Iran’s barrages of hundreds of ballistic missiles, drones, and other explosive unmanned weapons – mostly during the wee hours of the night or morning – have stressed all Israelis. Even before the war, they slept too little. Now they would give almost anything for a good night’s sleep.
But even before the massive conflict, according to new Jerusalem-based research, the war with Hamas, Hezbollah, and the Houthis in Yemen against Israel has had a profound and lasting impact on civilian sleep, even among those not directly exposed to combat.
Across four large-scale studies, researchers found sharp increases in insomnia, short sleep duration, and reliance on sleeping pills by Israelis during the last 20 months.
The study was led by Prof. Shoham Choshen-Hillel and Dr. Uri Zak of the Hebrew University of Jerusalem (HUJI) Business School and the Federmann Center for the Study of Rationality; Prof. Hagit Hochner of the Hadassah-Hebrew University School of Public Health and Community Medicine, and Prof. Alex Gileles-Hillel of Hadassah-University Medical Center and HUJI. It reveals a significant decline in sleep quality among the Israeli civilian population following the outbreak of the Israel-Hamas War.
These sleep disruptions persisted even six months into the conflict, despite a decrease in reported psychological distress, suggesting that the effects on sleep are not just immediate reactions to acute stress, but may have longer-term consequences of living under sustained threat.
The study also identified particularly vulnerable groups, including women and individuals with higher exposure to trauma, who experienced more severe sleep impairments.
Until now, the effects of war on sleep have been studied mostly among soldiers who were directly exposed to combat.
A critical component of civilian health amid war
These findings underscore the importance of recognizing sleep as a critical component of civilian health during times of war and ensuring that it is addressed in both emergency and long-term public health strategies.
Published in the International Journal of Clinical and Health Psychology, the study, titled “Tired of War: Changes in the Sleep of the Israeli Civilian Population in the Wake of the Israel-Hamas War,” is among the first to document the broad impact of warfare on the sleep health of civilians, rather than military personnel.
The research, which provides data-driven insights to guide national and global responses to civilian mental health in times of crisis, was based on four studies and thousands of data points. It shows a sharp rise in insomnia and sleep disturbances among Israelis during the conflict. They drew on a national survey by the Central Bureau of Statistics and other representative samples.
Choshen-Hillel, who earned her doctoral degree in social psychology from HUJI, was a Rothschild postdoctoral fellow at the Center for Decision Research at the University of Chicago’s Booth School of Business. She studies decision-making processes in social contexts and organizations, searching for answers to questions such as when decision-makers react negatively to others’ better outcomes and when they endorse them.
Among their findings was a marked increase in insomnia symptoms during the war; a 19% to 22% rise in the prevalence of short sleep (fewer than six hours per night); 16% to 19% increase in clinically significant insomnia; and a four-to-five percent increase in the use of sleep medications.
In an interview with The Jerusalem Post, Choshen-Hillel said she and her team have already launched a study on the effects of sleeplessness among Israelis caused by Iranian ballistic missile attacks.
“Between April 2024 and December 2024, we saw almost no improvement. From our current research, we know that women of all ages are affected by such stress more than men,” she said.
“Getting more sleep on weekends does not compensate for insomnia during the week. It may seem that the rise in people taking sleeping pills is not significant, but from 8% to 13%, this is a 50% increase. And these pills can be addictive. They should be taken under a doctor’s supervision only if there is no other choice.”
Sleep is vital for the proper function of the body and mind, Choshen-Hillel added.
“Inadequate sleep raises the risk for numerous health conditions, including heart attacks, diabetes, obesity, and cancer, and too little sleep is also linked with an increased likelihood of developing mental disorders, such as anxiety, depression, and even suicidal tendencies. In the long term, it can impair cognitive and emotional functioning, disrupt memory and executive function, intensify feelings of loneliness, and reduce empathy for the pain of others. It’s even been found that hospital doctors on duty who get little sleep feel less compassion for patients.”
She urged avoiding all screens – including smartphones, even an hour before going to sleep.
“People are eating more, and smokers are lighting up more, both of which are harmful. Don’t drink coffee or tea before going to bed. Do sports during the day. Reading a book can help you fall asleep.”
Study 1 compared the national prevalence of insomnia before and during the war by analyzing data on 6,474 people. Studies 2 and 3 comprehensively assessed reports on sleep before the war and two or three months into the war through validated tools, and also measured psychological distress and demographics. These studies included two independent samples of 1,706 adults.
Four re-surveyed the representative sample of Study 3 six months into the war, based on 273 Israelis.
In Study 1, the incidence of insomnia symptoms rose markedly during the war. In Studies 2 and 3, participants reported a 19% to 22 % increase in the prevalence of short sleep (fewer than six hours per night), a 16% to 19 % increase in clinical insomnia, and a 4-5 % increase in sleep medication usage compared to before the war.
“In Study 4, six months into the war, the majority of sleep impairments persisted for a year and a half, despite reduced psychological distress. We haven’t yet published this, but we know from the data we have that it’s true,” Choshen-Hillel said. “Across studies, women and individuals with greater exposure to trauma were more strongly
affected.”
The team said the findings of its four studies proved the detrimental effects of warfare on civilians’ sleep, indicating that these effects are likely to be long-lasting. The findings identify precursors for sleep problems and underscore the relationships among sleep, trauma, and psychological distress.
The majority of these effects persisted for at least half a year, even as psychological distress among respondents declined, indicating that war-related sleep disruptions may have long-term consequences.
The studies further highlight that women and individuals with greater exposure to trauma were more severely affected.
“This research underscores that war reaches far beyond the battlefield,” said the researchers. “Even those not in direct danger face deep and lasting impacts – sleepless nights being among them.”
They added that “understanding how war affects sleep can help policymakers and health professionals support civilian populations through and beyond conflict. Sleep is not a luxury – it is essential for coping, healing, and resilience.”