Chronic insomnia affects an estimated 10-15% of Australian adults at any given time and produces a substantial healthcare burden through both direct treatment costs and indirect effects on workplace productivity, road safety, and comorbid mental health conditions. The treatment landscape in Australia has shifted meaningfully through 2024-2026, with both encouraging developments and persistent challenges.

A practical read for GPs, allied health professionals, and patients navigating the current options.

CBT-i: more available, still rationed

Cognitive behavioural therapy for insomnia (CBT-i) remains the first-line evidence-based treatment for chronic insomnia. The clinical evidence base is robust, the durability of treatment effects is favourable, and the safety profile compares favourably to pharmacological alternatives.

The Australian access picture for CBT-i has improved through 2024-2026 but remains uneven. The expansion of digital CBT-i platforms — both clinician-supported and self-directed — has dramatically increased the geographic accessibility of the treatment. Several digital programs are now available with structured clinician support models, and the early outcome data suggests effectiveness broadly comparable to in-person delivery for appropriately-selected patients.

In-person CBT-i delivery remains limited by the small pool of trained clinical psychologists with insomnia-specific expertise. Wait times for in-person CBT-i with experienced practitioners are typically 3-6 months in major metropolitan centres and longer in regional areas. The bulk of expanded access has come through digital channels rather than expansion of the in-person workforce.

The Medicare arrangements for CBT-i continue to evolve. Better Access mental health treatment plans cover CBT-i delivery when the underlying mental health context warrants it. Standalone insomnia CBT-i delivery sits in a more complex billing space, with some clinicians using mixed approaches to fund treatment.

Medication trends

The medication landscape for insomnia has seen more substantive shift through 2024-2026 than at any point in the previous decade.

Benzodiazepine prescribing for insomnia has continued its long-term decline, in line with both clinical guidelines and regulatory pressure. The exceptions are short-term and specific use cases. The structural shift away from benzodiazepines as first-line insomnia medication is settled clinical practice in most Australian sleep services.

“Z-drug” prescribing (zolpidem, zopiclone) has stabilised at relatively modest levels. The clinical concerns about long-term use and the daytime impairment risks have been incorporated into the standard prescribing approach.

Sedating antidepressants (low-dose mirtazapine, doxepin) continue to have an evidence-supported role in selected patients. Use has held broadly steady.

Newer pharmacotherapy options — particularly orexin receptor antagonists (suvorexant, lemborexant, daridorexant) — have expanded access in Australia. PBS listing for some agents in selected indications has improved affordability. The clinical adoption has been gradual but is now established in specialist sleep medicine practice. Primary care prescribing of these agents has lagged the specialist uptake but is growing.

Melatonin continues to occupy a complex space. The 2mg modified-release product remains available with PBS coverage for older adults with primary insomnia. Off-label use of melatonin in other populations and at other doses is widespread but evidence support is more limited than the popular use would suggest.

The OSA-insomnia overlap

A clinical area where understanding has advanced meaningfully through 2024-2026 is the overlap between insomnia and obstructive sleep apnoea. The recognition that comorbid insomnia and OSA (sometimes labelled COMISA) is a distinct clinical entity with implications for both diagnosis and treatment has gained ground in Australian practice.

Patients with COMISA show different outcomes from patients with either condition alone. CPAP adherence is typically lower, response to standard insomnia treatment is often muted, and the symptom presentation can mask the underlying OSA component if the clinical team doesn’t actively investigate for it.

The clinical approach in 2026 is to actively screen insomnia patients for OSA risk factors and refer for sleep study when indicated, and conversely to actively address insomnia symptoms in OSA patients with persisting sleep complaints despite CPAP therapy. The two conditions are no longer routinely treated as if they were unrelated.

Digital health integration

The integration of digital sleep tracking — both consumer-grade and clinical-grade — with treatment workflows has continued to mature. Several Australian sleep services now incorporate patient-supplied digital sleep tracking data into their clinical assessment and treatment monitoring processes.

The clinical caveat that consumer wearables produce sleep tracking with meaningful accuracy limitations remains important. The data is useful as longitudinal trend information and as a patient-engagement tool. It is not yet a substitute for clinical-grade sleep assessment when diagnostic precision matters.

Several Australian digital health companies have built validated clinical-grade sleep monitoring tools using consumer-accessible hardware, and the regulatory pathway for these tools through the TGA framework has been refined. The clinical adoption of these tools is selective but growing.

What GPs should be doing

A practical summary for general practice management of insomnia in 2026:

Take a careful sleep history. The diagnostic distinction between chronic insomnia and other sleep disorders, including OSA, restless legs, and circadian rhythm disorders, materially affects treatment selection. A 15-minute sleep-focused consultation produces meaningfully better diagnostic outcomes than briefer assessments.

Consider digital CBT-i as first-line for appropriate patients. The access, the cost, and the evidence base all support digital CBT-i for patients with primary chronic insomnia and without significant complicating factors.

Maintain a conservative pharmacological approach. The decline in benzodiazepine prescribing for insomnia is appropriate. The newer agents have a place but should be used with the same care that would apply to any medication with potential for ongoing use.

Screen for and address comorbid conditions. Untreated depression, anxiety, OSA, and substance use issues all contribute to chronic insomnia in ways that won’t be resolved by treating the insomnia in isolation.

Maintain a referral pathway for refractory cases. The patients who don’t respond to first-line management deserve specialist sleep medicine assessment, and the wait times — while real — are usually worth the additional clarity the specialist assessment provides.

The Australian insomnia treatment landscape in mid-2026 is meaningfully better than it was even three years ago. Access has expanded, the evidence base has strengthened, and the clinical conversation has matured. The persistent challenges — workforce capacity for in-person CBT-i, the integration of insomnia care with broader mental health and chronic disease management, the cost barriers for some patients — remain but the trajectory is positive.