Psychosocial factors are strongly associated with insomnia in users and nonusers of prescribed sleep medication: evidence from the HUNT3 study

Figures & data

Table 1 Sample characteristics of sleep medication users and nonusers

Characteristic	Users		P-value	Nonusers		P-value
	Female (n=4,774), % (n)	Male (n=1,927), % (n)		Female (n=22,982), % (n)	Male (n=21,122), % (n)
Insomnia			0.001			<0.001
No	87.5 (4,175)	89.6 (1,727)		94.4 (21,692)	96.3 (20,350)
Yes	12.5 (599)	10.4 (200)		5.6 (1,290)	3.7 (772)
Age, years (in categories)			0.863			<0.001
<29	1.6 (76)	1.7 (33)		11.2(2,570)	8.7 (1,833)
30–39	4.5 (214)	4.4 (84)		16.5 (3,793)	13.1 (2,770)
40–49	11.2 (533)	11.1 (213)		21.4 (4,915)	20.6 (4,352)
50–59	21.3 (1,016)	22.0 (423)		21.7 (4,986)	23.7 (5,000)
60–69	25.7 (1,226)	24.5 (473)		17.0 (3,902)	19.9 (4,201)
70–79	22.6 (1,079)	22.1 (425)		8.7 (2,008)	10.6 (2,242)
≥80	13.2 (630)	14.3 (276)		3.5 (808)	3.4 (724)
Neuroticism (EPQ-N)
0	12.2 (583)	16.9 (325)	<0.001	24.9 (5,721)	33.5 (7,082)	<0.001
1	13.3 (633)	14.0 (269)		19.1 (4,389)	17.5 (3,698)
2	12.8 (613)	12.6 (243)		13.4 (3,091)	10.8 (2,285)
3	12.4 (593)	11.4 (219)		9.9 (2,271)	6.5 (1,363)
4	11.3 (541)	9.1 (176)		6.5 (1,493)	3.8 (806)
5	10.8 (517)	8.3 (159)		4.6 (1,050)	2.3 (488)
6	8.1 (389)	5.3 (103)		2.7 (611)	1.2 (247)
Missing	19.0 (905)	22.5 (433)		18.9 (4,355)	24.4 (5,153)
Death of a close family member			0.067			0.215
No	79.4 (3,791)	82.0 (1,580)		88.6 (20,354)	89.1 (18,812)
Yes	16.3 (777)	14.6 (282)		9.5 (2,185)	9.2 (1,939)
Missing				1.9 (443)	1.8 (371)
Relationship breakup			0.068			0.149
No	83.4 (3,980)	82.9 (1,598)		88.4 (20,317)	88.4 (18,670)
Yes	12.4 (591)	14.2 (274)		9.5 (2,192)	10.0 (2,110)
Missing	4.3 (203)	2.9 (55)		2.1 (473)	1.6 (342)
Lives with partner/others
No	46.7 (2,230)	38.7 (745)	<0.001	35.9 (8,245)	36.2 (7,650)	0.455
Yes	53.3 (2,544)	61.3 (1,182)		64.1 (14,737)	63.8 (13,472)
Physical activity			0.005			<0.001
Less than once a week	21.1 (1,008)	25.2 (485)		16.5 (3,789)	26.9 (5,688)
Once a week	18.3 (874)	16.6 (319)		21.1 (4,841)	22.2 (4,694)
Two to three times a week	36.1 (1,723)	35.2 (679)		41.8 (9,612)	33.9 (7,158)
Daily	20.9 (996)	20.2 (389)		18.9 (4,344)	15.5 (3,275)
Missing	3.6 (173)	2.9 (55)		1.7 (396)	1.5 (307)
Current smoking status			<0.001			<0.001
Nonsmoker	66.3 (3,163)	69.7 (1,343)		73.0 (16,788)	75.2 (15,872)
Smoker	28.9 (1,381)	26.5 (510)		24.3 (5,591)	22.4 (4,726)
Missing	4.8 (230)	3.8 (74)		2.6 (603)	2.5 (521)
Alcohol use (L/yr)			<0.001			<0.001
Median (range)	0.75 (0–24.6)	1.54 (0–24.6)		0.78 (0–36.9)	1.65 (0–59.2)
Missing	20.2 (801)	12.6 (216)		8.8 (2,023)	6.2 (1,235)
Satisfaction with life			<0.001			<0.001
Very satisfied	13.7 (652)	11.8 (227)		21.6 (4,955)	20.9 (4,406)
Satisfied	25.9 (1,238)	26.2 (504)		37.5 (8,610)	37.9 (7,995)
Somewhat satisfied	35.3 (1,687)	33.9 (653)		28.4 (6,521)	29.5 (6,234)
<Somewhat satisfied	23.3 (1,110)	26.4 (508)		11.4 (2,573)	10.5 (2,218)
Missing	1.8 (87)	1.8 (35)		1.4 (323)	1.3 (269)
Self-rated health			0.030			<0.001
Poor	3.8 (183)	5.1 (99)		0.9 (210)	1.1 (226)
Fair	46.9 (2,239)	44.5 (857)		21.7 (4,981)	19.3 (4,077)
Good	40.9 (1,952)	43.0 (829)		56.5 (12,979)	60.6 (12,810)
Very good	3.8 (183)	4.2 (81)		17.6 (4,043)	16.5 (3,491)
Missing	4.5 (217)	3.2 (61)		3.3 (769)	2.5 (518)

Abbreviations: EPQ-N, Eysenck Personality Questionnaire – Neuroticism Scale.

