Insomniacs with Nighttime Awakenings Have a Huge Impact on Health Care Costs and Workforce Management

Did you know that 30-40% of adults report some symptoms of insomnia within any given year?  But that’s nothing…according to the National Sleep Foundation, over 60% of people who work shifts report that they suffer from insomnia.  And, 30% of shift workers claim that they’re excessively tired all the time.  People who work shifts are twice as likely to fall asleep at the wheel as those working during the day-time. 

Insomnia is defined as having problems falling asleep, staying asleep, waking too early, or not feeling rested even after spending enough time in bed.  The effects of insomnia are significant to health, work, work/life balance, and quality of life.  A large number of insomniacs are thought to be suffering from depression or anxiety disorders at the same time.  For example, one study found that 28% of the study group with insomnia also reported a current mental health diagnosis and 25% reported a history of mental health conditions.  Results from a study by the National Institute of Mental Health indicated that chronic insomniacs were more than 4 times likely to experience a major depressive disorder and 6 times more likely to suffer from anxiety as those without insomnia.

A substantial number of people with depression and anxiety experience chronic sleep maintenance insomnia characterized by nighttime awakenings; they just can’t stay asleep.  The quality of life and work productivity loss impact is significant for these people.  In addition, their health care utilization is extremely high. While we don’t know how many shift workers suffer from nighttime awakenings (or daytime when working nights), given how many shift workers complain of insomnia it’s likely to be high.

Recently, a study looked more closely at insomnia with nighttime awakenings.[i] The study looked at two groups of insomniacs with nighttime awakenings, those who also had anxiety and those who also suffered from depression.

Depression sufferers had 10.4% greater lost productivity due to absenteeism and a 40.9% greater productivity impairment while working (presenteeism). Those with anxiety had 12.2% greater absenteeism and 42.7% greater presenteeism.  People suffering from depression and anxiety also experience other conditions, and when those with other illnesses were removed from the data set, even still 5.7% of subjects with depression had greater lost productivity and 18.1% had greater presenteeism.  For those with only anxiety, still 6.1% had greater lost productivity and 20.4% had greater presenteeism.

On average, those in the study with nighttime awakenings and depression, made 9.7 visits to traditional medical providers in the six months preceeding the study.  Those with anxiety made 10.6 visits.  According to the study, insomniacs with depression and anxiety spend $744 and $930, respectively, per year more than people without these conditions due to extra provider visits.  The study researchers projected these costs out to all U.S. adults – the aggregate cost was $1.57 billion for those with depression and nighttime awakenings and $1.44 billion for those with anxiety and nighttime awakenings.  This has significant implications for health care costs.  Assuming a 50 week work per year, those with depression and nighttime awakenings experience 7 weeks of lost productivity per year and those with anxiety and nighttime awakenings lose 9 weeks of productivity. This has serious implications for workforce management.

Using a Health and Quality of Life survey (HRQ) SF-8, the researchers measured eight domains of health: physical functioning, role limitations due to physical health, bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems, and mental health.  It yields scale scores for each of these eight health domains, and two summary measures of physical and mental health: the Physical Component Summary and Mental Component Summary.  The researchers found that nighttime awakeners with depression had a mean physical component score of 39.1 and those with anxiety had a mean score of 38.6, as compared to a normal adult score of 50.  Nighttime awakeners with depression had a mental component mean score of 34.8 and those with anxiety had a mean score of 35, again compared to a normal adult score of 50.

What does this all of this mean?  Clearly nighttime awakeners experience lower health-related quality of life; most certainly their overall quality of life is lower.  And they incur more health care costs and are less productive at work.

For ideas on how to deal with sleep issues, including insomnia, read these posts:

Women and Sleep

Men and Sleep


©2010 Circadian Age, Inc. ˜Working Nights”

[i] Burden of Chronic Sleep Maintenance Insomnia Characterized by Nighttime Awakenings among Anxiety and Depression Sufferers: Results of a National Survey, Susan C. Bolge et al, Prim Care Companion, J Clin Psychiatry 2010;12(2)

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