Abstract: Inadequate sleep, unmet mental health or substance use needs (unmet needs), and presenteeism are prevalent among military populations. This study aimed to cross‐sectionally determine the association between sleep disturbance profiles, unmet needs, and presenteeism in US active‐duty service members, both separately and combined. Data were collected from the 2018 Health‐Related Behaviours Survey. The response rate was 9.6%. Presenteeism was collected as the number of days (0–30) then collapsed for analysis. Latent class analysis (LCA) was used to classify service members into sleep disturbance profiles. Odds ratios and confidence intervals (CIs) were estimated by binary and ordinal logistic models. Approximately 21% of the 17,166 service members reported at least one presentee day (95% CI: 19.8%–21.8%). Persistent presenteeism was 13.6% (95% CI: 12.7–14.4%). Four sleep disturbance profiles were identified by LCA: (1) high sleep disturbance (reported in 22.5%), (2) short sleep duration (26%), (3) trouble sleeping (6.9%), and (4) none to slight sleep disturbance (reference, 44.6%). Female sex, being separated/divorced/widowed, short sleep duration, trouble sleeping, high sleep disturbance, unmet needs, and both unmet needs and inadequate sleep together were associated with higher odds of high presenteeism levels and persistent presenteeism. Bachelor's or higher educated, 25–34‐year‐old, Hispanic/Latinx, Officer, Air Force, and Coast Guard service members were associated with lower odds of high presenteeism levels and persistent presenteeism. Despite the decreasing trends between 2015 and 2018, the high prevalence of presenteeism presents a significant burden on work productivity and readiness that behavioural modification may alter.