My dad has heart failure and severe inso

You did the hard part already: you found out what actually works for your dad, and you already have the two things a sleep conversation needs — a diary and a cardiology call today. What I can do is get you a short, screenshot-able plan for tonight, a set of questions that are safe to ask the doctor, and a clear line for when this stops being a home job. I am not a clinician, and nothing below changes your dad's medicines — his cardiologist or prescriber decides every drug question.

One thing to check for me: I don't have your country or city on file, so I can't name your local emergency number or point to a local CBT-I service. Tell me the country and I'll look both up properly rather than guess.

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1) What you've tried vs. the better alternatives

The non-drug route that has the strongest evidence is behavioural. Sleep hygiene alone is not the recommended treatment for chronic insomnia; multicomponent CBT-I is (AASM 2021, Edinger et al.).
Source: https://doi.org/10.5664/jcsm.8986 · https://pmc.ncbi.nlm.nih.gov/articles/PMC7853203/

So the two things to push for on today's call:

1. A CBT-I referral (in-person or an approved self-help programme). NHS guidance notes GPs now rarely prescribe sleeping pills, and pills are generally for a few days or weeks when insomnia is very bad and other treatment hasn't worked.

Source: https://www.nhs.uk/conditions/insomnia/

1. Is the insomnia the symptom, or is something in his heart causing it? In heart failure, waking short of breath, needing extra pillows to lie flat, or waking to urinate are common — and those are things the doctor should be looking at, not things to rebrand as a sleep habit. Older adults don't need less sleep; they sleep less deeply and wake more easily.

Source: https://medlineplus.gov/healthysleep.html · https://www.nhs.uk/conditions/insomnia/

Also worth one sentence on the call: snoring, choking or gasping in sleep, or a witnessed pause in breathing is a screening question, not a pillow question. It's common alongside heart failure and it changes the plan completely. A sleep study is a legitimate thing to ask about; a wearable "sleep score" is not an answer.
Source: https://www.nhs.uk/conditions/sleep-apnoea/

Which fork is this? I can't tell from "severe insomnia" alone, and it matters because the plans are opposites. In heart failure I'd expect the maintenance fork — sleep starts, then he wakes repeatedly — but it could be onset difficulty. The diary settles it in a week, and I won't guess which is his. (This is not a body-clock/phase problem: that's a different signature, and it's not what a heart-failure night looks like.)
Source: https://www.medlineplus.gov/ency/article/000805.htm · https://www.nhs.uk/conditions/insomnia/

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2) Constraints and the avoid list

Do not, on your own:

• Stop, skip, halve, double, or move his benzodiazepine dose. Not one tablet, not one weekend. It is his prescriber's call and it has to be a plan, not an accident.
• Add melatonin, an antihistamine, valerian, or anything from a friend — on top of what he's already on. Tell the cardiology team it exists even if you don't plan to use it.
• Mix alcohol with a sleeping pill, or use alcohol as the nightcap. It shortens the time to fall asleep and then fragments the night — it's not a hypnotic. With his medicine list, this is a hard no tonight.
• Buy prescription sleep medicine online or from anyone but a pharmacy. No mystery powders, no "natural sleep" gummies from a chat or marketplace — content doesn't match the label.
• Try to "catch up" with an earlier bedtime or a long lie-in after a bad night. It flattens the next night's sleep drive.
• Use a wearable sleep score, or a phone app's AHI or "efficiency" number, as evidence for or against treatment. That figure is not what answers this question, and the person who set up any therapy device is the one who reads it.

Source: https://medlineplus.gov/lab-tests/sleep-study/

Home safety, tonight (this matters more in an older adult on a sedative): getting up at night raises fall risk, so modify rather than forbid — path lighting on, a stable chair in a dim room, non-slip footwear or socks, no rushing, no dark glasses. And if he's up, keep the screen dim and don't start a meal or a workout.
Source: https://www.nhs.uk/every-mind-matters/mental-wellelling-tips/... (NHS "how to fall asleep faster") · https://info.sleepio.com/suitability (falls correction)

Melatonin + school week: if it's gummies, put them in a locked drawer. They look exactly like candy to a seven-year-old. Same for any tablet in a shared home.

