The NHS says insomnia usually improves by changing sleep habits, and GPs now rarely prescribe sleeping pills because they can have serious side effects and you can become dependent on them. When they are used, it is only for a few days or weeks if insomnia is very bad and other treatments have not worked. Sleeping medicines can leave you drowsy the next day and raise the risk of falls, especially at night on the way to the toilet. Prefer sleep hygiene and CBT for insomnia first, keep night lights and a clear path, and never stop or change prescribed medicines yourself.
This guide is for one job: understanding why extra night sedation is a falls conversation when you have arthritis, what the NHS suggests trying first, and how to talk to your GP or pharmacist safely. For tonight's routine, see our how to sleep with arthritis guide. For what is waking you, see arthritis and sleep problems.
Why sleeping tablets and arthritis meet at night falls
Joint pain often means more night waking, more toilet trips and stiffer first steps. Medicines that make you sleepy can slow your reactions, blur your balance and leave you groggy the next morning. The NHS lists side effects of sleeping medicines such as zolpidem that include feeling sleepy or tired the next day, feeling dizzy, and falling over — particularly if you are over 65. That matters if you already have painful hips, knees or feet, use a walking aid, or get up in the dark.
The NHS also says medicines are one of the common causes of falls, and that a GP or pharmacist can review them. NICE falls guidance puts medicines review and home safety in the same conversation as strength and balance. This page does not give doses. It helps you prepare the right questions.
What the NHS wants you to try before sleeping pills
- Only go to bed when you are sleepy, and get up at the same time every day
- Relax for at least an hour before bed; keep the bedroom dark and quiet
- Exercise regularly in the day; avoid heavy exercise close to bedtime
- Avoid smoking, alcohol, tea or coffee for at least 6 hours before bed
- Avoid big late meals, daytime naps, and screens right before bed
- Do not sleep in after a bad night — stick to your usual get-up time
Pharmacy sleep aids (some with antihistamines or herbal ingredients) may help for 1 to 2 weeks only. The NHS says they should not be taken longer, they can make you drowsy, and you should check with your doctor before taking anything for sleep. Ask a pharmacist if you take arthritis medicines, blood pressure tablets or painkillers.
CBT for insomnia comes before long courses of tablets
If changing habits has not helped, you have had trouble sleeping for months, or insomnia is making daily life hard to cope with, see a GP. A GP will try to find the cause. Sometimes you will be offered cognitive behavioural therapy (CBT) for insomnia, face to face or through an online self-help programme. NICE has recommended Sleepio, a digital CBT programme, as an option for insomnia and insomnia symptoms. What is available depends on where you live.
GPs now rarely prescribe sleeping pills. When they do, it is only for a few days or weeks at most, if insomnia is very bad and other treatments have not worked. Do not start, share or top up someone else's sleeping tablets.
If you already take a sleeping medicine
- Do not stop, skip or change the dose yourself. Ask your GP or pharmacist how to review it safely
- Tell them about next-day drowsiness, near-misses, falls, confusion or memory problems
- Bring a full list of tablets, patches, inhalers, pharmacy sleep aids and alcohol use
- Ask whether joint pain, steroids, toilet trips, restless legs or sleep apnoea could be the real driver — our cause-by-cause sleep checklist helps
- Ask about CBT for insomnia and whether a shorter course, a different timing or stopping is safer for you
Make night trips safer while you sort the medicine
- Use a soft night light and keep a clear path to the toilet
- Keep glasses, phone, pendant alarm and walking aid within reach of the bed
- Sit on the edge of the bed for a moment before standing; stiff joints and drowsiness both slow you
- Ask about a walking aid that fits your hands and height — see our falls prevention guide
- If toilet trips dominate the night, read our night-time toilet trips guide
- After ice or snow, plan outdoor trips for daylight; see our ice and snow falls guide
Pain, flares and sleep work together
Settling pain before bed often reduces the urge to reach for a sleep aid. See our night pain toolkit, sleep positions guide and printable flare action plan. Poor sleep and worse pain also feed each other — our sleep and pain cycle guide has a two-week diary for the GP.
When to get help
- See a GP if insomnia lasts months, habits have not helped, or days feel unsafe because of tiredness
- See a GP or pharmacist urgently if a sleeping medicine leaves you confused, unsteady or falling
- Call 999 after a fall if you cannot get up, may have injured your head, neck, back or hip, or have severe hip or groin pain
- For urgent advice when you are unsure, contact NHS 111
- If you feel you cannot keep yourself safe, call 999. Samaritans is free on 116 123
Frequently asked questions
Are pharmacy sleep aids safer than prescribed sleeping tablets?
Not automatically. The NHS says some can make you drowsy and should only be used short term. Always check with a pharmacist if you take other medicines or are older and unsteady.
Can I stop my sleeping tablets tonight if I am scared of falling?
No. Do not stop prescribed medicines yourself. Book a same-day or urgent review with your GP or pharmacist and say you are worried about falls. Meanwhile, make the route to the toilet safer.
Will CBT for insomnia work if pain wakes me?
CBT-I helps the thoughts and habits that keep insomnia going, and it is often used alongside a pain plan rather than instead of one. Bring a sleep and pain diary so your clinician can treat both.
Sources and further reading
- NHS: Insomnia
- NHS: How to get to sleep
- NICE MTG70: Sleepio to treat insomnia and insomnia symptoms
- NHS: Side effects of zolpidem (falls risk)
- NHS: Falls
- NICE NG249: Falls — assessment and prevention
Educational information for people in the United Kingdom — not a diagnosis or personal medical advice. Charity no. 1218461. Pending clinical review. Everyone's situation is different, so always follow the advice of your own GP, pharmacist or rheumatology team. If you feel very unwell, call 999 or go to A&E. For urgent advice, contact NHS 111.
Continue with related help
- How to sleep with arthritis — tonight's routine
- What keeps you awake — cause-by-cause checklist
- Poor sleep and arthritis pain — break the cycle
- Night pain toolkit — settle pain before bed
- Sleep positions — joint by joint
- Night lights and falls — safer toilet trips
- Falls prevention — home and balance
- Codeine and drowsiness — another falls-risk medicine
- Ice and snow — outdoor falls
- Flare action plan — write your night plan down