OBJECTIVES: Insomnia is prevalent in many populations, both as a primary disorder and as a symptom secondary to a medication or underlying condition.  The objective of this study was to assess patient satisfaction with a variety of insomnia medications used in a community-based population in the U.S. METHODS: Patients are recruited from multiple sources including physician, pharmacy and online referrals and asked to report ongoing medications on the project website (www.iGuard.org).  A random sample of patients are contacted to complete the Treatment Satisfaction Questionnaire for Medication Version 1.4 (TSQM), a 14-item reliable and valid instrument to assess patients’ satisfaction with medication, providing scores on four scales—effectiveness, side effects, convenience and global satisfaction.  TSQM scores range from 0 to 100, with higher scores indicating higher satisfaction on the domain.  Analyses were conducted to explore differences in patient satisfaction across insomnia medications. RESULTS: A total of 239 patients on eight different insomnia medications were included: alprazolam (30), amitriptyline (33), eszopiclone (30), melatonin (30), quetiapine (30), temazepam (27), trazodone (30) and zolpidem (29). The mean age (SD) of the patients was 49.3 years (SD=11.8): 78.2% were female, 68.6% Caucasian, 23.0% Hispanic and 2.9% Black. The TSQM domains had good internal consistency, with Cronbach’s alpha for all domains exceeding 0.83.  After adjusting for patient age, race, gender, self-reported severity and Bonferroni correction for multiple comparisons, patients on products for secondary insomnia expressed lower TSQM scores than patients on products for primary insomnia.  Some differences were also observed when comparing TSQM scores for individual medication with the mean score from all patients.  For example, patients on amitriptyline had a significantly lower score on effectiveness (p=0.044) while patients on quetiapine had a significantly lower score on side effects (p=0.0005).CONCLUSIONS: When selecting an insomnia medication, clinicians should consider the patient's underlying condition as well as differences in patient satisfaction with insomnia medications.