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The Socioeconomic Impact of Insomnia

An Overview

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Summary

Insomnia is an extremely common symptom both de novo and in the context of other medical and psychiatric disorders. The impact of insomnia is often ignored both by the individual and by society in terms of its clinical and socioeconomic ramifications. Insomnia is therefore under-appreciated and almost certainly under-treated, thus making it a serious health concern. It is estimated that more than 60 million Americans suffer from insomnia annually, and this figure is expected to grow to 100 million by the middle of the 21st century. Whether it be difficulty initiating or maintaining sleep, the disruption of nocturnal sleep will invariably impact on daytime activities and often results in daytime fatigue, performance deficits (including memory and other cognitive deficits), an increase in the number of sick days taken by an individual and accidents (some catastrophic). This review examines the costs directly related to insomnia in various sectors of healthcare, the indirect costs associated with accidents, sick days and decreased work productivity, and related costs resulting from insomnia but which meet neither the criteria of direct nor indirect cost categories.

The total direct, indirect and related costs of insomnia are conservatively estimated at $US30 to 35 billion annually in the US (1994 dollars). Economic gains can be made by treating patients on an outpatient basis in sleep centres.

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References

  1. Wake up America: A national sleep alert. Vol. 2. Working group reports. Report of the national commission on sleep disorders research. Washington DC: National Institutes of Health, US Government Printing Office, 1994

  2. Mellinger GD, Balter MB, Uhlenhuth EH, et al. Insomnia and its treatment. Prevalence and correlates. Arch Gen Psychiatry 1985; 42: 225–32

    Article  PubMed  CAS  Google Scholar 

  3. Karacan I, Thornby JI, Anch M, et al. Prevalence of sleep disturbance in a primarily urban Florida county. Soc Sci Med 1976; 10: 239–44

    Article  PubMed  CAS  Google Scholar 

  4. Gislason T, Almqvist M. Somatic diseases and sleep complaints. An epidemiological study of 3,201 Swedish men. Acta Med Scand 1987; 221: 475–81

    Article  PubMed  CAS  Google Scholar 

  5. Bixler EO, Kales A, Soldatos CR, et al. Prevalence of sleep disorders in the Los Angeles metropolitan area. Am J Psychiatry 1979; 136(10): 1257–62

    PubMed  CAS  Google Scholar 

  6. Wake up America: A national sleep alert. Vol. 1. Executive summary and executive report. Report of the national commission on sleep disorders research. Washington DC: National Institutes of Health, US Government Printing Office, 1993

  7. White L, Hahn PM, Mitler MM. Sleep questionnaire in adolescents. Sleep Res 1980; 9: 108

    Google Scholar 

  8. Kales A, Vgontzas AN. Predisposition to and development and persistence of chronic insomnia: importance of psychobehavioral factors. Arch Intern Med 1992; 152: 1570–2

    Article  PubMed  CAS  Google Scholar 

  9. Ford, DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders: an opportunity for prevention? JAMA 1989; 262: 1479–84

    Article  PubMed  CAS  Google Scholar 

  10. Vogel GW, Morris D. The effects of Estazolam on sleep, performance, and memory: a long-term sleep laboratory study of early insomniacs. J Clin Pharmacol 1992; 32: 647–51

    PubMed  CAS  Google Scholar 

  11. Seyone C, Shapiro CM. Long-term therapy of insomnia. Baillière’s Clin Psychiatry 1995; 1(4): 605–37

    Google Scholar 

  12. Shapiro CM, Dement WC. Impact and epidemiology of sleep disorders. BMJ 1993; 306: 1604–7

    Article  PubMed  CAS  Google Scholar 

  13. Kales A, Caldwell AB, Preston TA, et al. Personality patterns in insomnia. Theoretical implications. Arch Gen Psychiatry 1976; 33: 1128–34

    Article  PubMed  CAS  Google Scholar 

  14. Wingard DL, Berkman LF. Mortality risk associated with sleeping patterns among adults. Sleep 1983; 6(2): 102–7

    PubMed  CAS  Google Scholar 

  15. Schweitzer PK, Engelhardt NA, Hilliker MJ, et al. Consequences of reported poor sleep. Sleep Res 1992; 21: 260

    Google Scholar 

  16. Vollrath M, Wicki W, Angst J. The Zurich study. VIII. Insomnia: association with depression, anxiety, somatic syndromes, and course of insomnia. Eur Arch Psychiatry Neurol Sci 1989; 239: 113–24

    Article  PubMed  CAS  Google Scholar 

  17. Lavie P. Sleep habits and sleep disturbances in industrial workers in Israel: main findings and some characteristics of workers complaining of excessive daytime sleepiness. Sleep 1981; 4(2): 147–58

    PubMed  CAS  Google Scholar 

  18. Kales JD, Kales A, Bixler EO, et al. Biopsychobehavioral correlates of insomnia, V: Clinical characteristics and behavioral correlates. Am J Psychiatry 1984; 141(11): 1371–6

    PubMed  CAS  Google Scholar 

  19. Tan TL, Kales JD, Kales A, et al. Biopsychobehavioral correlates of insomnia, IV: diagnosis based on DSM-III. Am J Psychiatry 1984; 141: 357–62

    PubMed  CAS  Google Scholar 

  20. Mason P, Wilkinson G. The prevalence of psychiatric morbidity. Br J Psychiatry 1996; 168: 1–3

    Article  PubMed  CAS  Google Scholar 

  21. Balter MB, Uhlenhuth EH. New epidemiologic findings about insomnia and its treatment. J Clin Psychiatry 1992; 53(12): 34–9

