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Volume 15 No. 04
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Accepted Papers

Scientific Investigations

Insomnia Disorder Among Older Veterans: Results of a Postal Survey

Armand M. Ryden, MD1,2; Jennifer L. Martin, PhD2,3; Sean Matsuwaka, MD4; Constance H. Fung, MD, MSHS2,3; Joseph M. Dzierzewski, PhD5; Yeonsu Song, PhD, RN2,3; Michael N. Mitchell, PhD3; Lavinia Fiorentino, PhD6; Karen R. Josephson, MPH3; Stella Jouldjian, MSW, MPH3; Cathy A. Alessi, MD2,3
1Pulmonary/Critical Care and Sleep Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California; 2David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California; 3Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California; 4Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, Washington; 5Department of Psychology, Virginia Commonwealth University, Richmond, Virginia; 6Department of Psychiatry, University of California San Diego, San Diego, California

Study Objectives:

To estimate the prevalence of insomnia disorder among older veterans and to study relationships among age and self-rated health, with insomnia disorder, self-reported sleep duration and sleep efficiency.


A cross-sectional postal survey of community-dwelling older veterans (older than 60 years) seen at one VA Healthcare System in the prior 18 months was performed, which was constructed to align with the general diagnostic criteria for insomnia disorder (International Classification of Sleep Disorders, Second Edition [ICSD-2]). The survey also queried self-reported sleep duration, bedtime, and wake time, which were used to calculate sleep efficiency. The survey also asked about race/ethnicity and self-rated health (using the general health item from the Short Form-36).


A completed survey was returned by 4,717 individuals (51.9% response rate; mean age 74.1 years). Of those, 2,249 (47.7%) met ICSD-2 diagnostic criteria for insomnia disorder. In logistic regression analyses, insomnia disorder was more likely among younger age categories (odds ratios [OR] 1.4–2.5) and in those with worse self-rated health (OR 2.1–14.4). Both total nocturnal sleep time and time in bed increased with older age (all P < .001), whereas sleep efficiency did not differ. Worse self-rated health was associated with shorter total nocturnal sleep time, more time in bed, and lower (worse) sleep efficiency.


Results of the postal survey suggest that almost half of community-dwelling older veterans have insomnia disorder, which was more common in young-old and among those with worse self-rated health. Additional work is needed to address the high burden of insomnia among older adults, including those with poor health.


Ryden AM, Martin JL, Matsuwaka S, Fung CH, Dzierzewski JM, Song Y, Mitchell MN, Fiorentino L, Josephson KR, Jouldjian S, Alessi CA. Insomnia disorder among older veterans: results of a postal survey. J Clin Sleep Med. 2019;15(4):543–551.

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