Applied Research in Quality of Life

, Volume 6, Issue 4, pp 335–347

Association Between Insomnia and Quality of Life: An Exploratory Study Among Software Engineers

Authors

    • Department of Studies in Food Science and NutritionUniversity of Mysore
  • Khyrunnisa Begum
    • Department of Studies in Food Science and NutritionUniversity of Mysore
Article

DOI: 10.1007/s11482-010-9131-5

Cite this article as:
Zadeh, S.S. & Begum, K. Applied Research Quality Life (2011) 6: 335. doi:10.1007/s11482-010-9131-5

Abstract

Insomnia is a major public health challenge. Due to its high prevalence and impact on health in recent years it has attracted attention of health care providers. The concept of quality of life (QOL) has gained importance as an outcome measure in sleep disturbed people. This study aims to determine the prevalence of insomnia among software engineers as the job related stress is considered very high. Ninety-one software engineers aged between 21 and 45 from a software developing company in Mysore formed the study population. Insomnia Screening Questionnaire and SF 36 Health Survey Questionnaire were used to elicit information about sleep quality and quality of life respectively. Sleep status among the subjects was as follows: 20.9% severe insomnia, 35.2% mild insomnia and 43.9% normal sleeper. Mean scores for SF 36 and those for physical and mental health were considerably lower among severe insomniacs. Software engineers run at the risk of developing insomnia, those with severe insomnia had poor QOL in comparison with the others. Quality of sleep among software engineers needs special attention since they are prone to develop sleep disturbances.

Keywords

Quality of lifeSleep qualityInsomniaSleep status

Introduction

Insomnia is a treatable disorder of insufficient or poor quality sleep, with adverse daytime consequences (Thorpy and Rochester 1990). It is characterized as trouble in falling asleep (long-sleep latency), staying asleep (excessive or prolonged awakenings), or feeling of non-restored sleep. Persistent and untreated insomnia is a strong risk factor leading to major depression (Nowell and Buysse 2001). More than 50 epidemiological studies have shown that one third of various populations in general have insomnia symptoms and that 9 to 21% have insomnia with serious daytime effects such as fatigue, diminished energy, difficulty in concentrating, memory impairment, low motivation, loss of productivity, irritability, interpersonal difficulties (with family, friends, coworkers), increased worrying, anxiety, and depression (Ohayon 2002; Spiegel et al. 1999). Reports have documented incidents of dangerous events such as occupational and vehicular accidents secondary to poor quality sleep, marital and social problems, poor health, metabolic and endocrine imbalance with impaired ability to control weight (Brown 1994; Corfitsen 1996). Chronic sleep loss, which occurs in untreated insomnia is a likely etiology for coronary heart disease, major depressive problems and suicidal tendency (Ayas et al. 2003; Spiegel et al. 1999). Although the scope of the existing problem is large, most insomniacs do not seek medical treatment. Poor sleep is therefore associated with perceived lowering of QOL, increase in physical complaints, and economic repercussions including decreased work productivity and loss of jobs. The magnitude of the problem indicates that routine clinical assessment and treatment for insomnia complaints have important health bearing on patients (Sateia et al. 2000). The primary issue of the present scenario is the lack of awareness among population about sleep. Physicians are also less oriented in recognizing sleep specific symptoms related to insomnia (Moline and Zendell 1993; Orr et al. 1980). Hence, a high incidence of insomnia complaints in conjunction with a minimal recognition of the problem by healthcare professionals has led to an underestimation of the tangible consequences of chronic insomnia.

Software engineers are known to encounter psychosomatic disorders due to job related stress. According to the report based on 33 surveys on different jobs software engineers ranked first for the job stress level (eknowledger.spaces.live.com; Ganster and Schaubroeck 1991). A staggering 97% of people working in software companies claim that their life at work is stressful on daily basis (Chen et al. 2006). One would expect that these professionals are at risk of succumbing to sleep related health problems. Therefore, the present investigation was executed to study the sleep status and quality of life (QOL) among selected software engineers from Mysore city, India. The objectives of this study are to:
  1. 1.

