Sedative hypnotic drugs are widely used to treat sleep disorders, but it is unclear how their utilization varies by drug and patient diagnosis. OBJECTIVES: To describe utilization patterns for various sedative hypnotic drugs in patients with and without a claim for insomnia. METHODS: This study was a cohort analysis of sedative hypnotic utilization in the US-based Marketscan commercial health care claims database for 2008-2010. Patients included those with and without an ICD-9 code for insomnia who were treated with sedative hypnotics including zolpidem, zaleplon, eszopiclone, and selected benzodiazepines (alprazolam, lorazepam, and diazepam). Outcomes included mean and median number of prescriptions filled, duration between refills, and switching patterns over 1 year of follow-up. RESULTS: A substantial proportion of sedative hypnotic use (55-92%, depending on the drug) is in patients without an insomnia diagnosis. The mean number of prescriptions was consistently higher in those with than without an insomnia diagnosis. In zolpidem, those with an insomnia diagnosis received a mean of 4.8 (95% CI 4.76-4.81) prescriptions within a year, while those without an insomnia claim received 2.8 (95% CI 2.82-2.84). Similarly, the duration of time between refills was lower for those with than without an insomnia claim; for zolpidem, the mean number of days between refills was 63.3 and 83.6, respectively. The duration between prescriptions also varied by drug, with zolpidem and eszopiclone having a shorter mean number of days between refills than zaleplon or the benzodiazepines (75, 65, 84 or 90, respectively).  More patients with than without insomnia claims (26.7% vs. 9.4%) switched from one sedative hypnotic drug to another. CONCLUSIONS: Drug utilization in users of sedative hypnotics varies substantially by diagnosis and drug. Those with claims for insomnia receive drug for longer periods of time, and with less time between refills than those without documented insomnia diagnoses.