Insomnia

Insomnia is Costly to the Workplace

Research suggests that insomnia costs employers more than $90 billion annually in reduced productivity and workplace accidents and errors. With as many as one-fifth of working Americans reportedly experiencing insomnia over the past year, sleeplessness is clearly a major public health issue with implications that extend beyond the bedroom.

Insufficient sleep is considered a major public health concern and one that affects as many as 50 to 70 million Americans (Colton et al., 2006). The term “sleep disorder” is wide ranging and can describe numerous types of sleep difficulties, including short sleep duration, unsatisfactory sleep quality despite having adequate duration (often termed nonrestorative sleep), breathing-related sleep disruptions (e.g., snoring, sleep apnea), nightmares or night terrors, and problematic sleep behaviors (e.g., restless legs syndrome, sleepwalking).

Despite differences in their symptoms and causes, sleep disorders as a whole are associated with a host of negative outcomes, such as an increased risk of certain medical diseases (e.g., cancer, hypertension, obesity) and mental disorders (particularly depression); higher mortality; increased suicidal thoughts and behaviors; and poorer quality of life. Sleep disturbances also contribute significantly to motor vehicle accidents, workplace errors and accidents, and reduced productivity due to absenteeism and work impairment (Swanson et al., 2011).

What is Insomnia Disorder?

Insomnia disorder is one of the most common sleep disturbances, occurring in approximately one in three working U.S. adults (Centers for Disease Control and Prevention, 2012). While many individuals may use the term insomnia to describe the experience of insufficient sleep, insomnia disorder is a mental disorder that can only be diagnosed when specific criteria are met. The criteria are listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the handbook that psychiatrists, other physicians, and mental health professionals use to guide diagnosis of a mental disorder (American Psychiatric Association, 2013).

Insomnia disorder is defined by the presence of poor sleep characterized by:

  • difficulty falling asleep (known as delayed sleep onset or initial insomnia),

  • difficulty staying asleep (known as sleep maintenance insomnia or middle insomnia), and/or wakening early and being unable to return to sleep (termed late insomnia).

  • In order to be diagnosed, the sleep disturbance must negatively impact a person’s functioning in important areas, such as work or school, completing daily responsibilities, or maintaining interpersonal relationships. Symptoms must be experienced for at least three nights per week for at least three months, despite having adequate opportunities for sleep.

Charles F. Reynolds III, MD, University of Pittsburgh Medical Center endowed professor in geriatric psychiatry and chair of the DSM-5 work group that helped developed the latest insomnia disorder criteria, notes that the effects of the disorder are far-reaching in terms of its symptoms and impact throughout the body.

“Insomnia disorder results in unmet sleep need, causing daytime problems, such as needing more time to process and react to information and having difficulty with complex thinking tasks, like problem solving. Further, irritability and other issues of mood regulation; difficulties interacting and maintaining relationships with others; and carbohydrate craving with weight gain can occur,” says Dr. Reynolds. “It is also a risk factor for the onset of common mental disorders, such as depression and substance use disorders.”

In fact, a recently published study in the Journal of the American Medical Association (Bernert, Turvey, Conwell, & Joiner, 2014) found that older adults (age 66 to 90 years) who reported poor sleep, including difficulty falling asleep and experiencing nonrestorative sleep, had a 1.4-times greater risk of dying by suicide over the 10-year period in which the study was conducted.

Insomnia in the Workplace

Given the scope of the impact of insomnia, it is not surprising that the disorder has been linked to problems in the workplace. The importance of adequate sleep and time away from work has increasingly become the subject of public discussion in light of revisions to work policies affecting positions of high risk to public safety, such as physician trainees, commercial airline pilots, and commercial vehicle drivers.

The most recent results from the America Insomnia Survey (AIS) support the idea that sleeplessness is negatively impacting the U.S. work environment (Shahly et al., 2012). Data were collected from 4,991 working Americans interviewed by telephone about insomnia and 18 other chronic medical conditions (e.g., cardiovascular, respiratory, and neurological disorders). An estimated 20% of those surveyed reported experiencing insomnia for at least 12 months, with even higher rates reported among women and workers age 45 to 64 years.

Researchers found that insomnia was associated with approximately 7% of all costly workplace accidents and errors and almost 24% of the overall costs of all accidents and errors — higher than any of the other medical conditions examined. The total costs of accidents and errors attributed to insomnia were higher than costs due to other conditions by an average of $10,148 per incident. And the annual cost of insomniarelated workplace accidents and errors was estimated to be more than $32 billion.

Insomnia also appears to compromise productivity, leading to missed days at work and low performance while at work. Recent data, also from the AIS, suggest the disorder results in significant reductions in work performance, yielding an annual rate of 11.3 days of lost work performance per individual with insomnia (Kessler et al., 2011). The study authors estimated that the annual cost of lost productivity due to insomnia is $59.8 billion.

