Perceived Stress and Clinical Insomnia in Primary Care: Associations with Lifestyle and Medication Use

Insomnia and perceived stress are among the most prevalent health concerns in primary care, yet their complex relationship remains underexplored. This study examines the association between perceived stress and insomnia severity, while considering the potential moderating or mediating effects of lifestyle factors and medication use.

A cross-sectional study was conducted with 300 consecutive primary care patients who completed validated questionnaires assessing insomnia severity (Insomnia Severity Index, ISI) and perceived stress (Perceived Stress Scale, PSS). Logistic regression models were employed to identify predictors of clinical insomnia and explore key relationships.

A moderate but statistically significant correlation (r = 0.460, p < 0.001) was observed between perceived stress and insomnia severity. In logistic regression analysis, higher perceived stress scores (OR = 1.134, p < 0.001) and hypnotic medication use (OR = 3.220, p < 0.001) were significant predictors of clinical insomnia. Interestingly, alcohol consumption was unexpectedly associated with insomnia (OR = 0.551, p = 0.048), warranting further exploration. No significant associations were found for caffeine intake, tobacco use, or demographic variables. The model explained 33% of the variance in insomnia (Nagelkerke R² = 0.328).

These findings highlight the significant role of perceived stress in insomnia severity and underscore the complex interplay between pharmacological interventions and sleep disturbances. While hypnotic medications are commonly used, their long-term impact and potential dependence require careful consideration. Integrating stress-reduction strategies into primary care may improve insomnia management while reducing reliance on pharmacological treatments. Future research should employ longitudinal designs to clarify causality and further explore additional factors influencing sleep disturbances.