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Insomnia is a highly prevalent condition that has profound and far-reaching implications for physical and mental health, workplace productivity, interpersonal relationships, child rearing and overall quality of life. While estimates vary, it is generally accepted that at least 10 percent of the U.S. population — that’s approximately 20 million adults — have ongoing issues falling asleep or staying asleep, with resultant daytime consequences, such as excessive sleepiness and fatigue, attention and concentration deficits and somatic complaints like persistent headache and neck pain. Additionally, the overall annual economic burden in terms of lost productivity, job site absenteeism and workplace accidents directly associated with these symptomatic insomnias was estimated at $31 billion in 2011. This translates into a loss of $2,280 per year, or 11.3 working days of lost wages per U.S. worker. Despite these staggering costs, symptomatic insomnia remains an elusive diagnosis that often goes unrecognized and untreated and exacts a tremendous toll on its sufferers.
Why Should we Care about Insomnia?
The implications of insomnia are widely felt. In older adults, fall rates are substantially higher in those prescribed sedative-hypnotic medications to treat insomnia. This has been consistently identified as an important public health concern. Decreases in leisure time and physical activity in the elderly have been strongly associated with insomnia symptoms and may be predictive of other coexisting illnesses like major depression, dementia and anhedonia, which is a lowered ability to experience pleasure.
Furthermore, insomnia occurs in 60 to 90 percent of adults with post-traumatic stress disorder (PTSD) and is an important target for early intervention and suicide prevention, especially in those suffering from combat-related PTSD. Chronic pain sufferers have a very high incidence of coexisting insomnia, and recognition and treatment of primary insomnia can decrease opiate pain medication utilization and improve quality-of-life scores. Those with chronic insomnia are four times more likely to report marriage and relationship problems. One interesting study from 2011 demonstrated that insomnia in women significantly increased the number of negative interactions with a spouse, while insomnia in men had no impact on relationship conflict.
Parents AND their Children are Affected by Poor Sleep
Of great concern is the impact of parental insomnia on offspring. Adolescent children of parents with chronic insomnia are significantly more withdrawn and apt to display behavioral problems. Rates of suicidal ideation, suicidal plan and suicidal attempts are also much higher in these adolescents when compared to similar children in households where parents do not report insomnia symptoms. Rates of attention deficit hyperactivity disorder (ADHD), depression and marijuana and alcohol use are also higher in children growing up with parents who self-report insomnia symptoms.
Reaction time is substantially impaired in subjects reporting five hours or less sleep per night. In fact, in a group of young adults randomized to 17 hours of consecutive wakefulness, task performance was comparable to a matched adult with a blood alcohol level (BAL) of 0.05, while 21 hours of consecutive wakefulness correlated with a BAL level of 0.08. Finally, longitudinal analysis has found that as few as 18 doses of sedative-hypnotic medications per year are associated with a threefold increase in all-cause death rates.
Insomnia can Affect the Severity of Other Illnesses
Amongst cancer patients, insomnia can be debilitating. Aggressive screening and treatment can substantially improve overall well-being and immune system functioning. Moreover, death from cardiac disease, such as heart attack or stroke, is 45 times more likely in patients with coexisting insomnia than in those patients with similar cardiovascular risks without insomnia. Both substance abuse and alcoholism have been associated with increased incidence of insomnia, and insufficient sleep may actually predispose individuals to a variety of risk-taking behaviors like intravenous drug use. In patients with human immunodeficiency virus (HIV), insomnia and insufficient sleep has been associated with lower CD4 counts and higher viral loads. Insufficient sleep may quadruple the risk of acquiring the common cold virus and decrease the responsiveness of the body’s immune system to common immunizations, such as those administered to protect against influenza, hepatitis and measles, mumps and rubella (MMR).
All told, the economic, physical, emotional and societal costs of chronic insomnia are staggering, and intensification of efforts aimed at the screening, diagnosis and treatment of this condition are warranted.