    Compare the prevalence of insomnia among software engineers to the population at large.

     
  2. 2.

    Assess gender differences in insomnia among software engineers.

     
  3. 3.

    Assess differences in the sleep environment among those who have and do not have insomnia.

     
  4. 4.

    Assess differences in nocturnal behavior among those who have and do not have insomnia.

     
  5. 5.

    Assess differences in QOL among those who have and do not have insomnia.

     

Conceptual Development

It is being realized that insomnia is on its incline giving rise to public health problems. Knowledge about its prevalence is localized to certain developed countries. The seriousness of the problem depends on its prevalence and the consequence of long standing insomnia. Insomnia leads to the development of restlessness in general population, particularly in the fields that involve competition. Employment stress, urban life style and sleep hygiene are the proposed etiologies in order of importance. Software developing and IT companies are propelled by enormous competition causing greater stress among the employees and employers as well (Ben-Bakr et al. 1995). Sleep is also understood to bear an effect from nutrient deficiencies or excess, the data used in this paper is part of a nutrition intervention study conducted on 600 people employed in various institutions, software engineers also were the participants. According to the observations our first hypothesis therefore is based on the argument that software engineers are susceptible to insomnia.
  1. H1:

    Software engineers report higher levels of insomnia than the population at large.

     
Women are the weaker gender in various functional aspects. Studies have reported that women have relatively higher stress compared to (Lentz 1999). Literature from India indicates that women in general and Indian women in particular suffer from chronic fatigue (Patel 2005). It could be possible that women are prone to develop insomnia more than men, hence our second hypothesis is:
  1. H2:

    Female software engineers report higher levels of insomnia than male software engineers.

     
Sound sleep is promoted when the environment is congenial (i.e., a comfortable dark and quiet environment with a feeling of safety). However, people with insomnia respond poorly to such a sleep environment. Evidently, a poor sleep environment tends to disturb sleep. Hence our third hypothesis is that:
  1. H3:

    Software engineers who have insomnia are likely to report higher levels of improper sleep environment than those who do not have insomnia.

     
Nocturnal behaviors are symptomatic of people who have insomnia. The literature adds sufficiently to the notion that people who experience disturbed sleep often perform activities during midnight such as drinking water, and checking clock. Probably the effect of day time stress, fatigue and poor quality sleep together cause higher level of somatization. Therefore, it is logical to expect the nocturnal behaviors and somatization in people with insomnia. Our fourth hypothesis is:
  1. H4:

    Software engineers who have insomnia are likely to report higher levels of somatization, drinking water at night, checking the clock, and drinking coffee before bed than those who do not have insomnia.

     
The consequences of insomnia are explicitly associated with individual’s health (Leger et al. 2001). The relationship of insomnia and health-related quality of life (HRQOL) is multifaceted and extensive. Past research shows a strong correlation between insomnia and decreased QOL (Hatoum et al. 1998). It is also evident that insomnia frequently co-morbid with both physical and psychiatric disorders, especially depression (Hohagen et al. 1993). Therefore our fifth hypothesis is:
  1. H5:

    Software engineers who have insomnia are likely to report lower levels of physical and mental health (i.e., QOL) than those who do not have insomnia.

     

Method

Sample Population

One of the leading software companies located in Mysore City, South India was approached for the study. All the software engineers (91 in total) comprising men and women (non-pregnant and non-lactating) volunteered to participate in the study. The participants were health adults aged 21 to 45 years and free from medical and psychiatric problems (none were on any medication on a regular basis). The selected subjects were informed about the objectives of investigation and instructions regarding protocols of the study. In order to compare the occurrence of insomnia in general population, 200 age- and gender-matched subjects employed in other institutions were included and their sleep status assessed.

Demographics

Information pertaining to age, sex, professional activity, marital status, and other relevant details were obtained through pre-tested questionnaire.

