Is Insomnia Genetic? What Gene Studies of Over 2 Million People Mean for Your Sleep

Is Insomnia Genetic? What Gene Studies of Over 2 Million People Mean for Your Sleep

This article is for educational purposes only. It does not replace medical care, diagnosis, or genetic counseling. It is not a substitute for advice from a licensed physician, board-certified medical geneticist, or board-certified genetic counselor. For any decisions about testing, treatment, or care, consult a qualified clinician. In emergencies, call 911.

Bottom line: Gene studies of more than 2 million people show that insomnia is partly genetic. But the genetic part is spread across hundreds of DNA spots, and each one adds only a tiny push. A consumer DNA report can hint at who is more prone to poor sleep. It cannot diagnose insomnia or pick a treatment. US guidelines still start every adult with CBT-I (cognitive behavioral therapy for insomnia), a structured talk-and-habit program.

What you’ll learn

• What large twin, family and gene studies say about how insomnia runs in families
• How to turn study percentages into plain “out of 100 people” numbers
• What a 23andMe-style insomnia result can and cannot tell you
• Which treatments guidelines recommend first, and the FDA and Health Canada status of newer sleep drugs

1. What Insomnia Disorder Is (and What It Is Not)

The National Heart, Lung, and Blood Institute (NHLBI) calls insomnia “a common sleep disorder”. People with it have trouble falling asleep, staying asleep, or getting good-quality sleep. This happens even when they have the time and a good place to sleep.

Doctors split insomnia into two main types:

Type	How long it lasts	Typical picture
Short-term insomnia	A few days or weeks	Often linked to stress or a change in schedule or setting
Chronic (long-term) insomnia	3 or more nights a week, for more than 3 months	Not fully explained by another health problem

Chronic insomnia is more than a bad week. NHLBI states that it “raises your risk of high blood pressure, coronary heart disease, diabetes, and cancer”. NHLBI also links it to anxiety, depression, falls and road accidents. The risk of insomnia rises with age. It is also more common in women than in men.

Poor sleep is a symptom, a bit like a smoke alarm. The alarm is real, but the fire may be somewhere else. So a clinician first looks for other causes before calling it “just insomnia”:

• Sleep apnea: breathing pauses during sleep. Clues include loud snoring or waking up gasping.
• Other health problems: chronic insomnia is defined as sleep trouble not fully explained by another condition.
• Habits and substances: caffeine, nicotine, alcohol, night shifts and clock-watching are listed risk factors.
• Stress: a common trigger for short-term insomnia.

This step matters for anyone who suspects their sleep problem is “in the genes.” A gene result does not rule out a treatable cause. If poor sleep has lasted more than 3 months, a visit to a primary care clinician is the right first step. The same goes for anyone whose partner notices loud snoring or breathing pauses.

Section recap: Chronic insomnia means poor sleep 3 or more nights a week for over 3 months, despite a fair chance to sleep. A clinician should rule out other causes, such as sleep apnea, before anyone blames genes.

2. How Insomnia Is Inherited: Many Genes, Each With a Tiny Effect

NHLBI puts it simply: “Your genes may raise your risk of insomnia, as insomnia sometimes runs in families”. Three kinds of research show how strong that link is.

Twin studies. These compare identical and non-identical twins to estimate heritability. Heritability is the share of differences in a trait across a whole population that lines up with genetic differences. It does not tell how “genetic” one person’s insomnia is.

A US study followed about 7,500 adult twins in Virginia. Heritability of insomnia symptoms was about 22% to 25% at a single time point. After the authors corrected for measurement error, it was about 38% in men and about 59% in women. The authors also found that each person’s own life events and setting still explained a large part of the variation.

Family history. A study of 953 adults in Quebec, Canada asked about insomnia in parents, siblings and children. About 39 in 100 people who had ever had insomnia reported an affected close relative. That compared with about 29 in 100 good sleepers who never had it. This kind of study cannot separate shared genes from a shared home life. It is also not a measure of personal risk.

Genome-wide association studies. A genome-wide association study (GWAS) scans DNA markers in very large groups. It looks for spots on the DNA, called loci, that are more common in people with a trait. Three landmark GWAS of insomnia are shown below.

