12 months of treatment. The most common side effects were headache and sleepiness. It must not be used by people with narcolepsy, or with certain strong interacting medicines.
Unlike z-drugs, the UK product information says daridorexant can be stopped without tapering. The US label says long-term use did not produce withdrawal symptoms in studies. It is still a Schedule IV controlled substance in the US. The US label says this is because it can be abused or lead to dependence.
UK (NICE TA922, October 2023): NICE recommends it only for adults with symptoms three or more nights a week, for at least three months. Daytime functioning must be considerably affected. CBT-I must also have been tried without success, or be unavailable or unsuitable. Treatment should be assessed within three months and stopped if it has not worked well enough.
Ireland: the HSE has not yet made a reimbursement decision. As of 28 October 2026, the National Centre for Pharmacoeconomics was still carrying out a full health technology assessment of daridorexant.
Suvorexant and lemborexant in the US. In the US, this class includes suvorexant (Belsomra, approved 2014), lemborexant (Dayvigo, 2019) and daridorexant (Quviviq, 2022). All three are Schedule IV controlled substances, and none should be used by people with narcolepsy. We found no UK product information for suvorexant or lemborexant.
Melatonin's legal status is very different on each side of the Atlantic:
Circadin is a 2 mg prolonged-release melatonin tablet. In Ireland and the UK it is licensed for short-term treatment of insomnia with poor-quality sleep in people aged 55 or over. Treatment can continue for up to 13 weeks.
Its trial effects are modest. In one sleep-lab study, it shortened time to fall asleep by 9 minutes compared with placebo. In one outpatient trial, 47% of people improved on sleep quality and morning alertness, against 27% on placebo. A second trial found 26% against 15%. A six-month trial kept a benefit at three months but failed its main analysis at six months.
The European guideline supports prolonged-release melatonin for up to three months in people aged 55 and over. It does not recommend fast-release melatonin for insomnia. The American Academy of Sleep Medicine's 2017 guideline suggested clinicians not use melatonin for insomnia, a weak recommendation.
Circadin's product information also lists interactions. It says the combination with the antidepressant fluvoxamine should be avoided. It may also add to the sedative effects of z-drugs. For the wider dose and timing research on melatonin, see melatonin: the real dose-response evidence.
Long-term insomnia can sit alongside low mood. If you are having thoughts of suicide or self-harm, please reach out now.
Are z-drugs safer than benzodiazepines? They are chemically different, but they act on the same receptor system. Their product information carries similar warnings on dependence, withdrawal and short-term use. They are not a risk-free alternative.
Is daridorexant addictive? Studies did not find withdrawal symptoms when long-term use stopped, and its UK product information says it can be stopped without tapering. It is still a controlled drug in the US, because it can be abused or lead to dependence. NICE notes that its effects beyond 12 months are unknown.
Can I buy melatonin over the counter in Ireland or the UK? No. Melatonin is prescription-only in both countries. In the US it is sold as a dietary supplement.
Is trazodone a sleeping tablet? No. It is an antidepressant that is sometimes prescribed off-label for sleep. A Cochrane review found low-quality evidence of a small short-term benefit and no evidence for long-term use.
Should I stop my sleeping tablet after reading this? No. Do not stop or change any prescribed medicine on your own. Stopping some sleep medicines suddenly can cause withdrawal. Talk to your GP or prescriber about a plan.
This article is general information, not medical advice. It does not replace advice from your GP, pharmacist or prescriber about your own situation.
Reviewed by: Proco Team
Last updated: November 2026