Measures

The Insomnia Screening Index of Clinical Practice Guideline by Alberta Medical Association was used (Morin et al. 2006). This questionnaire assesses the perception of insomnia among people and was reported suitable for reassessment in intervention studies (Sateia et al. 2000)

This questionnaire also assesses sleep hygiene. Presence of insomnia was assessed based on four questions enquiring whether, in the past 4 weeks, subjects experienced: (a) difficulty in initiating sleep; (b) nocturnal awakenings with difficulty in returning to sleep; (c) early awakening due to involuntary and too short sleep period (6 h or less); and (d) non-restorative sleep with a feeling of tiredness on awakening and negative consequences in terms of daytime alertness, fatigue and irritability as a result of sleep problem. Questions regarding sleep hygiene included sleep–wake schedule, total sleep time, sleep environment (in terms of feeling of safety at night and disturbances due to noise and light), nocturnal behaviors, daytime consequences of sleep problems, current and past consumption of pre-bedtime stimulants such as alcohol, coffee and medication to induce sleep.

QOL was assessed using the SF-36 Health Survey Questionnaire. The SF-36 is a 36-item, short-form version of a questionnaire recommended by WHO and is scored in eight subscales: physical functioning, role-physical, bodily pain, general health perceptions, energy/vitality, social functioning, role-emotional, and mental health. It is probably the most popular generic instrument to measure the mental health and general health components of QOL (Chartier-Kastler and Davidson 2007).

Classification of Insomnia

Characteristics of insomnia and its severity as described by Hohagen et al. (1994) were adopted for the present study. According to him presence of at least one symptom of sleep problem that recurs twice a week for a period of 4 weeks was considered as a stable diagnosis of “insomnia.” Repeated occurrence of symptoms per week over a month along with persistent day time consequences was classified as “severe insomnia.” Based on the presence or absence of insomnia and its severity, participants were divided into three groups: normal sleepers, mild, and severe insomniacs.

Results

The general profile of the selected subjects is presented in Table 1; both male (49.5%) and female (50.5%) subjects participated in the study. A higher percentage of participants were younger being 21 to 32 years of age. Twenty seven percent of male and 15.2% of female participants were married. The mean duration of sleep was 7.1 and 6.5 for normal sleepers and insomniacs respectively; however the range in hours of total sleep was 4.0–10.3 and 3.0–10.0 indicating less difference between the two groups.
Table 1

General profile of the selected subjects

 

Male

Female

Total

Number of subjects

%

Number of subjects

%

Number of subjects

%

Age range (years)

 21–26

29

64.4

32

69.7

61

67.0

 27–32

9

20.0

13

28.3

22

24.2

 33–38

3

6.6

0

0

3

3.3

 39–45

4

8.8

1

2.2

5

5.5

 Total

45

49.5

46

50.5

91

100

Marital status

 Unmarried

33

73

39

84.8

72

79.1

 Married

12

27

7

15.2

19

20.9

 Total

45

46

91

100

Sleep duration

 

Normal sleepers

Insomniacs

Total

Actual duration of sleep

7.1 ± 0.97

6.5 ± 1.33

7.0 ± 1.0

Total hour of sleep

Min

4.0

3.0

4.0

Max

10.3

10.0

10.3

Occurrence of Insomnia (Hypothesis 1)

Hypothesis 1 states that software engineers report higher levels of insomnia than the population at large. Sleep status of the participants is presented in Table 2; it is evident that 43.9% of the participants had normal sleep. Thirty five and 21% of the subjects appeared to have mild and severe insomnia respectively.
Table 2

Gender difference in insomnia and comparing degree of insomnia with general population

Sleep status

Software engineers

General population

Male

Female

Total subjects

No. of subjects

%

No. of subjects

%

No. of subjects

%

No. of subjects

%

Normal sleepers

21

52.50

19

47.5

40

43.9

188

62.7

Mild insomniacs

10

31.25

22

68.8

32

35.2

65

21.7

Severe insomniacs

14

73.7

5

26.3

19

20.9

47

15.6

Total

45

46

91

100

300

100

Chi-square (observed value)

8.853

7.288

Chi-square (critical value)

5.991

5.991

P-Value

0.012 [p < 0.05 df 2]*

0.026 [p < 0.05 df 2]*

It is obvious from our findings that software engineers are at a greater risk of developing insomnia because 35.2 and 20.9% of the software engineers had mild and sever insomnia compared to 21.7 and 15.6% respectively in the general population. Markedly higher percent differences (p < 0.05) in prevalence of insomnia between software engineers and general population signify the seriousness of the health consequences attached to this profession.

