Trends and Factors Associated with Insomnia and Sleep Apnea in U.S. Military Aviators, 2006–2022

INTRODUCTION: Insomnia and sleep apnea (SA) can have adverse effects on operating aircraft. This study examined trends in insomnia and SA incidence rates in U.S. military aviators from 2006–2022 and examined associated demographic and operational factors.

METHODS: Data on incidence cases of outpatient insomnia and SA, aviator demographics, and operational factors were obtained from the Defense Medical Epidemiological Database, a comprehensive online archive of military medical data. Insomnia and SA cases were identified using specific International Classification of Diseases codes.

RESULTS: For the entire military aviator population (N = 331,992 ± 1649, mean ± SD) overall rates of insomnia and SA were 10.2 and 24.9 cases/1000 person-years, respectively. Compared to the entire U.S. military nonaviator population, aviators had lower incidence of insomnia, but higher incidence of SA. Insomnia rates among aviators increased up to 2015 and declined afterwards, while SA rate generally rose over the period. Insomnia and SA rates among aviators increased with age, were higher among those of black and other nonwhite races, were highest among Army personnel (compared to other services) and were highest among helicopter pilots (compared to fixed-wing aircraft pilots). Insomnia rates were similar among male and female aviators, but SA rates were higher among men.

DISCUSSION: These data indicate that insomnia and SA are prevalent within the military aviation population; however, the incidence of insomnia appears to have fallen as the tempo of military operations has decreased while the incidence of SA continues on an upward trajectory, possibly associated with the growing problem of obesity.

Caldwell JA, Knapik JJ. Trends and factors associated with insomnia and sleep apnea in U.S. military aviators, 2006–2022. Aerosp Med Hum Perform. 2025; 96(1):23–30.