5.1 Although RCTs to assess the relative clinical effectiveness and cost effectiveness of the Z-drugs and the shorter-acting benzodiazepines could potentially clarify some of the uncertainty, it is unlikely that they would be a cost-effective use of NHS resources. Efforts should therefore be concentrated on determining the clinical and cost effectiveness of pharmacological treatments relative to non-pharmacological interventions, including their relative roles in the long-term management of insomnia.
5.2 Previous trials have concentrated on the use of sleep-specific measures of outcomes, which have not been directly related to improvements in daytime functioning and quality of life. Further research should therefore include the impact of hypnotics and any resultant improvement in sleep quality, on daytime functioning and health-related quality of life.
5.3 There is limited evidence on the risk of dependency associated with the Z-drugs and benzodiazepines. In particular, the risk of dependence should be examined with respect to intermittent use of hypnotics, and the relationship between risk of dependence and length of treatment.
5.4 The patient groups informed the Committee that there was a lack of support for patients and inadequate information about the management of insomnia and the risks associated with the use of hypnotics. Research should therefore be conducted to establish the most suitable method of conveying good quality information to people with insomnia