Skip to main content


Log in

The Health Economics of Sleep Disorders Among Older Adults

  • Sleep and Aging (A Spira, Section Editor)
  • Published:
Current Sleep Medicine Reports Aims and scope Submit manuscript


Purpose of Review

Sleep disorders are associated with well-documented health consequences and substantial economic burden among older adults. This review aims to highlight the existing health economic evidence of sleep disorders among older adults.

Recent Findings

As highlighted throughout this review, sleep disorders are associated with substantial economic costs that are borne by patients, payers, and society. Direct and indirect costs, as well as diminished health-related quality of life, are reviewed for common sleep disorders. Further, potential health economic benefits from diagnosing and treating sleep disorders among older adults are considered.


This review highlights the economic aspects of sleep disorders among older adults, including the economic costs of treating sleep disorders and potential economic gain from treating sleep disorders. Future research should seek to include and incorporate economic endpoints into studies of sleep among older adults. Particular emphasis should be placed on older adults with comorbid medical and psychiatric disease (e.g., cardiovascular disease, depression, neurodegenerative disorders including Alzheimer’s disease), as well as the relative economic impact of various approaches to diagnosis and treatment, including telemedicine and remote monitoring of sleep among older adults.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Endeshaw YW, Bloom HL, Bliwise DL. Sleep-disordered breathing and cardiovascular disease in the Bay Area Sleep Cohort. Sleep. 2008;31(4):563–8.

    Article  Google Scholar 

  2. Ou Q, Chen B, Loffler KA, Luo Y, Zhang X, Chen R, et al. The effects of long-term CPAP on weight change in patients with comorbid OSA and cardiovascular disease: data from the SAVE trial. Chest. 2019;155(4):720–9.

    Article  Google Scholar 

  3. Scala O, Paolillo S, Formisano R, Pellegrino T, Rengo G, Gargiulo P, et al. Sleep-disordered breathing, impaired cardiac adrenergic innervation and prognosis in heart failure. Heart. 2016;102(22):1813–9.

    Article  Google Scholar 

  4. Nasr-Wyler A, Bouillanne O, Lalhou A, Goldenberg F, Bissery A, Piette F. Sleep apnea syndrome and stroke in the elderly population. Rev Neurol. 1999;155(12):1057–62.

    CAS  PubMed  Google Scholar 

  5. Wu YH, Feenstra MG, Zhou JN, Liu RY, Torano JS, Van Kan HJ, et al. Molecular changes underlying reduced pineal melatonin levels in Alzheimer disease: alterations in preclinical and clinical stages. J Clin Endocrinol Metab. 2003;88(12):5898–906.

    Article  CAS  Google Scholar 

  6. Alperin N, Wiltshire J, Lee SH, Ramos AR, Hernandez-Cardenache R, Rundek T, et al. Effect of sleep quality on amnestic mild cognitive impairment vulnerable brain regions in cognitively normal elderly individuals. Sleep. 2019;42(3).

  7. Wang S, Wu Y, Ungvari GS, Ng CH, Forester BP, Gatchel JR, et al. Sleep duration and its association with demographics, lifestyle factors, poor mental health and chronic diseases in older Chinese adults. Psychiatry Res. 2017;257:212–8.

    Article  Google Scholar 

  8. Baglioni C, Nanovska S, Regen W, Spiegelhalder K, Feige B, Nissen C, et al. Sleep and mental disorders: a meta-analysis of polysomnographic research. Psychol Bull. 2016;142(9):969–90.

    Article  Google Scholar 

  9. •• Lubetkin EI, Jia H. Burden of disease due to sleep duration and sleep problems in the elderly. Sleep Health. 2018;4(2):182–7. This is the only study focused on HRQoL loss in older adults. It reports that short sleep duration had a greater adverse impact on morbidity, with reductions in HRQoL, while long sleep duration had a greater adverse impact on mortality. Compared to participants who reported between 7 and 9 hours of sleep per night, mean QALYs were significantly lower among participants who slept 10 or more hours a night (7.8 QALY; decrease of 9.8 QALY). By distinguishing between long sleep (in excess of 10 hours) associated with increased mortality (i.e., reduction in Life Years), and short sleep (>7 hrs) associated with increased morbidity (i.e., reduction of HRQoL), they suggest different mechanisms for economic impact of short and long sleep duration.