Table 2 Use of PSM by sex and dose

Sex	Dose (DDD)	Anxiolytics, % (n)	Hypnotics, % (n)	Combined, % (n)
Females	Low (1–30)	58.5 (1,184)	24.9 (894)	32.2 (1,537)
	Moderate (31–179)	31.1 (629)	34.4 (1,237)	33.6 (1,602)
	Frequent (≥180)	10.4 (211)	40.7 (1,463)	34.2 (1,635)
	Total	100 (2,024)	100 (3,594)	100 (4,774)
Males	Low (1–30)	56.1 (464)	28.8 (399)	35.6 (686)
	Moderate (31–179)	30.0 (248)	29.9 (413)	29.3 (565)
	Frequent (≥180)	13.9 (115)	41.3 (571)	35.1 (676)
	Total	100 (827)	100 (1,383)	100 (1,927)

Abbreviations: PSM, prescribed sleep medication; DDD, defined daily dose.

Table 3 Logistic regression analysis of personality and lifestyle predictors of insomnia (dependent variable) among users of PSM

Variables	Females			Males
	OR	95% CI	P-value	OR	95% CI	P-value
Age	1.47	1.35–1.61	<0.001	1.40	1.22–1.59	<0.001
Self-reported health (ref = very good)
Fairly good	2.04	1.28–3.22	0.003	2.50	1.32–4.76	0.005
Good	4.00	2.50–6.66	<0.001	4.76	2.27–10.00	<0.001
Poor	5.55	2.44–14.26	<0.001	11.11	2.13–50.00	0.004
Neuroticism (EPQ-N)	1.26	1.19–1.34	<0.001	1.29	1.16–1.43	<0.001
Sleep medication dose (ref = low)
Moderate	1.16	0.89–1.50	0.275	1.39	0.90–2.14	0.137
Frequent	1.17	0.89–1.55	0.257	0.63	0.39–1.01	0.058
Satisfaction with life (ref = very satisfied)
Satisfied	1.17	0.74–1.86	0.509	1.30	0.54–3.18	0.560
Somewhat satisfied	1.36	0.87–2.11	0.172	1.26	0.53–3.01	0.600
Less than somewhat satisfied	1.73	1.09–2.75	0.020	1.64	0.68–3.99	0.271
Smoking (ref = nonsmoker)	0.96	0.76–1.21	0.718	0.97	0.64–1.46	0.873
Alcohol use (L/yr)	1.05	0.99–1.11	0.094	1.00	0.93–1.06	0.951
Living with others (ref = living alone)	1.01	0.79–1.29	0.936	0.80	0.52–1.23	0.311
Death in the family (ref = no death)	1.08	0.81–1.44	0.606	1.13	0.68–1.87	0.629
Relationship breakup (ref = no breakup)	1.19	0.88–1.61	0.267	1.00	0.60–1.65	0.992
Exercise (ref = less than once a week)
Once a week	0.87	0.63–1.20	0.387	0.78	0.46–1.32	0.347
Two to three times a week	0.77	0.58–1.02	0.070	0.62	0.39–0.97	0.036
Daily	0.78	0.56–1.08	0.133	0.55	0.31–0.97	0.037

Note: Bold values are statistically significant.

Abbreviations: PSM, prescribed sleep medication; OR, odds ratio; CI, confidence interval; EPQ-N, Eysenck Personality Questionnaire – Neuroticism Scale; ref, reference group; yr, year.

Table 4 Logistic regression analysis of personality and life style predictors of insomnia (dependent variable) among nonusers of PSM

Variables	Females			Males
	OR	95% CI	P-value	OR	95% CI	P-value
Age	1.30	1.25–1.37	<0.001	1.12	1.05–1.19	<0.001
Self-reported health (ref = very good)
Fairly good	1.30	0.83–2.00	0.254	1.56	0.98–2.50	0.060
Good	3.12	4.76–5.55	<0.001	3.45	2.17–5.55	<0.001
Poor	4.76	7.69–2.94	<0.001	5.88	3.23–10.00	<0.001
Neuroticism (EPQ-N)	1.38	1.33–1.43	<0.001	1.47	1.40–1.54	<0.001
Satisfaction with life (ref = very satisfied)
Satisfied	1.04	0.83–1.30	0.710	1.24	0.91–1.69	0.175
Somewhat satisfied	1.41	1.13–1.76	0.002	1.64	1.21–2.22	0.002
Less than somewhat satisfied	2.08	1.63–2.65	<0.001	2.19	1.56–3.06	<0.001
Smoking (ref = nonsmoker)	1.09	0.94–1.25	0.264	0.89	0.73–1.08	0.237
Alcohol use (L/yr)	0.98	0.95–1.03	0.489	1.03	1.00–1.06	0.013
Living with others (ref = living alone)	1.03	0.88–1.21	0.707	1.05	0.85–1.29	0.654
Death in the family (ref = no death)	1.24	1.00–1.53	0.055	0.81	0.61–1.09	0.164
Relationship breakup (ref = no breakup)	0.87	0.71–1.08	0.205	1.35	1.06–1.71	0.015
Exercise (ref = less than once a week)
Once a week	0.86	0.70–1.04	0.111	1.00	0.80–1.25	0.972
Two to three times a week	0.32	0.21–0.51	<0.001	1.02	0.83–1.26	0.809
Daily	0.21	0.13–0.34	<0.001	1.00	0.77–1.30	0.987

Note: Bold values are statistically significant.

Abbreviations: PSM, prescribed sleep medication; OR, odds ratio; CI, confidence interval; ref, reference group; EPQ-N, Eysenck Personality Questionnaire – Neuroticism Scale; yr, year.