BackgroundInsomnia is one of the most common complaints in chronic pain. This study aimed to evaluate the association of insomnia with well-being, quality of life and health care costs. MethodsThe sample included 2790 older individuals (median age=76; interquartile range [IQR]=70-82) with chronic pain. The participants completed a postal survey assessing basic demographic data, pain intensity and frequency, height, weight, comorbidities, general well-being, quality of life and the insomnia severity index (ISI). Data on health care costs were calculated as costs per year (Euro prices) and measured in terms of outpatient and inpatient care, pain drugs, total drugs and total health care costs. ResultsThe overall fraction of clinical insomnia was 24.6% (moderate clinical insomnia: 21.9% [95% CI: 18.8-23.3]; severe clinical insomnia: 2.7% [95% CI: 1.6-3.2]). Persons who reported clinical insomnia were more likely to experience pain more frequently with higher pain intensity compared to those reported no clinically significant insomnia. Mean total health care costs were Euro 8469 (95% CI: Euro4029-Euro14,271) for persons with severe insomnia compared with Euro 4345 (95% CI: Euro4033-Euro4694) for persons with no clinically significant insomnia. An association between severe insomnia, well-being, quality of life, outpatient care, total drugs costs and total health care costs remained after controlling for age, sex, pain intensity, frequency, body mass index and comorbidities using linear regression models. ConclusionsOur results determine an independent association of insomnia with low health-related quality of life and increased health care costs in older adults with chronic pain. SignificanceThe concurrence and the severity of insomnia among older adults with chronic pain were associated with decreased well-being and quality of life, and increased health care costs to society.