OBJECTIVES The aims of this study were to quantify the burden of insomnia and to quantify the association between side effects of insomnia medications and health outcomes. METHODS Data from the 2013 US (N=75,000) and 5EU (N=62,000) National Health and Wellness Survey (NHWS) were used. The NHWS is a patient-reported survey administered to a demographically representative sample of adults (with respect to age, sex, race/ethnicity, and region).  Those who met DSM-V criteria for insomnia and, separately, those treated with insomnia were compared with their respective propensity score-matched control groups on health status (SF-36v2), work productivity (WPAI-GH), and healthcare resource use using ANOVA tests. Among those with treated insomnia, those with and without side effects were compared on health outcomes using general linear models controlling for demographics, health history, and comorbidities. RESULTS Compared with their respective matched control groups, patients with insomnia (n=4147) and treated insomnia (n=2860) in the 5EU reported significantly worse mean health utilities (0.60 vs. 0.74; 0.60 vs. 0.74, respectively), greater overall work impairment (38.74% vs. 14.86%; 39.50% vs. 15.66%), and more annual physician visits (9.10 vs. 4.08; 9.58 vs. 4.11). Similar findings were observed in the US cohort.  Among those treated for insomnia, 13.56% and 24.55% in the US and 5EU, respectively, were non-adherent due to side effects. In the US, this behavior was associated with significantly worse health utilities (0.60 vs. 0.64) and greater overall work impairment (37.71% vs. 29.08%), among other variables (all p<.05). These relationships were not significant in the 5EU. CONCLUSIONS A significant humanistic and economic burden of insomnia was observed in both the US and 5EU, and the burden remains even after treatment.  Non-adherence due to side effects was common and, in the case of the US, associated with significantly poorer health outcomes.