Clinical ReviewSocietal costs of insomnia
Introduction
Today, sleep disorders such as insomnia are better recognized as major public health issues, associated with numerous societal consequences: accidents, lost lives, lost income, disability, lost educational opportunities, etc. Sleep disorders affect the quality of life of millions of people around the world. Insomnia is the most common sleep disorder.1, 2, 3, 4
To start with, epidemiological studies made in multiple countries have clearly shown that millions of adults are chronically ill with various sleep disorders: insomnia, sleep apnea, sleep deprivation and hypersomnia. The consequences of these sleep disorders are diverse. Some sleep disorders may be fatal; some affect the whole life, others have less important consequences but may disturb several months of the life. In adults, insomnia affects one in five men and one in three women. In the elderly, disturbed sleep with night wandering is amongst the most frequently cited causes of dependence. In the last decade, several consensus meetings about insomnia, its recognition, diagnosis and treatment, have published recommendations.5, 6, 7 All these consensus groups have underlined the impact of insomnia on public health and the need to better understand the consequences of insomnia on work, economics and quality of life. However, insomnia is still unrecognized by health professionals. One issue lies in the fact that insomnia is frequently considered as a symptom rather than as a disease in itself. Moreover, it is not clear for practitioners whether it is a symptom or a disease. Another difficulty lies in the decision made by the patient and the health professional, as to when insomnia becomes severe enough to need treatment. Finally, there is still insufficient knowledge about the management of insomnia.
The aim of this review is to carefully describe the possible links between insomnia and public health concerns and to point out what are the certitudes and the missing data on the consequences of insomnia on work, economics and health related quality of life (HrQol).
Section snippets
Epidemiology: the magnitude of insomnia, screening the disorders and seeking help
Although the aim of this review is not to describe the epidemiology of insomnia, it is necessary to put its prevalence, socio-demographic characteristics and access to care in a universal and economical perspective. Recent international studies have shown that insomnia concerns a large amount of individuals everywhere. Independent of the country and of the socio-economical characteristics of the patients, insomnia has common features around the planet which require equal care.
Insomnia at the workplace
As we previously argued insomnia has a high prevalence in adults and therefore also in professionals. Very few studies are specifically devoted to insomnia in the workplace. However, it is commonly accepted that insomnia affects daytime functioning and working ability of professionals.35 Riedel and Lichstein have recommended using objective measures of work performance (absenteeism, work limitation, errors, job promotion…) to clarify the impact of insomnia on daytime activity.36 Insomnia is not
Insomnia and accidents
The impact of sleep disorders on automobile accidents is a crucial issue from a public health point of view. Public authorities and the media are actually well informed of the risk of sleepiness at the wheel during the night and of the effects of sleep debt and sleep pathologies (sleep apnea, hypersomnia) on accidents. Surprisingly, there are very few data on the risk of accidents due to insomnia.
Insomnia may impact on the risk of accidents in different ways: sleep deprivation, lack of
Comorbidities and health care use
Several studies have looked at the links between insomnia and general health status. Although insomnia appears to be associated with poorer health status, it is difficult to know whether insomnia is the result or the cause. Comorbid insomnia includes not only psychological but also physical diseases associated with insomnia and it may represent at least 50% of chronic insomniacs, and therefore impact health care use. Poor health leads to an increase in the use of medical services. This includes
Quality of life in insomnia
There are still very few articles specifically designed to assess the impact of insomnia on Quality of life (Qol). Most articles were devoted to the impact of sleep disorders on the quality of life of patients suffering from cancer. Many were exploring Qol in relation to poor sleep in diabetes, depression, Parkinson's, chronic renal diseases with hemodialysis, patients with the human immunodeficiency virus (HIV) or with chronic psychiatric diseases. Actually, Qol is also systematically used to
Final comments
Insomnia affects the daily lives of millions of people around the world. The economic impact of this sleep disorder on the collectivity seems enormous. There is also increasing evidence linking this disorder to several severe other public health major concerns: depression, anxiety, accidents… Sleep apnea, restless leg syndrome, shift work sleep disorders, hypersomnia have also been proved to have an important impact on a socio- economic perspective. Beside the patients themselves, their family
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