Trends in insomnia diagnosis and sleep prescriptions in the COVID-19 peri-pandemic period among U.S. active duty service members

Abstract: INTRODUCTION: Insomnia is a prevalent condition that can significantly impair cognitive function, emotional regulation, and overall health, particularly affecting military personnel. The COVID-19 pandemic introduced additional stressors that may have exacerbated sleep disturbances among active duty service members (ADSMs). OBJECTIVE: This study aims to analyze trends in insomnia diagnoses and sleep medication prescriptions among U.S. ADSMs during the COVID-19 peri-pandemic period, assessing the potential impact of the pandemic on sleep health. MATERIALS AND METHODS: A repeated cross-sectional analysis was conducted using the Military Health System's outpatient and pharmacy records from January 2018 to February 2022. Incident insomnia diagnoses and days supplied for both Food and Drug Administration-approved and off-label medications for insomnia were evaluated with change-point analyses and Poisson regression. RESULTS: The cross-sectional study included 1,858,060 individuals, with 174,542 identified cases of incident insomnia and 2,031,910 individuals for the analysis of medications. Initial findings indicated a decrease in incident insomnia diagnoses during early pandemic periods, likely because of limited health care access. Incident insomnia diagnosis rates gradually returned to near baseline levels as access improved. Food and Drug Administration-approved medication days-supplied decreased significantly, while off-label medication use increased, potentially addressing both insomnia and comorbid conditions. Demographic analysis revealed varying rates by sex, race, age, rank, and geographic location. CONCLUSIONS: There were complex changes to rates of incident insomnia and its management among ADSMs during the COVID-19 pandemic period. Although healthcare access disruptions may have initially reduced encounters with incident insomnia diagnoses, ongoing needs for sleep disorder management persist. Changes in medication prescribing practices may highlight a shift towards addressing broader health concerns. Demographic variations in insomnia prevalence underscore the need for tailored interventions. Further research is needed to explore long-term impacts and develop effective interventions.