Study	People studied	Main finding
Hammerschlag et al. 2017	113,006 (UK Biobank)	3 loci and 7 genes; top signal in MEIS1, a gene also tied to restless legs syndrome
Jansen et al. 2019	1,331,010	202 loci and 956 genes; together the variants explained 2.6% of the differences in insomnia complaints
Watanabe et al. 2022	593,724 cases and 1,771,286 controls	554 loci, 364 of them new; 289 top genes active mainly in the brain and in nerve-cell signaling

The message is clear. Insomnia risk is polygenic, meaning it comes from many genes at once. The 2022 study called this “extreme polygenicity”. No single gene causes insomnia. Genes such as MEIS1, SCFD2 and WDR27 (the last one in men only) are research signals. None of them is a diagnostic test.

Think of it like a dimmer switch with thousands of tiny steps, not an on-off switch. Each variant nudges the light a little.

One more link is worth knowing. Orexin is a brain signal that helps keep people awake. Some newer sleep drugs work by blocking it. However, the gene studies have not shown that insomnia risk genes act through orexin. The two topics connect only through treatment.

A family history of poor sleep is useful to share with a primary care clinician. It adds context, even though it cannot predict one person’s future.

Section recap: A large twin study put insomnia heritability at about 22% to 59%, depending on sex and method. Gene studies of more than 2 million people found hundreds of loci, each with a tiny effect.

3. How Big Is the Risk? Turning Percentages Into Real Numbers

Insomnia is common, with or without a family history. The best recent North American figures come from Canada.

Measure	Figure	About how many in 100 adults	Source
Insomnia disorder, Canada, 2023 survey	16.3%	About 16
Nighttime insomnia symptoms, Canada, 2015	23.8% (up from 16.8% in 2007)	About 24
Chronic insomnia disorder, industrialized nations	At least 5% to 10%	At least 5 to 10
Occasional, short-term insomnia	30% to 50%	30 to 50

Symptoms and disorder are not the same thing. Many people have some poor nights without meeting the full definition.

Relative vs absolute risk. Studies often report a risk ratio. A risk ratio is the chance of an outcome in one group divided by the chance in another. In the 2023 Canadian survey, women had a risk ratio of 1.24 compared with men. That means about a 24% higher relative rate, not 24 extra people in every 100. The same survey found a risk ratio of 1.77 for Indigenous peoples.

Gene studies often use a cousin measure, the odds ratio. An odds ratio compares the odds of a condition in two groups. When a condition is common, an odds ratio can make the gap look bigger than the real difference in risk.

Here is an illustrative example, not a study result. Suppose 10 in 100 people in a group develop insomnia. A 20% relative increase would move that to 12 in 100. That is 2 extra people per 100, not 20.

What a consumer report number means. A 23andMe sample report with an “increased likelihood” result says: “An estimated 50% of people with genetics like yours develop insomnia by their 60s”. That is a company estimate. It means about 50 in 100 such people develop insomnia by their 60s, and about 50 in 100 do not.

Linked health problems. The 2019 GWAS used a method called Mendelian randomization. This method uses gene variants as natural experiments to test cause and effect. Its results suggest that insomnia may contribute to depression, diabetes and heart and blood vessel disease. This is genetic evidence, not final proof. The 2022 study also linked insomnia genes to metabolic and mental health pathways.

Genes are only one input. All gene variants found in 2019 together explained just 2.6% of the differences in insomnia complaints. Stress, shift work, caffeine, nicotine, alcohol and age also raise risk. A primary care clinician can help weigh these everyday factors against any gene report.

Section recap: About 16 in 100 Canadian adults have insomnia disorder. Gene effects are real but small, and daily habits and health often matter as much or more.

4. Testing Options: Consumer DNA Reports vs a Clinical Sleep Check

There are two very different paths. One is a consumer DNA report. The other is a clinical sleep evaluation.

The 23andMe Insomnia report. This report gives a polygenic score. That is a single number that adds up the small effects of many DNA variants. This one uses more than 28,000 variants.