    PubMed  Google Scholar 

  22. Allain H, Delahaye C, Le Cox F, et al. Postmarketing surveillance of zopiclone in insomnia: analysis of 20,513 cases. Sleep 1991; 14(5): 408–13

    PubMed  CAS  Google Scholar 

  23. Balter MB, Uhlenhuth EH. The beneficial and adverse effects of hypnotics. J Clin Psychiatry 1991; 52(7): 16–23

    PubMed  Google Scholar 

  24. Humphreys S, Hallström C. Benzodiazepine dependence and withdrawal — an update. Prim Care Psychiatry 1995; 1: 99–105

    Google Scholar 

  25. Dement WC. The proper use of sleeping pills in the primary care setting. J Clin Psychiatry 1992; 53(12): 50–6

    PubMed  Google Scholar 

  26. Coleman RM, Zarcone VP, Redington DJ, et al. Sleep-wake disorders in a family practice clinic. Sleep Res 1980; 9: 192

    Google Scholar 

  27. Berlin RM, Litovitz GL, Diaz MA, et al. Sleep disorders on a psychiatric consultation service. Am J Psychiatry 1984; 141(4): 582–4

    PubMed  CAS  Google Scholar 

  28. Mindell JA, Moline ML, Zendell SM, et al. Pediatricians and sleep disorders: training and practice. Pediatrics 1994; 94(2): 194–200

    PubMed  CAS  Google Scholar 

  29. Orr WC, Stahl ML, Dement WC. Physician education in sleep disorders. J Med Educ 1980; 55: 367–9

    PubMed  CAS  Google Scholar 

  30. Merkel WT, Walbroehl GS. The annual third-year resident rampage: a separation crisis of manageable proportions. J Med Educ 1980; 55: 366–7

    PubMed  CAS  Google Scholar 

  31. Chung SA, Hussain MRG, Shapiro CM. How much do primary care physicians in Ontario know about sleep apnea? Sleep Res 1996. In press

    Google Scholar 

  32. Kroenke K, Mangelsdorff AD. Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. Am J Med 1989; 86: 262–6

    Article  PubMed  CAS  Google Scholar 

  33. Kupych-Woloshyn N, MacFarlane J, Shapiro CM. A group approach for the management of insomnia. J Psychosom Res 1993; 37 Suppl. 1: 39–44

    Article  PubMed  Google Scholar 

  34. O’Reilly R. The use of sedative-hypnotic drugs in a university teaching hospital. Can Med Assoc J 1990; 142(6): 585–9

    Google Scholar 

  35. Sanford JR. Tolerance of debility in elderly dependents by supporters at home: its significance for hospital practice. BMJ 1975; 3: 471–3

    Article  PubMed  CAS  Google Scholar 

  36. Pollack CP, Perlick D. Sleep problems and institutionalization of the elderly. J Geriatr Psychiatry Neurol 1991; 4: 204–10

    Article  Google Scholar 

  37. Walsh JK, Engelhardt CL, Hartman PG. The direct economic cost of insomnia. In: Nutt D, Mendelson W, editors. Hypnotics and anxiolytics. London: Baillière Tindall, 1995; 369–81

    Google Scholar 

  38. Mendelson WB, Garnett D, Linnoila M. Do insomniacs have impaired daytime functioning? Biol Psychiatry 1984; 19(8): 1261–4

    PubMed  CAS  Google Scholar 

  39. Mitler MM, Carskadon MA, Czeisler CA, et al. Catastrophes, sleep, and public policy: consensus report. Sleep 1988; 11(1): 100–9

    PubMed  CAS  Google Scholar 

  40. Stoller MK. Economic effects of insomnia. Clin Ther 1994; 16(5): 873–97

    PubMed  CAS  Google Scholar 

  41. Lauber JK, Kayten PJ. Sleepiness, circadian dysrhythmia, and fatigue in transportation system accidents. Sleep 1988; 11(6): 503–12

    PubMed  CAS  Google Scholar 

  42. O’Hanlon JF. Ten ways for physicians to minimize the risk of patients causing traffic accidents while under the influence of prescribed psychoactive medication. Prim Care Psychiatry 1995; 1: 77–85

    Google Scholar 

  43. Jennum P, Sjol A. Self-assessed cognitive function in snorers and sleep apneics. Eur Neurol 1994; 34: 204–8

    Article  PubMed  CAS  Google Scholar 

  44. Greenberg PE, Stiglin LE, Findelstein SN, et al. The economic burden of depression. J Clin Psych 1993; 54: 405–18

    CAS  Google Scholar 

  45. Walsh JK. Correlates, Consequences and Costs Associated with Insomnia. The Pharmacological Management of Insomnia: A White Paper of the National Sleep Foundation. In press

  46. Lavis JN, Anderson GM. Appropriateness in health care delivery: definitions, measurement and policy implications. Can Med Assoc J 1996; 154(3): 321–8

    CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry, The University of Toronto and the Toronto Hospital (Western Division), Toronto, Canada

    Lisa A. Chilcott & Colin M. Shapiro

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  1. Lisa A. Chilcott
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  2. Colin M. Shapiro
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Chilcott, L.A., Shapiro, C.M. The Socioeconomic Impact of Insomnia. Pharmacoeconomics 10 (Suppl 1), 1–14 (1996). https://doi.org/10.2165/00019053-199600101-00003

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