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Objective: To identify sociodemographic, psychological, and health factors related to trajectories of insomnia symptoms in older adults during the COVID-19 pandemic.

Methods: From May 2020 to May 2021, 644 older adults (mean age = 78.73, SD = 5.60) completed telephone-administered self-reported measures (ie, Insomnia Severity Index, consensus sleep diaries, UCLA Loneliness Scale, Kessler Psychological Distress Scale, Post-Traumatic Checklist, perceived health threat, and International Physical Activity Questionnaire) and provided sociodemographic data at 4 timepoints. Using the Insomnia Severity Index score at each timepoint, group-based trajectory modeling was conducted to identify groups with distinct insomnia trajectories.

Results: On average, there was no significant change in insomnia symptoms over time. Three groups with distinct sleep trajectories were identified: clinical (11.8%), subthreshold (25.3%), and good sleepers (62.9%). Older adults who were younger, male, had elevated psychological distress and posttraumatic stress disorder symptoms, perceived more SARS-CoV-2 health threat, spent more time in bed, and had shorter sleep duration during the first wave of the pandemic were more likely to belong to the clinical than to the good sleepers group. Those who were younger, female, had elevated psychological distress and PTSD symptoms, greater loneliness, spent more time in bed, and had reduced sleep duration during the first wave were more likely to belong to the subthreshold than to the good sleepers group.

Conclusions: Over 1 in 3 older adults experienced persistent subthreshold or clinically significant insomnia symptoms. Both sleep-related behaviors as well as general and COVID-19-related psychological factors were associated with insomnia trajectories.