Changing Patterns of Insomnia Incidence Among U.S. Air Force Physicians, 2014 and 2024

Military physicians face risks to sleep health common to civilian physicians alongside additional military-specific stressors. Insomnia is prevalent among service members and associated with cognitive, health, and occupational impairment, yet its incidence among military physicians remains poorly characterized. This project examined the one-year incidence of insomnia among U.S. Air Force (USAF) physicians and assessed variation by demographic and occupational characteristics across two cohorts a decade apart.

We constructed a retrospective cohort using de-identified electronic health record and personnel data. USAF physicians on orders in 2014 and 2024 were included. Incident insomnia was defined as a first-time diagnosis using ICD-9 and ICD-10 codes, excluding individuals with prior diagnoses since 2006. Multivariable logistic regression assessed associations with rank, sex, race/ethnicity, and service component. Separate models examined associations with physician specialty and aggregated specialty categories. Robust standard errors and Bonferroni-adjusted comparisons were used. Analyses assume near-complete capture of clinically documented diagnoses within the Military Health System.

The analytic sample included 8,292 physicians. The one-year incidence proportion of documented insomnia declined from 3.6 percent in 2014 to 1.1 percent in 2024. In 2014, higher incidence was associated with senior officer rank and active-duty status and differed by aggregated specialty category, with elevated odds in preventive, diagnostic, and administrative specialties compared with general medical specialties. In 2024, higher incidence was associated with junior officer rank and male sex, and no statistically significant specialty differences were observed, although point estimates remained highest in emergency and critical care fields.

There was a marked decrease in documented insomnia incidence over the decade, alongside shifts in demographic and occupational correlates, among USAF physicians. These findings likely reflect changes in documentation, workforce composition, and help-seeking rather than true reductions in sleep disturbance. Continued surveillance and targeted prevention efforts are warranted to support physician readiness and force health protection.