Abstract
OBJECTIVES: Research has shown that insomnia and chronic diseases can simultaneously impact overall health, including physical, mental, emotional, and spiritual health. This study aims to find the association between insomnia and the four domains of health based on an Indigenous Medicine Wheel and to find the role of multimorbidity as a mediator between this relation among First Nations people. METHODS: We used data (n = 588) from the First Nations Sleep Health Project, a collaboration between two Cree First Nations communities in Saskatchewan and a research team at the University of Saskatchewan. Insomnia was measured by the Insomnia Severity Index (ISI). A multivariable logistic regression model was fitted, and the strength of significant predictors was presented as odds ratio (OR) and 95% confidence interval (CI). Using generalized structural equation modelling, we assessed the mediating effect of multimorbidity after adjusting confounders. RESULTS: Most participants (~ 70%) reported good or better health in the four domains. After adjusting for potential risk factors, we found that the probability of having poor or fair health in all four domains (physical, mental, emotional, and spiritual) was higher among people with severe to moderate insomnia (OR = 3.06 (1.76-5.30), 2.77 (1.54-4.99), 3.19 (1.85-5.52), and 1.57 (0.88-2.80), respectively). Additionally, the total effect of ISI on physical, mental, emotional, and spiritual health was 51.34%, 61.72%, 44.81%, and 57.27%, respectively, mediated by multimorbidity. CONCLUSION: The impact of insomnia on four domains of health and the mediation effect of multimorbidity on this path are unique findings. Early diagnosis and treatment of these conditions might improve overall health.