Innovative Approaches to Advancing Equitable Access to Insomnia Interventions.

Abstract

Purpose of review: Insomnia disorder is a prevalent and impairing sleep-wake disorder characterized by persistent difficulty initiating or maintaining sleep, accompanied by daytime impairment. Cognitive behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment and has a strong evidence base. Building on this foundation, recent work has increasingly focused on translating these advances into accessible and scalable interventions. This review (1) highlights key challenges in the delivery of insomnia interventions that constrain equitable access and (2) examines emerging approaches that may address these gaps.

Recent findings: Recent research has identified four primary challenges limiting equitable access to insomnia interventions: high comorbidity with mental health and other sleep and circadian disorders, limited testing and adaptation outside of academic settings, a shortage of trained providers, and structural barriers related to funding and reimbursement. In response, growing evidence supports transdiagnostic treatment approaches, implementation strategies for real-world settings, delivery by non-specialist providers, brief and single-session interventions, and digital and stepped care models as promising pathways to improve access and scalability.

Summary: Our review underscores the importance of moving beyond testing efficacy to address the practical and structural barriers that limit access to evidence-based insomnia interventions. Advancing research that prioritizes real-world application remains essential for narrowing the longstanding gap between evidence and practice and to improve equitable access to effective insomnia interventions.