Already at home, no shopping, no cooking project: no large late meal; a small familiar food if he's actually hungry; caffeine can still be working up to about 8 hours after the last cup, so count backwards from his sleep time, not from "evening"; dim the lights in the last hour; phone out of reach.
Source: https://medlineplus.gov/healthysleep.html · https://www.nhs.uk/conditions/insomnia/

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Tonight's three moves (all under 25 minutes total)

1. Same wake time tomorrow, whatever happened tonight. Not earlier in bed, not a catch-up lie-in. That single anchor is the thing the family holds.
2. A dim, quiet, boring last hour. Lights down, no alcohol, no late meal, phone out of the bedroom, bathroom path lit.
3. Write one diary row in the morning — whoever is up first can do it. Bed, lights-out, rough minutes to fall asleep, number of wakes and rough total minutes awake, final wake, rise time, plus caffeine and whether his medicine was taken. No doses written down. Do this for 7 mornings and take it to the next appointment — that's exactly what a sleep diary is for.

Source: https://www.nhlbi.nih.gov/resources/sleep-diary · https://www.nhlbi.nih.gov/health/insomnia/diagnosis

The weekly anchor (one sentence, no reply needed): *We do not move his bedtime; we hold his wake time, seven days a week, and we let the diary — not the pills — tell the doctor what kind of night this is.*

This is a week to both record and hand to a clinician. Record from tonight so the diary is ready for the next review; today's cardiology call is where the medication and CBT-I questions go.

For you, the caregiver: ask the sibling or the one nearby family member to own one specific night — a date, not "sometime this week." You cannot hold the anchor and the diary if you're awake every night yourself. One evening covered is worth more than three vague promises.

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3) Red flags — when to stop the home plan

Stop the DIY plan and get clinical help the same day:

• He needs extra pillows to breathe, or can't lie flat, or wakes gasping/choking at night — in heart failure that is a cardiac question, not a sleep habit.
• New or increasing swelling, or weight going up over a few days.
• Loud snoring, choking, or someone saw him stop breathing → ask for sleep-apnoea screening.
• Falling asleep while driving, at work, or mid-conversation. There is no "short trip only" allowance and no "if you feel alert enough" — arrange the ride or the stop, and let the clinician or licensing authority decide fitness to drive.

Emergency care, not a message:

• Chest pain, or breathlessness at rest, or fainting.
• Confusion or severe unsteadiness that is new.

Stop and talk to someone today, not the sleep plan:

• Two bad nights in a row with him saying he can't keep going, or any hint of wanting to end it. Say it plainly to me or to his doctor and I will help you with the local number and the nearest place — I won't print a number I haven't looked up.

Source: https://medlineplus.gov/healthysleep.html · https://www.nhs.uk/conditions/sleep-apnoea/ · https://www.nhs.uk/mental-health/conditions/depression-in-adults/symptoms/

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Script for today's cardiology call — screenshot this

> "Three things about my dad's sleep. He's been on a benzodiazepine and it's the only thing that works, and I don't want to change it myself. First, is his insomnia coming from the heart itself — breathlessness when lying flat, or getting up to urinate at night? Second, he's a fall risk, so could we review whether there's a non-benzodiazepine option, and if we ever come off the current one, can that be a planned taper rather than a sudden stop? Third, can we get a referral for CBT-I, and is a sleep study worth ruling out apnoea? I've kept a sleep diary for [number] days."

That is a whole call's worth of structure, and every drug question in it lands on the prescriber's side of the line.

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Want me to keep the diary with you? Give me tonight's or last night's numbers in plain words and I'll hold the rows and print a 7-day table you can hand over. I can also set a morning reminder for the diary — tell me your city or country first so the time is right, and I'll set it properly rather than guess at the clock.