The report is labeled “Powered by 23andMe Research.” It is not one of the company’s reports that meet FDA requirements for genetic health risks. The sample report states that it “has not been clinically validated and should not be used to make medical decisions”.

It also says it has not been validated for some ancestries, including some people with mixed ancestry. The report does not count rare, large-effect variants.

Other consumer DNA companies may or may not offer a similar report. The safest move is to check each provider’s current report list before buying.

The clinical path. Insomnia is diagnosed from a person’s history, not from a gene test. None of the major US guidelines uses a gene test to diagnose or treat insomnia.

Feature	Consumer polygenic report	Clinical sleep evaluation
What it measures	Small DNA variants linked to insomnia in research	Sleep pattern, symptoms, health and habits
Can it diagnose insomnia?	No	Yes
Main tools	Saliva DNA sample	1- to 2-week sleep diary, interview, physical check
Checks for sleep apnea?	No	Yes, by asking about snoring and gasping
Guides treatment choice?	No	Yes, through guideline-based care

A sleep diary is a simple daily log. It records bedtime, wake time, night wakings and naps. NHLBI suggests keeping one for 1 to 2 weeks before a visit. A full overnight sleep study is usually saved for people who may have sleep apnea or another sleep disorder.

Bring the diary to a primary care clinician. That visit is the start of the covered medical path. Exact coverage depends on each person’s health plan.

Section recap: A consumer insomnia report is a research-based estimate, not a medical test. Diagnosis comes from a clinical visit and a 1- to 2-week sleep diary.

5. How to Read a Polygenic Insomnia Result

A polygenic score is a single number that adds up the small effects of thousands of DNA variants. It estimates how prone a person may be compared with others. It is not a diagnosis.

A weather forecast is a good comparison. A 50% chance of rain does not mean it will rain on you. It also does not mean you should cancel the day.

Key points for reading a result:

• “Increased likelihood” is not a diagnosis. The report itself says it “does not diagnose insomnia”.
• “Typical likelihood” does not rule insomnia out. Most of the variation in insomnia is not explained by known variants.
• Ancestry matters. The large gene studies drew mostly on people of European ancestry. The company notes the report is not validated for some ancestries.
• It leaves things out. The report “does not account for every possible factor” and excludes rare variants.
• It does not predict treatment response. No genetic test has been shown to predict who will respond to CBT-I or to any sleep medicine. The ACP guideline does not use genes to choose treatment.

The report also advises people already diagnosed to keep following their prescribed treatment plans. A gene result should never be a reason to change or stop a treatment alone.

What to bring to a clinician:

• The sleep diary, if one has been kept
• How long the problem has lasted and how many nights a week
• Daytime effects, such as tiredness, mood or focus
• Family sleep history
• All medicines, supplements, caffeine, alcohol and nicotine use
• The DNA report, if it helps start the conversation

A primary care clinician can review these together. Questions about the report itself can go to a certified genetic counselor (see Section 8).

Section recap: A polygenic score shows tendency, not destiny. It cannot diagnose insomnia, rule it out, or choose a treatment.

6. First-Line Treatment: CBT-I for Every Adult

The American College of Physicians (ACP) recommends CBT-I as the first treatment for all adults with chronic insomnia disorder. It rated this a strong recommendation. The American Academy of Sleep Medicine (AASM) also gives multicomponent CBT-I a strong recommendation.

CBT-I stands for cognitive behavioral therapy for insomnia. It is usually a 6- to 8-week plan. It can be done in person, by phone or online. It has five main parts:

Part	What it involves
Stimulus control	Using the bed only for sleep, and getting up if unable to sleep
Sleep restriction	Limiting time in bed at first, so sleep becomes deeper and steadier
Cognitive therapy	Changing worried thoughts about sleep
Relaxation	Calming the body and mind before bed
Sleep education	Learning how sleep, light, caffeine and alcohol interact

How well it works. A 2015 review pooled 20 trials with 1,162 people. After face-to-face CBT-I, people fell asleep about 19 minutes faster. They spent about 26 minutes less time awake during the night. Sleep efficiency, the share of time in bed spent asleep, rose by about 10 points. Total sleep time rose by about 8 minutes, a change that was not statistically clear.

