OBJECTIVES : To fully evaluate sleep characteristics (difficulty initiating sleep [DIS], difficulty maintaining sleep [DMS] and non-restorative sleep [NRS]) across all self-reported insomnia symptoms.

METHODS : Using data from a nationally-representative survey fielded in 2018, sleep characteristics, health-related quality of life (HRQoL), resource utilization and work productivity were assessed in participants with self-reported insomnia. Standardized sleep questionnaires characterized insomnia symptoms. Those experiencing an insomnia symptom five or more nights per week were classified as having the corresponding insomnia symptom(s). Descriptive statistics and adjusted odds ratios and 95% confidence intervals across groups were reported for the US adult population.

RESULTS : Insomnia symptoms are reported in 21.07% of the US adult population. HRQoL was lowest for those reporting all 3 symptoms (DIS, DMS and NRS) vs. those reporting one symptom alone. Mental health and physical health were lower than population norms for participants with any insomnia symptom; among those with insomnia symptoms the mental component score (MCS) and physical component score (PCS) were highest for those reporting DIS or DMS alone vs. those reporting DIM, DMS and NRS (MCS 43.98 [12.16] vs. 36.90 [13.13], p<0.001; PCS; 44.59 [11.76] vs 40.11 [12.30], p<0.001). Those with insomnia symptoms experiencing all 3 symptoms vs. no or minimal symptoms were more likely to have severe anxiety (54.32% vs. 5.14%; p<0.001), and severe depression (51.75% vs. 6.20%; p<0.001). Work hours missed in the past week due to health were higher for those with all 3 symptoms vs. those with no or minimal symptoms (2.75 [6.23] vs. 1.15 [3.81]; p<0.05). Those experiencing an emergency department visits over the last 6 months was higher for those with all 3 insomnia symptoms compared to those with DIS or DMS alone (31.06% vs. 6.36%; p<0.001).

CONCLUSIONS : Insomnia is a common complaint expressed in several ways. How patients characterize insomnia symptoms is related to HRQOL and resource utilization.