Episode 220: Approach of Insomnia in Adults

This episode of Rio Bravo Q Week explores the growing challenge of insomnia in adults, emphasizing its high prevalence, long-term consequences, and frequent underdiagnosis in primary care. Host Héctor Arias and guest Moira, a third-year medical student and public health master's student, discuss the shift in clinical guidelines toward cognitive behavioral therapy for insomnia (CBTI) as the first-line treatment, replacing outdated reliance on sleep hygiene alone. They highlight that insomnia affects 10% of adults, with rates spiking during and after the COVID-19 pandemic, and is linked to serious outcomes including suicide risk, cognitive decline, and increased healthcare costs. The episode details the components of CBTI—stimulus control, sleep restriction, cognitive restructuring, relaxation techniques, and sleep hygiene—and underscores that while CBTI is highly effective and durable, access remains limited due to a severe shortage of trained providers. Innovative solutions like digital CBTI, Brief Behavioral Treatment for Insomnia (BBTI), and direct-to-patient interventions are presented as scalable alternatives to expand access. The episode concludes with a call to action for primary care providers to pursue CME and integrate evidence-based approaches into routine practice. Key takeaways include: 1) CBTI is the gold standard for chronic insomnia and should be first-line treatment; 2) Sleep hygiene alone is insufficient and should be part of a broader behavioral intervention; 3) BBTI offers a practical, accessible alternative in primary care settings; 4) Digital tools and mailed behavioral interventions can significantly improve population-level insomnia outcomes; 5) Clinicians must move beyond surface-level advice and invest in training to address this widespread condition effectively.