The gains seemed to last, and no adverse outcomes were reported. That review left out people whose insomnia came with other medical, sleep or mental health conditions.

Habits alone are not enough. The AASM suggests that clinicians not use sleep hygiene tips as a stand-alone treatment for chronic insomnia. Tips like a fixed bedtime help, but they work best as part of full CBT-I.

What about genes? There is no evidence that a high genetic score blocks the benefit of CBT-I. There is also no test that predicts who will respond. That is why the guidelines recommend CBT-I to all adults with chronic insomnia, without any gene check.

Think of CBT-I as physical therapy for sleep. It retrains a system rather than covering up a symptom.

A primary care clinician can refer a patient to a behavioral sleep medicine provider or a program that offers CBT-I. It is worth asking about this directly.

Section recap: CBT-I is the recommended first treatment for adults with chronic insomnia, whatever their genes. Trials show it shortens the time to fall asleep and the time spent awake at night.

7. Sleep Medicines: Orexin Receptor Antagonists and Older Options

Medicines are a second step in US guidelines. The ACP suggests a shared decision about short-term medicine when CBT-I alone has not worked. The AASM 2017 guideline rates every sleep drug it covers as a weak recommendation.

Orexin receptor antagonists. An orexin receptor antagonist is a drug that blocks orexin, a brain signal that keeps people awake. Three are approved in the US. All three are Schedule IV controlled substances in the US, meaning their prescribing is tightly regulated.

Drug (brand)	FDA status	Health Canada status
Suvorexant (Belsomra)	Approved August 13, 2014	Authorized in Canada in 2018, but no longer marketed there
Lemborexant (Dayvigo)	Approved December 20, 2019	Authorized November 2020; marketed in Canada
Daridorexant (Quviviq)	Approved January 7, 2022	Authorized April 2023; 50 mg tablet marketed in Canada
Vornorexant	Not approved in the US	Not approved in Canada

The AASM 2017 guideline gives suvorexant a weak “suggest use” for trouble staying asleep. That guideline came before lemborexant and daridorexant were approved. So it does not rate those two drugs.

What the trials show. Trials report adverse events. An adverse event is any unwanted health event during a trial, whether or not the drug caused it. Placebo groups have them too. So adverse events are not the same as proven side effects.

Trial	Design	Key results
Mignot et al. 2022	Two 3-month trials, about 1,850 people, 17 countries	At month 3, 50 mg cut time awake at night by about 18 minutes vs placebo. Adverse events: about 38 in 100 on 50 mg vs 34 in 100 on placebo.
Uchimura et al. 2024	4-week trial, 490 people in Japan	50 mg added about 20 minutes of self-reported sleep vs placebo. Sleepiness as an adverse event: about 7 in 100 vs 2 in 100 on placebo.
Uchiyama et al. 2026	2-week trial, 596 people in Japan	Vornorexant shortened self-reported time to fall asleep by about 10 minutes vs placebo

Drug companies funded the daridorexant trials. The 2024 and 2026 trials studied only people in Japan, so results may differ in the US and Canada. Vornorexant is an investigational drug. No FDA or Health Canada approval was found for it as of October 2026. Its trial authors call it a possible new option, but that is their view, not a regulator’s.

Label warnings. The FDA label for daridorexant lists headache and sleepiness or fatigue as the most common adverse reactions. Orexin receptor antagonists should not be used by people with narcolepsy. Their labels warn about next-day impairment, including driving. They also warn about complex sleep behaviors, such as sleepwalking, but not as a boxed warning. Orexin receptor antagonists have not been proven safer than older sleeping pills in long-term head-to-head studies.

Older “Z-drugs”. In 2019 the FDA added a boxed warning, its strongest warning, to three common sleep drugs. The reason was complex sleep behaviors, such as sleep driving, that led to serious injuries and deaths. The FDA identified 66 such cases over 26 years.