Gender Difference in Insomnia (Hypothesis 2)

Hypothesis 2 states that female software engineers report higher levels of insomnia than male software engineers. A gender effect was evident in the pattern of insomnia (see Table 2). Significantly higher (χ2 = p < .05) percent of females exhibited mild insomnia while males suffered severe insomnia. Although general population also is inflicted with insomnia, the prevalence differed from that seen in software engineers. Significantly higher percentage of general population was normal sleepers and lower percentages experienced mild and sever insomnia.

Sleep Environment (Hypothesis 3)

Hypothesis 3 states that software engineers who have insomnia are likely to report higher levels of improper sleep environment than those who do not have insomnia. An environment congenial to promote sound sleep is the primary requirement for restorative sleep. Disturbances caused due to sound, light and feeling of being unsafe are part of the etiology for insomnia (Cheek et al. 2004).

The sleep environment encountered by the selected subjects is presented in Table 3. It is interesting to note that 25% of the selected subjects who were categorized as normal sleepers revealed to have improper (disturbances) sleep environment. On the other hand those who exhibited symptoms of insomnia, a majority (56 and 78% mild and severe insomnia) suffered from sleep problem despite having proper sleep environment. However, Chi-square analysis suggests that sleep was independent of the sleep environment to a significant extent (see Table 3).
Table 3

Differences in sleep environment

Sleep status

Sleep environment

Improper

Proper

No. of subjects

%

No. of subjects

%

Normal sleepers

10

25.0

30

75.0

Mild insomniacs

14

43.0

18

56.0

Severe insomniacs

4

21.0

15

78.9

Total

28

63

Chi-square (observed value)

3.998

Chi-square (critical value)

5.991

p-value

0.135 p<: 0.05 *df: 2

Nocturnal Behavior (Hypothesis 4)

Hypothesis 4 states that software engineers who have insomnia are likely to report higher levels of somatization, drinking water at night, checking the clock, and drinking coffee before bed than those who do not have insomnia. Certain behaviors are often associated with sleep problems, such as drinking coffee before bed is a common food behavior among people.

According to the present study drinking coffee was found in relatively higher percent of insomniacs against that of normal sleepers (see Table 4). Checking clock at midnight was the most prevalent behavior among those who got up in the middle of the night. It is also apparent that drinking water was also a common behavior though it was observed among the normal subjects to similar extent. Somatization is reported as a common behavioral problem in general, it is described as a process by which psychological distress (anxiety and nervousness) is overtly expressed as a physical symptom. Somatization was seen markedly higher (18.8 and 21.1%) among subjects with mild and severe insomnia in the study group. Although nocturnal behaviors are seen more frequently among insomniacs the Chi-square analysis indicated the associations to be insignificant statistically.
Table 4

Differences in nocturnal behavior

Sleep status

Somatization

Drinking water at night

Checking the clock

Drinking Coffee before bed

No. of subjects

(%)

No. of subjects

(%)

No. of subjects

(%)

No. of subjects

(%)

Normal sleepers

3

7.5

7

17.5

22

55

2

12.5

Mild insomniacs

6

18.8

8

25.0

21

65.6

5

15.6

Severe insomniacs

4

21.1

3

15.8

15

78.9

3

15.8

Total

13

18

58

 

10

Chi-square (observed value)

2.736

0.633

3.272

2.618

Chi-square (critical value)

5.991

5.991

5.991

5.991

p-value

p<: 0.05 *df: 2

0.255

0.729

0.195

0.270

Quality of Life (Hypothesis 5)