Also, insomnia can be linked to certain other mental and medical disorders that themselves may impair work performance or attendance. Insomnia is considered a risk factor for anxiety and depression, both of which have a negative impact on participation in the labor market, likelihood of employment, and years of education (which in turn can affect employment status and earning potential). Cardiovascular and metabolic conditions that co-occur with insomnia disorder — such as diabetes, obesity, hypertension, and hypercholesterolemia — are costly to treat and pose a substantial burden to workplace costs and productivity.

Tips for Employers

One of the more challenging aspects of treating insomnia stems from the fact that only a fraction of individuals with the disorder seek medical treatment (Morin, 2006). Poor sleep is so widespread that it is practically seen as normal in American society; consequently, many people often are not aware that a disorder is present and that treatment can help. Integration of insomnia management into employee wellness programs can help provide basic education to raise awareness about the seriousness of symptoms and the usefulness of formal medical treatment. Workplace wellness programs can educate employees about the variety of treatment options available while leveraging employee assistance programs to offer a variety of such interventions.

Sleep Hygiene Education: Sleep is a behavior and, like many other behaviors, can be altered by adopting new habits. Employee wellness programs should always include basic education on sleep hygiene to help workers shape healthier sleep routines on their own. This includes developing a regular schedule in which one goes to bed at the same time each night and wakens at the same time each morning; reducing environmental distractions, such as cell phones, televisions, and other electronics; and ensuring bedrooms are dark, quiet, and cool in temperature. Large meals, caffeine, and alcohol should be avoided close to bedtime.

Access to Professional Treatment: While improving sleep hygiene is often all that is needed to relieve insomnia, some individuals will need more formal treatment by a professional. Many of these treatments do not involve medication and can be extremely effective in restoring healthy sleep. Some individuals, in consultation with their physicians, may decide that short-term treatment with medication is the best course of action.

Stress Management Programs: Insomnia commonly emerges when people feel stressed—and vice versa: getting inadequate sleep itself can be incredibly stressful. Employee wellness programs that include approaches to stress management (such as mind-body exercises, engaging in relaxing activities, and maintaining a healthy lifestyle) can potentially help alleviate sleep disturbances as well.

Flexible Schedules: Employers also can contribute by allowing for flexible work schedules and reducing the need for late work days. If shift work is required, employers should be lenient in offering adjustable shift rotations to the extent possible so that workers stay well-rested.

Work Expectations: Finally, businesses should be vigilant about their internal policies regarding work expectations and hours. The drive to succeed that can result in pushing personnel to increase workloads can actually backfire and undermine productivity and results.

The health of a company starts with the health of its workers. Investing greater efforts into ensuring employees are well rested is likely to pay off many times over.


Resources

A guide on Insomnia from one of the leading resources for sleep disorder information, the National Sleep Foundation, an organization dedicated to sleep health education and advocacy.

Emily A. Kuhl, Ph.D., owner and operator of Right Brain/Left Brain, LLC, is a consultant to the Partnership for Workplace Mental Health and a medical writer and editor in the Washington, D.C., area.

References

  • American Psyc hiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

  • Bernert, R. A., Turvey, C. L., Conwell, Y., & Joiner, T. E., Jr. (2014). Association of poor subjective sleep quality with risk for death by suicide during a 10-year period: A longitudinal, populationbased study of late life. JAMA Psychiatry. Advance online publication. doi: 10.1001/jamapsychiatry.2014.1126

  • Centers for Disease Control and Prevention. (2012). Short sleep duration among workers — United States, 2010. Morbidity and Mortality Weekly Report, 61(16), 281–285.

  • Colten, H. R., & Altevogt, M. B. (Eds.). (2006). Sleep disorders and sleep deprivation: An unmet public health problem. Washington, DC: National Academies of Science.

  • Kessler, R. C., Berglund, P. A., Coulouvrat, C., Hajak, G., Roth, T., Shahly, V., . . . Walsh, J. K. (2011). Insomnia and the performance of U.S. workers: Results from the America Insomnia Survey. Sleep, 34(9), 1161–1171.

  • Morin, A. K. (2006). Strategies for treating chronic insomnia. American Journal of Managed Care, 12(8 Suppl), S230–S245.

  • Shahly, V., Berglund, P. A., Coulouvrat, C., Fitzgerald, T., Hajak, G., Roth, T., . . . Kessler, R. C. (2012). The associations of insomnia with costly workplace accidents and errors: Results from the America Insomnia Survey. Archives of General Psychiatry, 69(10), 1054–1063. doi: 10.1001/archgenpsychiatry.2011.2188

  • Swanson, L. M., Arnedt, J. T., Rosekind, M. R., Belenky, G., Balkin, T. J., & Drake, C. (2011). Sleep disorders and work performance: Findings from the 2008 National Sleep Foundation Sleep in America poll. Journal of Sleep Research, 20(3), 487–494.

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