Mapping the insomnia patient journey in Europe and Canada.

Insomnia affects daily functioning and overall health, and is thus associated with significant individual, societal, and economic burden. The experience of patients living with insomnia, their perception of the condition, and its impact on their quality of life is not well documented. The objective of this study was to map the patient journey in insomnia and identify unmet needs. Participants were individuals with insomnia, and healthcare professionals (HCPs) who treat insomnia, in the United Kingdom, France, Germany, Italy, and Canada. Qualitative interviews (50 patients, 70 HCPs) and a quantitative survey (700 patients, 723 HCPs) were conducted to inform the patient-journey mapping and obtain information on the emotions, perceptions, and experiences of patients and HCPs. The patient journey comprises seven phases. The first defines the onset of insomnia symptoms. Phase 2 represents self-initiated behavior change to improve sleep (e.g., sleep hygiene, reducing caffeine, exercise). The next phase is characterized by use of over-the-counter (OTC) treatments, which generally fail to provide lasting relief. Phase 4 describes the first HCP consultation (occurring several months to several years after onset) and typically occurs at a crisis point for the patient; patients may be looking for an immediate solution (e.g., medication), which may not align with their HCP's recommendation. The following stage comprises sleep hygiene/behavioral changes (±OTC treatment) under HCP guidance for many patients, although offering prescription treatments without a sleep hygiene stage under supervision is more common in some countries. Phase 6 describes prescription medication initiation, where patients fluctuate between relief/hopefulness and a sense of failure, while HCPs try to balance the need to provide relief for the patient while maintaining best medical practice and minimizing adverse effects. The final phase (living with long-term insomnia) represents an indefinite period during which sleep issues remain unresolved for many patients, with most of them continuing to use prescription treatments for longer than indicated and creating their own variable, self-managed regimens combining multiple modalities. This patient journey analysis for insomnia revealed seven distinct phases, highlighting different touchpoints where insomnia management could be optimized.

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Copyright © 2023 O’Regan, Garcia-Borreguero, Gloggner, Wild, Leontiou and Ferini-Strambi.

Déclaration de conflit d'intérêts

This work was supported by Idorsia Pharmaceuticals Ltd., Allschwil, Switzerland. This study sponsor was involved in designing the interview questionnaires and surveys (in collaboration with third-party market research vendors); in the analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Data collection was conducted by the third-party vendors. DO’R, DG-B, and L-FS were independent of the funder. All authors had full access to all the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. DO’R has received honoraria for lectures, presentations and/or participation in scientific advisory boards from the British Association of Psychopharmacology, Neurodiem, TEVA, and Idorsia. DG-B has received research grants from MSD and Roche, and has performed consulting work for Idorsia and Roche. FG, IW, and CL are employees of Idorsia Pharmaceuticals Ltd. LF-S has received honoraria for lectures, presentations and/or participation in scientific advisory boards from Sanofi, Lundbeck, Italfarmaco, Valeas, Angelini, Bayer, Pfizer, Bioprojet, Jazz Pharma, and Idorsia.