Researchers: Alex Gileles-Hillel^1,2, Shoham Choshen-Hillel², Hagit Hochner²

Background: Insufficient sleep increases risks for cardiovascular disease, diabetes, obesity, cancer and mental disorders, and impairs cognition, emotion regulation and prosocial behavior. War's effects on sleep have mainly been studied among combat-exposed military; little was known about civilians, or whether disturbances persist over prolonged conflict

Objectives: To describe war-related sleep changes in Israeli civilians over an extended period now reaching two and a half years into the Israel-Hamas war; to identify factors rendering individuals more vulnerable or resilient; and to replicate these findings in the Jerusalem Perinatal Study (JPS) cohort, which brings decades of pre-war health data.

Method: We combined Central Bureau of Statistics data with three surveys (four analyses, N=8,453) covering the war's first six months, then repeated iPanel surveys at roughly six-month intervals through April 2026. In parallel, 391 JPS participants were interviewed in depth against this cohort's pre-war baseline.

Findings: Clinical insomnia rose 16-19%, short sleep (<6 hours/night) rose 19-22%, and sleep-medication use rose 4-5% versus before the war. Monitoring through April 2026 shows this chronic pattern re-exacerbating at moments of escalation rather than resolving. In the JPS replication, insomnia rose significantly; distress and routine disruption, more than trauma exposure itself, were the strongest predictors of new insomnia, with war exposure acting mainly indirectly through these pathways.

Conclusions: The war has had a substantial, persistent impact on Israeli civilians' sleep, re-intensifying at moments of escalation rather than resolving naturally, with women, the more distressed, and those with greater routine disruption at particular risk.

Recommendations: Sleep should be a standing part of Israel's public mental-health response to conflict, including public awareness, primary-care screening, telemedicine CBT-I, national medication guidance, and integration with trauma services. We recommend NIHP-commissioned Hebrew-, Russian-, and Arabic-language self-help CBT-I tools to close a gap in stepped care.

Research end date: 09/2026