Mixed-methods review highlights delays and pharmacological overreliance in chronic insomnia and GAD management.

BackgroundChronic insomnia is a prevalent condition associated with significant psychosocial and economic burden. When comorbid with Generalized Anxiety Disorder (GAD), symptom severity is intensified resulting in treatment pathways becoming more complex. Despite the impact, insomnia is often normalized, under recognized as a medical condition, and managed through fragmented care systems.MethodsA mixed-methods study was conducted in the United States to explore the patient journey of chronic insomnia with and without comorbid GAD. Qualitative insights were generated through 29 semi-structured online interviews with patients (n = 16), family members (n = 5), and healthcare professionals (n = 8), supported by secondary data review. Quantitative symptom data were collected using the Insomnia Severity Index (ISI) and Generalized Anxiety Disorder-7 (GAD-7) questionnaires to characterize the sample. A structured three step approach was applied: data immersion, qualitative research, and thematic analysis.ResultsFindings revealed substantial delays in help seeking and diagnosis, often spanning years or decades, driven by symptom normalization, stigma, and reliance on self-management remedies. Diagnosis was experienced as a moment of relief and validation, though expectations were frequently unmet due to brief consultations, limited information, and reliance on over-the-counter (OTC) options. Treatment was characterized by trial-and-error approaches, with healthcare professionals (HCP) acknowledging an overreliance on pharmacological interventions and systemic barriers to the implementation of cognitive behavioral therapy for insomnia (CBT-I). Ongoing management highlighted adaptation to insomnia as a chronic condition, emotional strain on families, and fragmented care across mental health and sleep services. Across all groups, the comorbidity of insomnia and GAD was recognized as exacerbating symptom severity and complicating management.ConclusionThis study uniquely captures the lived experience of chronic insomnia and comorbid GAD from the perspectives of patients, family members, and healthcare professionals across the US care spectrum. The findings underscore unmet psychological needs, systemic barriers to nonpharmacological interventions, and the absence of integrated, patient centered care models. Addressing these gaps requires improved recognition of insomnia as a medical condition, expansion of access to CBTI, and inclusion of family perspectives in long term management strategies.