Understanding the insomnia patient journey in Germany: survey findings from patients and healthcare professionals

Abstract Background In Germany, fewer than 10% of patients with insomnia receive guideline-recommended care (cognitive behavioural therapy for insomnia, CBT-I), often after long delays. Little is known about what patients do in the meantime. Objective This article aims to describe patients’ actions before receiving professional care and to identify gaps and opportunities for improving insomnia management in routine care by considering healthcare professionals’ (HCPs’) perspectives. Materials and methods Between August and September 2024, online surveys were conducted among adults with insomnia and HCPs. Patients were recruited via a digital CBT‑I application (somnio; mementor DE GmbH, Leipzig, Germany) and HCPs via a newsletter. Results In total, 523 patients participated; 47.8% had had insomnia for more than 5 years. Before their first consultation, 92.2% had tried self-help measures, mainly over-the-counter (OTC) sleep aids (69.3%), relaxation techniques (56.2%), and sleep hygiene approaches (51.9%). A substantial proportion of patients (56.0%) waited several years before seeking help; 37.4% were first offered prescription medication, and 14.1% used it regularly. At the time of the survey, 40.5% had no formal diagnosis of insomnia. Among 34 HCPs who took part in the survey, most reported offering sleep hygiene advice (90.3%) and digital health apps (80.6%), followed by sleep diaries (51.6%) and OTC medication (41.9%). Prescription sleep medication was mentioned by 25.8%, psychotherapy referrals by 22.6%. Conclusion Care pathways remain fragmented, and diagnosis is often missing. Improving diagnostics, expanding CBT‑I access, and strengthening education for patients and providers are key to timely, effective insomnia care.