    Article  Google Scholar 

  10. Onen SH, Onen F. Chronic medical conditions and sleep in the older adult. Sleep Med Clin. 2018;13(1):71–9.

    Article  Google Scholar 

  11. Hafner M, Stepanek M, Taylor J, Troxel WM, van Stolk C. Why sleep matters-the economic costs of insufficient sleep: a cross-country comparative analysis. Rand Health Q. 2017;6(4):11.

    PubMed  PubMed Central  Google Scholar 

  12. Hillman D, Mitchell S, Streatfeild J, Burns C, Bruck D, Pezzullo L. The economic cost of inadequate sleep. Sleep. 2018;41(8).

  13. Muennig P, Bounthavong M. Cost-effectiveness analysis in health: a practical approach. 3rd ed. San Francisco: Jossey-Bass (Wiley); 2016.

    Google Scholar 

  14. Neumann PJ, Sanders GD, Russell LB, Siegel JE, Ganiats TG. Cost-effectiveness in health and medicine. 2nd ed. New York: Oxford University Press; 2017.

    Google Scholar 

  15. Mohit B, Cohen JT. Trends of cost-effectiveness studies in sleep medicine. Sleep Med. 2019;53:176–80.

    Article  Google Scholar 

  16. Chhatre S, Chang YHA, Gooneratne NS, Kuna S, Strollo P, Jayadevappa R. Association between adherence to CPAP treatment and cost among Medicare enrollees. Sleep. 2019.

  17. Diaz K, Faverio P, Hospenthal A, Restrepo MI, Amuan ME, Pugh MJ. Obstructive sleep apnea is associated with higher healthcare utilization in elderly patients. Ann Thorac Med. 2014;9(2):92–8.

    Article  Google Scholar 

  18. Gamaldo AA, Beydoun MA, Beydoun HA, Liang H, Salas RE, Zonderman AB, et al. Sleep disturbances among older adults in the United States, 2002-2012: nationwide inpatient rates, predictors, and outcomes. Front Aging Neurosci. 2016;8:266.

    Article  Google Scholar 

  19. Tarasiuk A, Greenberg-Dotan S, Brin YS, Simon T, Tal A, Reuveni H. Determinants affecting health-care utilization in obstructive sleep apnea syndrome patients. Chest. 2005;128(3):1310–4.

    Article  Google Scholar 

  20. Tarasiuk A, Greenberg-Dotan S, Simon-Tuval T, Oksenberg A, Reuveni H. The effect of obstructive sleep apnea on morbidity and health care utilization of middle-aged and older adults. J Am Geriatr Soc. 2008;56(2):247–54.

    Article  Google Scholar 

  21. Tuohy CV, Montez-Rath ME, Turakhia M, Chang TI, Winkelman JW, Winkelmayer WC. Sleep disordered breathing and cardiovascular risk in older patients initiating dialysis in the United States: a retrospective observational study using Medicare data. BMC Nephrol. 2016;17:16.

    Article  Google Scholar 

  22. •• Wickwire EM, Tom SE, Scharf SM, Vadlamani A, Bulatao IG, Albrecht JS. Untreated insomnia increases all-cause health care utilization and costs among Medicare beneficiaries. Sleep. 2019;42(4). This is the most recent study that shows during the year prior to insomnia diagnosis and relative to matched non-sleep disordered controls, each Medicare beneficiary with insomnia had increased healthcare utilization and higher total annual costs across all points of service.

  23. Wickwire EM, Tom SE, Vadlamani A, et al. Older adult US Medicare beneficiaries with untreated obstructive sleep apnea are heavier users of health care than matched control patients. J Clin Sleep Med. 2020;16(1):81–89.

