Research Study aims to measure economic burden of insomnia

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Anne-Marie Tobin
THE CANADIAN PRESS

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TORONTO - A new study aims to put a price tag on the burden of insomnia in society, and estimates the total cost in the province of Quebec at $6.5 billion a year.

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Of a sample of 948 participants, almost 52 per cent were classified as good sleepers, while 32 per cent had insomnia symptoms and 15 per cent had insomnia syndrome.

The study, published in the journal Sleep on Dec. 25, says more than three-quarters of that total is attributable to indirect costs - insomnia-related work absences and reduced productivity.

But there were also direct costs such as health-care consultations, transportation to get to consultations, prescription medicines and over-the-counter products.

And the analysis, conducted by researchers in Quebec City, estimated that reliance on alcohol as a sleep aid ended up costing almost $340 million.

"I think the costs related to alcohol were a bit of a surprise to us, and the frequency of the use of alcohol as a sleep aid," said Meagan Daley, a co-author of the study and a professor of psychology at CEGEP Champlain-St.Lawrence in Quebec City.

She noted that sleep medications cost as little as 11 cents a pill but a glass or two of wine costs substantially more.

"Most of us have felt that drowsy effect that having a glass or two of alcohol can bring on, so I think people, because of that experience, strongly suspect that it will help them fall asleep," said Daley.

It often does, she said, but there's a down side to the quality of sleep after imbibing.

"When we take alcohol the proportion of our night spent in deep sleep where we recuperate that physical energy and in dreaming is reduced," she explained.

"And what is increased is the time that we spend in light sleep, the lighter stages of stage 1 and 2. And so what that means is we're depriving ourselves of very essential sleep stages ... Even if we've slept or think we've slept a good six, seven, eight hours, we may not feel like that sleep was restorative."

The research was part of a larger epidemiological study to document the natural history of insomnia. A final sample of 948 participants filled out questionnaires.

Almost 52 per cent were classified as good sleepers, while 32 per cent had insomnia symptoms - they had some sleep difficulties. And 15 per cent had insomnia syndrome, meeting all the diagnostic criteria for insomnia. They expressed dissatisfaction with their sleep and had symptoms of insomnia three nights per week for a minimum of a month.

The average annual costs per person were $5,010 for those with insomnia syndrome, compared to $1,431 for those with symptoms and $421 for those classified as good sleepers.

Daley, who is also a psychologist in private practice, said many people don't seek help and there seems to be a shame or stigma about telling others.

"The research shows that very often people wait 10 to 12 years before consulting for their first time, so they've been suffering for years and years and years."

Daley said it's difficult to assess indirect costs, and the researchers developed their own tool.

Study subjects were asked in 2002 to report whether they'd been absent from work in the previous month, and how frequently and for what reason. And they were asked to report to what extent they felt they had been less productive, and to attribute a cost to their reduced productivity.

"We were able to - we think, we hope - pull out the productivity that was uniquely related to sleep dysfunction, sleep problems. And then we were able to .... weigh the impact or the contribution of the insomnia to their lost productivity," Daley said.

"We took their gender, their age, and we used Statistics Canada data on typical wages and we estimated their lost wages for that month. Then we extrapolated and we drew an estimate for the year, for the province."

The study authors note some limitations to the work. For instance, it relied on self-reporting, and they note "individuals with insomnia have a tendency to overestimate sleep difficulties and daytime impairments relative to objective measures."

"Another limitation is that the methods used to estimate productivity have not been validated," the authors wrote.

"However, unless dealing with assembly-line style occupations where work productivity measures can be obtained by counting output units, quantifying productivity decreases will remain approximate."

Daley said there are effective treatments that will reduce the costs to society and to individuals. But she said primary care practitioners don't necessarily have a lot of training or knowledge about sleep disorders and, in particular, insomnia.

"We need to be informing people that there are effective treatments that don't necessarily involve medications, that can help them obtain or find that better sleep that they're looking for."

The research was supported by a grant from the Canadian Institutes of Health Research.

Sleep is the official journal of the Associated Professional Sleep Societies.

Daley said a Canada-wide replication study is being conducted to gather data from across the country to see if there are any differences among the provinces.