Health, safety, and quality of life
In recent years, it has become increasingly clear that insomnia—especially chronic insomnia—is a medical condition that can affect your patients’ overall health status.¹ Insufficient sleep—from various causes, including insomnia—can have wide-ranging health, safety, and quality-of-life implications. According to the Centers for Disease Control and Prevention (CDC), "Insufficient sleep is associated with a number of chronic diseases and conditions—such as diabetes, cardiovascular disease, obesity, and depression…[it is also] responsible for motor vehicle and machinery-related accidents."²

At a 2005 National Institutes of Health (NIH) State-of-the-Science Conference, insomnia was identified as the most common sleep complaint across all stages of adulthood.³ And according to the conference findings, people with insomnia have higher rates of work absenteeism and usage of healthcare services.³ The CDC recommends that healthcare providers consider adding an assessment of sleep to their routine office visits so interventions and referrals can be made when necessary.⁴

Insomnia prevalence and persistence
According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR™), insomnia is characterized by one or more of these sleep complaints, which cause clinically significant impairment of daytime functioning:⁵

• Difficulty initiating sleep
• Difficulty maintaining sleep
• Nonrestorative sleep

While numbers vary, approximately one third of adults report suffering from sleep disruption, with 10% suffering from chronic or persistent insomnia.^{3, 6} And the prevalence is even higher among elderly patients.⁵ While transient or acute insomnia can be brought on by temporary stress or medical conditions, insomnia can persist long after the original causative factors have been resolved.⁵ It is hypothesized that frequent bouts of transient insomnia can lead to the development of chronic insomnia when left untreated.⁶

Including a routine discussion of sleep habits in taking your patients' medical histories is all the more important in light of a recent study on the natural history of insomnia. It found that patients who met the diagnostic criteria for insomnia (difficulty initiating or maintaining sleep and/or nonrestorative sleep with daytime impairment of functioning at least 3 nights per week for at least 1 month) were unlikely to remit spontaneously. The most likely trajectory for these patients was that the problem would persist.⁷

Insufficient sleep has many negative consequences
According to the 2009 survey by the National Sleep Foundation, people who reported inadequate sleep (from all causes) were more likely than good sleepers to report being unable to do the following because they were too sleepy:⁸

• Working well and efficiently (25% vs 9%)
• Exercising (30% vs 10%)
• Healthy eating (22% vs 6%)
• Having sex (16% vs 7%)
• Engaging in leisure activities (28% vs 10%)

Insomnia impacts your patients' health-related quality of life (HRQOL)
Using the SF-36* in a cross-sectional analysis of medical outcomes study data of 3,445 patients diagnosed with one or more of 5 chronic medical or psychiatric conditions, investigators were able to demonstrate the independent relationship between insomnia and reduced HRQOL.¹⁰ Patients rated themselves on the following 8 health-related domains:¹⁰

• Physical functioning
• Role limitation due to physical health problems
• Bodily pain
• General health perceptions
• Vitality
• Social functioning
• Role limitation due to emotional problems
• Mental health

Importantly, the data showed that insomnia is independently associated with a significant reduction of HRQOL. According to the study, the magnitude of the HRQOL impact in patients with severe insomnia was comparable to that reported by patients with chronic conditions, such as congestive heart failure or clinical depression.¹⁰

The importance of routine screening for sleep problems
The role of sleep, as it affects both physical and mental health, is just beginning to be fully understood.¹¹ Insomnia, the most common sleep-related complaint among adults, is often minimized or inaccurately evaluated by patients.^3,4,6 This can create a challenge for healthcare professionals because sleep is central for both well-being and disease management.¹¹ That's why the CDC has recommended that healthcare professionals consider assessing patients' sleep habits—just like they would assess blood pressure, pulse rate, and other vital signs—as part of a routine office visit.⁴

* The SF-36^{® 9} Health Survey is a multi-purpose, short-form health survey which contains 36 questions. It yields an eight-scale profile of scores as well as summary physical and mental measures. The SF-36 is a generic measure of health status as opposed to one that targets a specific age, disease, or treatment group. Accordingly, the SF-36 has proven useful in comparing general and specific populations, estimating the relative burden of different diseases, differentiating the health benefits produced by a wide range of different treatments, and screening individual patients.

^a In clinical studies, LUNESTA was proven effective to help the majority of patients fall asleep and stay asleep for up to 7 hours. Individual results may vary.

Health Challenges of Insomnia

References:

• 1. Bonnet MH, Arand DL. Hyperarousal and insomnia: state of the science. Sleep Med Rev.2010;14(1):9-15.
• 2. Centers for Disease Control and Prevention. Sleep and sleep disorders: a public health challenge. Centers for Disease Control and Prevention Web Site. Available at: http://www.cdc.gov/sleep/. Accessed July 9, 2010.
• 3. National Institutes of Health, Office of the Director. NIH State-of-the-Science Conference Statement on Manifestations and Management of Chronic Insomnia in Adults. NIH Consens Sci Statements. 2005. Jun 13-15;22(2):1-30. Accessed April 23, 2010.
• 4. Centers for Disease Control and Prevention. Perceived insufficient rest or sleep among adults—United States, 2008. MMWR Morb Mortal Wkly Rep. 2009;58(42):1175-1179.
• 5. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR™. 4th ed. Text rev. Washington, DC: American Psychiatric Association; 2000.
• 6. Roth T, Roehrs T. Insomnia: epidemiology, characteristics, and consequences. Clin Cornerstone. 2003;5(3):5-15.
• 7. Morin CM, Bèlanger L, LeBlanc M, et al. The natural history of insomnia: a population-based 3-year longitudinal study. Arch Intern Med. 2009;169(5):447-453.
• 8. National Sleep Foundation. 2009 Sleep in America™ Poll: Highlights and Key Findings. Washington, DC: National Sleep Foundation. 2009; http://www.sleepfoundation.org/sites/default/files/2009%20POLL%20HIGHLIGHTS.pdf. Accessed July 9, 2010.
• 9. Ware JE, Gandek B, for the IQOLA Project. Overview of the SF-36 health survey and the international quality of life assessment (IQOLA) project. J Clin Epidemiol. 1998;51(11):903-912.
• 10. Katz DA, McHorney CA. The relationship between insomnia and health-related quality of life in patients with chronic illness. J Fam Pract. 2002;51(3):229-235.
• 11. National Institute of Neurological Disorders and Stroke, National Institutes of Health. Brain basics: understanding sleep 2010; 1-9. Available at: http://www.ninds.nih.gov/disorders/brain_basics/understanding_sleep.htm. Accessed July 9, 2010.