Hypothesis 5 states that software engineers who have insomnia are likely to report lower levels of physical and mental health (i.e., QOL) than those who do not have insomnia. It is recognized that insufficient sleep causes distress among people and directly influences QOL, this in turn potentially alters life style of people in general and especially those susceptible to poor sleep. Therefore, it was imperative to assess the QOL of the participants having different sleep quality. The mean scores of total SF36, physical health and mental health of subjects having different sleep quality (Normal, Mild and Severe) are shown in Table 5.
Table 5

Differences in QOL among male and female software engineers

Sleep status

Average

Total-SF 36

Average physical health

Average mental health

Mean ± SD

Mean ± SD

Mean ± SD

Normal sleepers

74.82 ± 15.38

76.02 ± 14.81

71.1 ± 17.93

Mild insomniacs

69.8 ± 10.31

70.9 ± 11.44

66.37 ± 10.43

Severe insomniacs

63.42 ± 12.45

65.1 ± 13.0

61.05 ± 14.56

F value

4.917929

4.465451

3.330396

P value

p<: 0.05

0.009448

0.01422

0.040341

It can be seen that mean scores for SF-36, mental and also physical health were low for subjects suffering from severe insomnia. It is therefore apparent that severe insomnia affects QOL much more than what could occur due to milder forms of insomnia.

SF-36 includes eight different components defining the QOL; the mean scores of subjects with varying sleep problems are shown in Fig. 1, although all the components were affected because of severe insomnia, the most affected components were role emotional and role physical. Nevertheless, Chi-square (p<: 0.05) analysis performed (Physical Function = 0.584, Role Physical = 0.309; Body pain = 0.209; General health = 0.669; Social function = 0.243; Role emotional = 0.524; Mental health = 0.259; Vitality = 0.123) did not exhibit significant association between QOL components and sleep (see Table 6). However it is important to realize that the situation of the participants with sleep problem is the initial stages, probably in later stages of severity could restrict one’s thinking ability as well as the voluntary responses of individuals limiting their capabilities. Scores for general health and social functioning were low in mild insomnia indicating that sleep disturbances of any type and severity may possibly affect the competence of the individuals. Gender differences were not marked, thereby poor sleep effects are general and not gender specific.
https://static-content.springer.com/image/art%3A10.1007%2Fs11482-010-9131-5/MediaObjects/11482_2010_9131_Fig1_HTML.gif
Fig. 1

Quality of life among subjects with different sleep quality

Table 6

Quality of life among subjects with different sleep quality

Sleep quality

Physical function

Role physic

Body pain

General health

Social function

Role emotional

Mental health

Vitality

Chi-square (observed value)

18.047

11.656

29.297

43.211

19.505

15.008

34.548

29.831

Chi-square (critical value)

31.410

18.307

36.415

65.171

26.296

26.296

43.773

33.924

p-value

 p<: 0.05

0.584

0.309

0.209

0.669

0.243

0.524

0.259

0.123

Discussion

This study sought to determine the prevalence of insomnia among software engineers, using a standardized insomnia survey assessment. The results show that 56% of the selected software engineers exhibited at least one symptom of insomnia. The striking observation contrasting the available literature is that younger participants were affected with insomnia more than their older counterparts (Barry et al. 2008; Hohagen et al. 1994; Karacan et al. 1976). The reason could obviously be attributed to the enthusiasm to achieve and anxiety to excel in their job performances. In general, people make use of the night time to accomplish jobs at the cost of their sleep, expecting to cope with the stress of sleeplessness on subsequent nights. According to a report by online learning provider Skill Soft, of all the occupations, IT profession and software developers suffer highest levels of stress. A study about job stress reports a staggering 97% of software developers to claim workplace stress affect them on a daily basis (http://www.stress.org/job.htm).

The software engineers are usually considered as one of the worst in terms of work load, and it may have consequences on sleep. The commonly observed sleep duration among the participants both males and females was 7–8 h (Bixler et al. 1979; Ferley et al. 1988; Hohagen et al. 1994; Karacan et al. 1976; Lugaresi et al. 1987; Weyerer and Dilling 1991). The overall prevalence of insomnia among the selected group, both men and women, was more than 50% indicating the possibility of insomnia to be an important problem and a liability for health consequences. These findings support the first hypothesis that software engineers are at a greater risk of developing insomnia.

