Behavioral Insomnia Treatment Accessibility in the US: A Real-World Assessment of Cost, Location, and Availability

Document Type

Conference Proceeding

Publication Date

5-19-2025

Publication Title

Sleep

Abstract

Introduction: Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold-standard treatment for insomnia disorder. There have been consistent calls to increase patient accessibil ity to CBT-I. However, there have been few studies of what the experience is for patients who are recommended CBT-I and seek community-based care. Even less attention has been paid to this experience in patients and communities with lower incomes and poorer insurance coverage. We sought to examine the real-world access to providers with CBT-I expertise. Methods: We contacted all clinicians listed on the Society of Behavioral Sleep Medicine’s provider registry who met the fol lowing inclusion criteria: (1) US-based, (2) master’s degree or above, and (3) eligible for state licensure. Initial data on treat ment modality, insurance coverage, session costs, waitlist times, and practice locations were collected through internet searches, and were supplemented by contacting providers as potential patients through a maximum of three emails, with follow-up phone calls used as needed. Practice addresses were used to generate census-tract income data to compare to the 2022 fami ly-of-four poverty line. Results: Data from N=240 CBT-I providers were collected, spanning 42 states. Of these, 92.1% (n=221) were accepting new patients, but only 56.3% (n=135) accepted insurance. Among CBT-I providers accepting new patients, initial session costs averaged $260.71 (SD=$91.81, mode=$250.00, range=$100.00- $530.00); subsequent session costs averaged $227.74 (SD=$76.50, mode=$250.00, range=$75.00-$500.00), and wait times averaged 51.1 days (SD=61.9, range=0-300, mode=7). Average household income in practice areas was $95,246 (SD=$52,622). Only 5.0% (n=12) of CBT-I providers accepting new patients operated in communities at or below the poverty line, and just 3.3% (n=8) accepted insurance. Among these providers, only one accepted Medicaid. Conclusion: This study underscores significant access disparities for behavioral insomnia treatment in the US, highlighting how high treatment costs and limited availability of CBT-I provid ers have disproportionate and negative impacts on lower-income populations and those with inadequate insurance coverage. A large proportion of CBT-I providers do not accept insurance, leaving 135 behavioral sleep providers to treat those millions of Americans with insomnia unable to afford private pay. Even with insurance, logistical barriers like provider location and nearly two-month wait times exacerbate insomnia care disparities.

Volume

48

First Page

A246

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