Tired of war: Changes in the sleep of the Israeli civilian population in the wake of the Israel-Hamas war

Study Objectives: War profoundly impacts various aspects of human life. The effects of war on sleep have been mainly studied among military personnel who are directly exposed to combat. The present work studies changes in sleep patterns of the civilian population following a war, assessing sleep before and during the 2023-2024 Israel–Hamas war. Methods: Study 1 compared the national prevalence of insomnia before and during the war by analyzing data from the 2023 Israeli Central Bureau of Statistics survey (N = 6,474). Studies 2 and 3 comprehensively assessed reports on sleep before the war and 2-3 months into the war through validated tools, and also measured psychological distress and demographics. These studies included two independent samples (N = 1,706), one of which was representative of the Israeli population. Study 4 re-surveyed the representative sample of Study 3 six months into the war (N = 273). Results: In Study 1, the incidence of insomnia symptoms rose markedly during the war. In Studies 2 and 3, participants reported a 19-22 % increase in the prevalence of short sleep (< 6 hours/night), a 16-19 % increase in clinical insomnia, and a 4-5 % increase in sleep medication usage compared to before the war. In Study 4, 6 months into the war, the majority of sleep impairments persisted despite reduced psychological distress. Across studies, women and individuals with greater exposure to trauma were more strongly affected. Conclusions: The findings of four studies demonstrate the detrimental effects of warfare on civilians’ sleep, indicating that these effects are likely long-lasting. The findings identify precursors for sleep problems and underscore the relationships between sleep, trauma, and psychological distress. Brief Summary Current knowledge: War is an event of profound magnitude that alters the lives of many. The effects of war on people's sleep have been mainly studied among combat-exposed military personnel. How does war impact the sleep patterns of the civilian population? Study Impact: This comprehensive population-based study, conducted in 2023-2024 before and during the Israel–Hamas war, found that the Israeli civilian population experienced increased clinical insomnia, a significant reduction in sleep duration, and greater use of sleep medications, accompanied by high levels of psychological distress. The effects on sleep persisted 6 months into the war. The sleep of women and individuals with greater exposure to trauma was particularly affected. These findings call for sleep-targeted interventions in the context of war-related trauma and psychological distress.