It is rather interesting that milder forms of insomnia were common among females while severe form of insomnia was common among male participants, the reasons for such differences are not known. In other studies, women are reported to suffer from insomnia more than men independent of their age. The difference between men and women in the present study is more obvious when “severe insomnia” is considered. This information supports our second hypothesis.

In assessing the factors that can lead to insomnia, sleep environment should not be underestimated. In general, it is easiest to sleep in a quiet place because people respond to external stimuli while asleep and insomniacs are particularly more sensitive. Disturbing stimuli such light, improper room temperature and noise, are known to disturb sleep. Co-morbid factors as anxiety and feeling of lack of safety can also cause trouble falling asleep among insomniac. Such disturbances seem to affect insomniacs more than normal sleepers; hence this observation supports our third hypothesis.

Specific behaviors related to insomnia include drinking tea or coffee before bedtime and other nocturnal habits (e.g., drinking water and checking the clock at midnight). Consciousness about not getting sufficient sleep can lead to Somatization in insomniacs. One of the observations in relation to the work environment (noted by the investigator) was that software engineers rarely consumed water during the day. This could probably be attributed to cold temperature maintained in computer laboratories. Although these behaviors were noted among normal sleeper, their occurrence seems higher among insomnias. These observations support our fourth hypothesis.

Insomnia compounds its initial impact with long-term health consequences, running a health risk, exposing people to a number of disorders such as anxiety, depression, and substance abuse (Taylor et al. 2003). It is worthwhile to mention that the participants of the study were questioned about their visit to medical doctors seeking assistance for sleep problem. Unfortunately, the participants who suffered from insomnia never obtained medical assistance. Studies have indicated that only 1 insomniac in 4 consciously complained about it to their general practitioner during a visit made for another problem, and 1 in 20 attended specifically to discuss the problem of insomnia (Ancoli-Israel and Roth 1999). Further, a small fraction of the reporting patients received the correct treatment (Ancoli-Israel and Roth 1999; Mellinger et al. 1985). It is a general consensus that sleep affects job performance; it would be probable that long standing sleeplessness may also be an etiology for poor QOL. It was demonstrated from the present investigation that mental health is sensitive to sleep quality. Reduction in the scores for total QOL, physical and mental health among those who were mildly and severely insomniac indicates that sleep is undoubtedly an important factor for overall health. Especially marked reduction in mental scores suggests that mental performance, which is crucial for QOL, is influenced by good sleep. Lawton suggested that QOL has many dimensions, including psychological well being, quality of living environment, behavioral competence, social activity, and others (Lawton 1991). A report by Zammit et al. (1999) demonstrated that insomnia is associated with QOL deficits in many different life domains (Zammit et al. 1999). These observations support our fifth hypothesis that, sleep quality has a bearing on QOL and tends to deteriorate various components of functionality, especially physical and mental health.

Managerial and Policy Implications

In view of the serious health consequences due to insomnia in software engineers who are at high risk, suitable awareness programs should be developed as a preventive measure. Public awareness regarding the importance of sleep and proper sleep hygiene should be created through mass communication. Sleep assessment should be included as part of the medical checkup so that management of the problem is easier during the primary stages. Lifestyle management programs including sleep hygiene and care should be incorporated as a policy matter in the IT industry. Doing so should significantly enhance the QOL of IT employees.

Study Limitations and Future Research

This study inherits the following limitations: The sample size of the study is small. Future research should replicate this study with large samples. Furthermore, it is possible that misconceptions about the consequences of sleep among people in general restricted their participation in the present study. Future research should address possible misconceptions and attempt to recruit a large sample of participants truly representative of the IT/software engineering population.

Conclusions

Based on the findings it can be concluded that awareness about sleep and its effect should be promoted in the general population, especially those in high stress jobs such as software engineers and IT professionals. This might help to understand the etiology of insomnia in different populations and its effects. Also the potential harm to the population at risk can be decreased significantly.

Copyright information

© Springer Science+Business Media B.V./The International Society for Quality-of-Life Studies (ISQOLS) 2010