Drug (US brand)	FDA status	Health Canada status
Zolpidem (Ambien)	FDA-approved; boxed warning added in 2019	Zolpidem products marketed in Canada
Eszopiclone (Lunesta)	FDA-approved; boxed warning added in 2019	Generic eszopiclone marketed in Canada
Zaleplon (Sonata)	FDA-approved; boxed warning added in 2019	All products cancelled; not marketed in Canada

Over-the-counter options. The AASM suggests not using diphenhydramine (a common antihistamine sleep aid) or melatonin for chronic insomnia in adults. Even so, about 29 in 100 Canadian adults used natural products or over-the-counter sleep aids in the past year.

Safety rule. Never start, raise, stop or combine any sleep medicine with alcohol without talking to the prescriber. A pharmacist can also check for interactions with other medicines.

Section recap: Sleep medicines are a second step after CBT-I. Three orexin receptor antagonists have FDA approval, but only two are marketed in Canada, and vornorexant is investigational.

8. Family, Insurance and Privacy: GINA and Canada’s Genetic Non-Discrimination Act

Family testing. For single-gene conditions, doctors often offer cascade testing, which means testing relatives for a known family variant. That does not apply to polygenic insomnia. There is no single variant to test for.

Family habits are a better place to focus. The AASM says teenagers aged 13 to 18 should sleep 8 to 10 hours per 24 hours on a regular basis. Regular, enough sleep is linked to better attention, learning, memory and mood control in young people. A parent with poor sleep can model a steady schedule and a calm wind-down at night. A pediatrician can help if a teen’s sleep is a concern.

Insurance and work in the US. The Genetic Information Nondiscrimination Act (GINA) is a 2008 federal law. The Affordable Care Act (ACA) adds rules for health plans.

Area	US protection
Health insurance	Protected under GINA Title I
Employment	Protected under GINA Title II, enforced by the EEOC
Life, disability and long-term care insurance	Not covered by GINA; some states add their own protections
Pre-existing conditions	ACA health plans cannot reject a person or charge more for a prior condition

HealthCare.gov states that no plan can “reject you, charge you more, or refuse to pay for essential health benefits” for a prior condition.

Canada. Canada’s Genetic Non-Discrimination Act became law in 2017. Its main rules are simple:

• No one may require a genetic test as a condition of goods, services or a contract.
• No one may require a person to share results, or use them, without written consent.
• Unlike GINA, it is not limited to health insurance and jobs, so it also reaches other insurance contracts.
• The Supreme Court of Canada upheld the Act in 2020.

Privacy. Before sharing DNA data, it helps to read the company’s privacy and research-consent settings. A life insurance application is one place where GINA does not help in the US.

Who can help. For most people with a polygenic insomnia result, a sleep medicine referral is more useful than genetic counseling. That can be a board-certified sleep physician, an AASM-accredited sleep center or a behavioral sleep medicine provider. Genetic counseling is a visit with a trained specialist who explains what a DNA result means for a person and family. For questions about the DNA report itself, a certified genetic counselor can help:

• United States: counselors certified by the American Board of Genetic Counseling (ABGC)
• Canada: counselors certified by the Canadian Association of Genetic Counsellors (CAGC)
• Directory: the National Society of Genetic Counselors offers a “Find a Genetic Counselor” search at NSGC.org. It is a professional society and does not certify counselors.

Section recap: There is no family gene test for polygenic insomnia, so healthy family sleep habits matter more. GINA protects US health insurance and jobs only, while Canada’s law applies more broadly.

Frequently Asked Questions

Does an “increased likelihood” result mean a person will get insomnia?

No. It is a risk estimate, not a diagnosis. In the company’s own sample, about 50 in 100 people with similar genetics develop insomnia by their 60s, and about 50 in 100 do not. Stress, habits and health play a large part. A primary care clinician can assess real symptoms.

Will children inherit a parent’s insomnia?

They may inherit some tendency, but not a set outcome. Heritability describes a population, not a child’s personal chance. There is no family gene test for polygenic insomnia. Steady sleep schedules matter more, with 8 to 10 hours per 24 hours for teens. A pediatrician can help with a child’s sleep problems.

Does CBT-I still work for someone with a high genetic score?

