The societal and economic burden of insomnia in adults: An international study
Understanding the broader societal effects of insomnia is crucial in identifying opportunities for scalable interventions designed to positively impact the health, well-being and productivity of individuals and, collectively, to benefit society as a whole.
What is the issue?
Insomnia is characterised by difficulty falling or staying asleep or poor quality or non-restorative sleep and is the most common sleep disorder. Insomnia exacts a significant toll on an individual’s mental and physical health, quality of life (QoL) and productivity. The consequences of this condition go well beyond the individual, as there may be cascading effects on families, employers and global economies. Understanding the broader societal effects of insomnia is crucial in identifying opportunities for scalable interventions designed to positively impact the health, well-being and productivity of individuals and, collectively, to benefit society as a whole.
To date, limited research has focused on the societal and economic impacts of chronic insomnia, which is defined as insomnia symptoms experienced at least 3 times per week for at least 3 months with impairment to daily activities. Our study was conducted to fill this knowledge gap.
How did we help?
We first conducted a literature review to identify and quantify the societal burden of insomnia, including the prevalence of insomnia and its impacts on QoL and workplace productivity, followed by meta-regression to estimate the predicted prevalence of insomnia.
Secondly, we conducted analyses on secondary data to quantify the impact of insomnia on overall well-being and to calculate intangible costs using a well-being valuation approach that represents a monetary value that people with insomnia would be willing to trade to attain the same level of well-being as a person without insomnia.
Lastly, we used macro-economic modelling to estimate the indirect costs of insomnia related to loss in productivity.
The focus of this study was on chronic insomnia among adult populations within Organisation for Economic Co-operation and Development (OECD), high-income countries from Northern, Southern and Western Europe, as well as North America and Australia.
What did we find?
Insomnia affects a significant proportion of the general adult population across the 16 countries included in this report, with an estimated 8% predicted to suffer from chronic insomnia and 14% predicted to suffer from clinical insomnia in any given year, representing approximately 41.6m and 72.1m working-age adults, respectively.
Insomnia is associated with a host of downstream consequences on both the individual and society as a whole. In particular, insomnia is strongly linked with poorer QoL and lower life satisfaction. Expressed in terms of well-being costs, an individual suffering from insomnia would on average be willing trade an estimated 14% of their per-capita annual household income in order to recuperate the well-being loss associated with insomnia. At the national level this translates annually to between $1.5bn and $127.1bn in 'hidden' costs due to chronic insomnia.
Chronic insomnia is also associated with reduced productivity in the workplace due to absenteeism and presenteeism, resulting in the loss of an average of 44–54 working days per year and an estimated loss in annual GDP ranging from 0.64% to 1.31%, or approximately $1.8–207.5bn in indirect economic costs.
What can be done?
Policy: Policies are needed to provide access to and reimbursement for safe, evidence-based, affordable and cost-effective treatments for chronic insomnia. Furthermore, workplace interventions are needed to better identify insomnia and mitigate its impacts, and public health campaigns should emphasise the importance of sleep quality in addition to sleep quantity.
Clinical practice: Medical school and graduate medical training should be revised to include a more in-depth focus on sleep health and ongoing education should be provided to physicians regarding evidence-based treatments to improve the identification and management of insomnia. Given the often bidirectional relationship between insomnia and other health conditions, a holistic approach to management and treatment is needed, with screening for insomnia at routine clinical visits. Lastly, clinical care pathways should be established/standardised to ensure timely diagnosis and treatment of insomnia.
Research: More research is needed on the prevalence of chronic insomnia, its societal and economic impacts and the social determinants of sleep-health inequalities, as well as the interrelationships between COVID-19, physical health, mental health and sleep. Well-designed studies are needed to test the long-term efficacy of current and emerging pharmacological and behavioural interventions for chronic insomnia on societal and economic outcomes. Lastly, research using person-generated digital health data could help to close knowledge gaps related to the prevalence, determinants and consequences of insomnia, but such research should be conducted within a health-equity lens.
Marco Hafner
Erez Yerushalmi, Birmingham City University
Funding
This report was funded by Idorsia Pharmaceuticals Ltd. Switzerland and was conducted by RAND Europe under the advisement of a steering committee whose members were selected by the RAND Europe research team for their subject-matter expertise and objectivity. RAND Europe had full editorial control and independence of the analyses performed and presented in this report, which has been peer-reviewed in accordance with RAND Europe’s quality assurance standards. This work is intended to inform the public good and should not be taken as a commercial endorsement of any product or service.
