Sleeping tablets are not designed for long-term use. They lose effectiveness as the body builds tolerance, and the dose that once worked well no longer produces the same effect. This is expected pharmacology, not a failure on your part.

The more important question at 48 is: why are you not sleeping? If the root cause is perimenopause — which is likely — increasing tablet doses or switching medications addresses the symptom without touching the cause. Night sweats, early waking, and hyperarousal driven by oestrogen and progesterone changes will continue regardless of the sedative on board.

The path forward typically involves two things happening together. First, a supervised taper of the sleeping tablets — this must be done slowly with medical guidance, as stopping sleeping tablets abruptly causes rebound insomnia and can trigger withdrawal. Do not stop on your own. Second, addressing the perimenopause: speak to a gynaecologist about whether HRT is appropriate for you. If hot flashes and hormonal disruption are driving the sleep problem, HRT treats the cause directly and many women find their sleep normalises without needing any sedative medication.

Alongside this, CBT-I (Cognitive Behavioural Therapy for Insomnia) has the best long-term evidence for maintaining sleep improvements. Ask your doctor about a supervised plan that addresses both the medication and the underlying hormonal cause.