Trends in non-pharmacological treatment for insomnia: A nationwide study

Background: As the prevalence of insomnia disorder in Korea is gradually increasing, understanding real-world treatment patterns is essential for designing appropriate clinical guidelines. Although non-pharmacological treatments are recommended as first-line interventions, their actual use in clinical settings remains insufficiently studied. This study examined the current status of non-pharmacological treatments for insomnia implemented by Korean doctors. Methods: Data from the National Health Insurance Service (NHIS) sample cohort, comprising 518,119 patients diagnosed with insomnia disorder (ICD-10 code: G47) between 2002 and 2019, were analyzed. Treatment types at the time of first diagnosis and the timing of non-pharmacological treatment initiation were assessed. Results: Only 0.01% of patients received non-pharmacological treatment at their first diagnosis, and 97.5% did not receive such treatment during the study period. Among those who eventually received it, the interval from diagnosis to treatment initiation decreased over time. A modest increase in the use of non-pharmacological treatments was observed after 2018, following changes in national insurance coverage. Conclusion: The findings highlight a significant gap between clinical guidelines and real-world practice. Although non-pharmacological treatments remain underutilized, recent improvements suggest potential for better integration into routine care, emphasizing the need for ongoing efforts to enhance access to recommended therapies.