Guidelines recommend CBT-I to all adults with chronic insomnia, with no gene check. No test predicts who will respond. There is also no evidence that a high score blocks the benefit. A clinician can refer to a CBT-I provider.

Can a genetic insomnia result affect insurance or a job?

In the US, GINA protects against genetic discrimination in health insurance and employment. It does not cover life, disability or long-term care insurance. In Canada, the Genetic Non-Discrimination Act limits the use of genetic test results more broadly. A certified genetic counselor can explain the details.

When is a sleep study or a second opinion worth considering?

A sleep study is usually for people who may have sleep apnea, such as those with loud snoring or waking up gasping. A board-certified sleep physician can also help when insomnia lasts despite CBT-I, or when the cause is unclear.

Summary

Insomnia is partly genetic. A large twin study put heritability at about 22% to 59%, depending on sex and method. Gene studies of more than 2 million people found hundreds of DNA spots, each with a tiny effect. Together, the variants found in 2019 explained only 2.6% of the differences in insomnia complaints.

A consumer insomnia report is a research-based estimate. It cannot diagnose insomnia, rule it out or pick a treatment. CBT-I is the recommended first treatment for all adults. Sleep medicines are a second step with real warnings. Their FDA and Health Canada status differs by country.

The most useful next step is simple. Keep a sleep diary for 1 to 2 weeks and bring it to a primary care visit.

This article is for educational purposes only. It does not replace medical care, diagnosis, or genetic counseling. It is not a substitute for advice from a licensed physician, board-certified medical geneticist, or board-certified genetic counselor. For any decisions about testing, treatment, or care, consult a qualified clinician. In emergencies, call 911.

References

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21. National Human Genome Research Institute (genome.gov) – Genetic Discrimination; HealthCare.gov – Coverage for pre-existing conditions. Genetic Information Nondiscrimination Act (GINA) of 2008 and ACA pre-existing-condition protections. https://www.genome.gov/about-genomics/policy-issues/Genetic-Discrimination ; https://www.healthcare.gov/coverage/pre-existing-conditions/
22. Department of Justice Canada – Genetic Non-Discrimination Act, S.C. 2017, c. 3; Supreme Court of Canada – Reference re Genetic Non-Discrimination Act, 2020 SCC 17. https://laws-lois.justice.gc.ca/eng/acts/G-2.5/page-1.html ; https://decisions.scc-csc.ca/scc-csc/scc-csc/en/item/18417/index.do
23. Paruthi S, Brooks LJ, D’Ambrosio C, et al. Recommended Amount of Sleep for Pediatric Populations: A Consensus Statement of the American Academy of Sleep Medicine. J Clin Sleep Med. 2016;12(6):785-786. PMID 27250809. doi:10.5664/jcsm.5866. https://pubmed.ncbi.nlm.nih.gov/27250809/
24. American Board of Genetic Counseling (ABGC); Canadian Association of Genetic Counsellors (CAGC); National Society of Genetic Counselors (NSGC). Genetic counselor credentialing and referral resources (US/Canada). https://www.abgc.net/ ; https://www.cagc-accg.ca/ ; https://www.nsgc.org/

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Last updated: 2026-10-16

Author: Yu Mizuno (Editor-in-Chief, non-physician), GeneLumen editorial team.

This article aggregates 24 sources. Of these, 17 are tier 1 and 6 are tier 2. One company product page describes the 23andMe report only. Sources include NHLBI and NHGRI at the NIH, the US FDA and Health Canada. They also include Statistics Canada, the Department of Justice Canada and the Supreme Court of Canada. Guidance comes from the American College of Physicians, the American Academy of Sleep Medicine, ABGC, CAGC and NSGC. PubMed-indexed studies are included too.

This article is for educational purposes only. It is not a substitute for medical advice from a licensed physician, board-certified medical geneticist, or board-certified genetic counselor. It does not replace medical care, diagnosis, or genetic counseling. In emergencies, call 911.

Related: Neurogenetic Diseases

🇯🇵 For readers in Japan — a separate Japanese edition written for Japan’s healthcare system (not a translation): https://genelumen.com/ja/ja-neurogenetic/insomnia-genetic-risk