Sleepless hours: the lived experience of chronic insomnia and anxiety across the US care spectrum.

Background: Chronic 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. Methods: A 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 ( Results: Findings 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. Conclusion: This 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.