Traditionally insomnia has been diagnosed on the basis of quantity of sleep:
While it is important not to ignore quantity of sleep, epidemiological surveys show that poor quality of sleep has a greater negative impact on health, well-being and satisfaction with life than the quantity of sleep a person gets.3,4 Individual need for sleep differs but it is quality of sleep which results in alertness, improved functioning the following day and better quality of life.
Insomnia is not just a problem of the night, leaving the sufferer tired in the morning. A number of surveys have shown that leaving insomnia untreated ay affect the sufferer long term, with severe impact on general health, well-being and quality of life.5-9
Insomnia that affects normal functioning can be detrimental to daily life, with poor alertness and efficiency raising the risk of vehicle or occupational accidents.7 As an example, nearly 50% of lorry drivers admit to falling asleep at the wheel.10, 11
In the untreated patient, insomnia can also affect work performance. There can be a change in character and a drop of quality in work, which may be misinterpreted as laziness or lack of motivation. Increased absenteeism from work results in reduced productivity and is also uneconomical for the employer. Eventually, if the disorder remains untreated, this may even lead to reduced job prospects and loss of employment.12
Furthermore, directly or indirectly, disrupted sleep can also have a negative effect on family life and relationships by affecting a person's mood and the way in which they are able to perform daily activities and interact socially.12 Insomnia may create irritability or a change in mood that damages relations between couples. Family and friends may refuse to accept sleep-related disorders as illnesses and attribute sleepiness to boredom, laziness or psychological problems.13 This can leave patients feeling misunderstood and unsupported by those closest to them.
Studies have shown that people with insomnia suffer from more symptoms of anxiety and depression than people without insomnia.3
Clinical studies show us that poor quality of sleep negatively corresponds with measures of health, wellbeing and satisfaction.1
Insomnia affects a large percentage of the population, particularly the elderly. Literature reports varying estimates of prevalence, a variation that relates to the lack of definition and consistency in diagnostic criteria. Nevertheless, the large number of individuals affected, along with its chronic nature, cause insomnia to convey a substantial economic burden.14, 15
Insomnia has been shown to be associated with increased healthcare utilisation compared with patients who did not suffer from insomnia and this consumption increases with the severity of the disease.16 Insomnia patients experience significantly more limited activity and higher total health services than those without insomnia. A recent US study estimated the annual costs to be between $92.5billion and $107.5 billion.17
The direct costs of insomnia have been shown to be split between prescription drugs, over-the counter remedies, GP consultations, tests and investigations, inpatient and outpatient hospital visits and referrals to hospital specialists. With regards to the indirect costs, they mainly include the cost of lost earnings due to absenteeism and to decreased productivity.
References:
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2. Diagnosis and statistical manual of mental disorder for primary insomnia, fourth edition, American Psychiatric Association, 2000:597-661
3. Zammit GK, Weiner J, Damato N et al. Quality of life in people with insomnia. Sleep 1999; 22 Suppl 2: S379-85
4. Pilcher JJ. Sleep quality versus sleep quantity: relationships between sleep and measures of health, well-being and sleepiness in college students. J Psychosom Res. 1997; 42(6): 583-96
5. Léger D, Poursain B, Neubauer D et al. An international survey of sleeping problems in the general population. Curr Med Res Opin 2008; 24(1): 307-317
6. Taylor DJ, Lichstein KL, Durrence HH. Insomnia as a health risk factor. Behav Sleep Med 2003; 1: 227-247
7. Ohayon MM, Zulley J. Correlates of global sleep dissatisfaction in the German population. Sleep 2001; 24: 780-787
8. Okuji Y, Matsuura M, Kawasaki N et al. Prevalence of insomnia in various psychiatric diagnostic categories. Psychiatry Clin Neurosci 2002; 56: 239-240
9. Katz DA, McHorney CA. Clinical correlates of insomnia in patients with chronic illness. Arch Intern Med 1998; 158: 1099-107
10. McCartt AT, Rohrbaugh JW, Hammer MC et al. Factors associated with falling asleep at the wheel among long-distance truck drivers. Accid Anal Prev 2000; 32: 493-504
11. McNicholas WT on behalf of the European Respiratory Society Task Force. Sleep apnoea and driving risk. Europ Respir J 1999; 13(6): 1225-1227
12. Metaline A et al. Socioeconomic Impact of Insomnia in Working Populations. Indust Health 2005; 43(1): 11-19
13. Beusterien KM, Rogers AE, Walslenben J et al. Health related quality of life effects of modafinil for treatment of narcolepsy. Sleep 1999; 22(6): 757-765
14. Leger D, Guilleminault C, Bader G et al. Medical and socio-professional impact of insomnia. Sleep 2002; 25(6): 625-629.
15. Roth T, Franklin M, Bramley TJ. The state of insomnia and emerging trends. Am J Manag Care 2007; 13(Suppl 5): S117-S120
16. Hatoum HT, Kong SX, Kania CM et al. Insomnia, health-related quality of life and healthcare resource consumption. A study of managed-care organisation enrollees. Pharmacoeconomics 1998; 14(6): 629-637.
17. Reeder CE, Franklin M, Bramley TJ. Current landscape of insomnia in managed care. Am J Manag Care 2007;13(Suppl 5):S112-6