    Article  Google Scholar 

  24. Asche CV, Joish VN, Camacho F, Drake CL. The direct costs of untreated comorbid insomnia in a managed care population with major depressive disorder. Curr Med Res Opin. 2010;26(8):1843–53.

    Article  Google Scholar 

  25. Kaufmann CN, Canham SL, Mojtabai R, Gum AM, Dautovich ND, Kohn R, et al. Insomnia and health services utilization in middle-aged and older adults: results from the health and retirement study. J Gerontol A Biol Sci Med Sci. 2013;68(12):1512–7.

    Article  Google Scholar 

  26. Ozminkowski RJ, Wang S, Walsh JK. The direct and indirect costs of untreated insomnia in adults in the United States. Sleep. 2007;30(3):263–73.

    Article  Google Scholar 

  27. Wickwire EM, Vadlamani A, Tom SE, Johnson AM, Scharf SM, Albrecht JS. Economic aspects of insomnia medication treatment among Medicare beneficiaries. Sleep. 2019.

  28. Avidan AY. Insomnia in the geriatric patient. Clin Cornerstone. 2003;5(3):51–60.

    Article  Google Scholar 

  29. Allen RP, Bharmal M, Calloway M. Prevalence and disease burden of primary restless legs syndrome: results of a general population survey in the United States. Mov Disord. 2011;26(1):114–20.

    Article  Google Scholar 

  30. Dodel R, Happe S, Peglau I, Mayer G, Wasem J, Reese JP, et al. Health economic burden of patients with restless legs syndrome in a German ambulatory setting. Pharmacoeconomics. 2010;28(5):381–93.

    Article  Google Scholar 

  31. Kushida C, Martin M, Nikam P, Blaisdell B, Wallenstein G, Ferini-Strambi L, et al. Burden of restless legs syndrome on health-related quality of life. Qual Life Res. 2007;16(4):617–24.

    Article  Google Scholar 

  32. Javaheri S, Caref EB, Chen E, Tong KB, Abraham WT. Sleep apnea testing and outcomes in a large cohort of Medicare beneficiaries with newly diagnosed heart failure. Am J Respir Crit Care Med. 2011;183(4):539–46.

    Article  Google Scholar 

  33. McMillan A, Bratton DJ, Faria R, Laskawiec-Szkonter M, Griffin S, Davies RJ, et al. Continuous positive airway pressure in older people with obstructive sleep apnoea syndrome (PREDICT): a 12-month, multicentre, randomised trial. Lancet Respir Med. 2014;2(10):804–12.

    Article  Google Scholar 

  34. Tripathi A, Jerrell JM, Stallworth JR. Cost-effectiveness of adenotonsillectomy in reducing obstructive sleep apnea, cerebrovascular ischemia, vaso-occlusive pain, and ACS episodes in pediatric sickle cell disease. Ann Hematol. 2011;90(2):145–50.

    Article  Google Scholar 

  35. Tannenbaum C, Diaby V, Singh D, Perreault S, Luc M, Vasiliadis HM. Sedative-hypnotic medicines and falls in community-dwelling older adults: a cost-effectiveness (decision-tree) analysis from a US Medicare perspective. Drugs Aging. 2015;32(4):305–14.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations



EMW has served as a scientific consultant for Dayzz, Eisai, Merck, and Purdue and is an equity shareholder in WellTap.

Corresponding author

Correspondence to Emerson M. Wickwire.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest. Dr. Wickwire reports grants from AASM Foundation, grants from Department of Defense, grants from Merck, grants from ResMed, personal fees from Dayzz, personal fees from Eisai, personal fees from Merck, personal fees from Purdue, and his role as an equity shareholder at WellTap, outside the submitted work. EMW’s institution has received research funding from the AASM Foundation, Department of Defense, Merck, and ResMed.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Sleep and Aging

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mohit, B., Wickwire, E.M. The Health Economics of Sleep Disorders Among Older Adults. Curr Sleep Medicine Rep 6, 21–31 (2020).

Download citation

  • Published:

  • Issue Date:

  • DOI: