Insomnia

Part
01
of three
Part
01

Insomnia Prevalence Breakdown

Insomnia is a common sleeping disorder that has affected many people globally. Insomnia incidence is on the rise globally. On average, 33% to 50% of the global population is affected by insomnia. People who are 60 years and above are at a higher risk of insomnia. It is prevalent in females, older adults and people with mental illness. Parents with children report cases of insomnia more often than those with no children.

Methodology

We started our research by looking for global statistics and reports on the prevalence of insomnia from sources like Oxford Academic, Daily Mail, Statistic Stats, NCBI, Persistence Market Research, Sleep Foundation, and Science Daily, among others. During our search, sources with global data provided us with limited information on the global insomnia prevalence breakdown by age and gender. We then expanded our scope to include sources that had data on the prevalence insomnia by age and gender in one or more countries like Canada, Australia, and United States, Germany France, North Korea, Netherlands. We were then able to get adequate data that helped to draw a satisfactory conclusion on the global prevalence of insomnia by age and gender.

Overview

According to a health report published on Persistence Market Research, 25% of the adult population have sleep disorders, out of which 6%-10% have insomnia. According to the United Nations statistics, by 2030, the population of individuals aged 60 years and above is expected to grow by 56 %. Hence, there will be an increased rate of insomnia as most people within this age group are susceptible to sleep deprivation.
According to a report published on Oxford Academic, the survey conducted on 10 countries revealed that there is 5.7% insomnia prevalence in the Netherlands, 10% in Japan, 10.5% in Australia, 11% in the United States, 13.4% in the United Kingdom, 14.6% in Germany, and 21.7% in France. In South Korea, the prevalence was 23.5%; in China, 24%; and in Brazil, 30.5%. According to this report, there is a broad global variation on the incidence of insomnia. An interactive tool created by Hillarys shows which countries have the highest number of insomnia cases by analyzing tweets related to sleep deprivation from individuals all over the world. According to the statistics of this tool, the countries that have reported the highest number of lack of sleep are USA- 83,952, Brazil-56,628, Argentina- 33,759, the United Kingdom- 14,850, and Mexico-8,750.

INSOMNIA Prevalence in Australia and the United States.

According to a clinical report published on the Science Direct website, 10% to 30% of the Australian population aged 18 years and above have insomnia. This is an average of 2.5 million individuals from Australia, and 770 million worldwide. 30% of US adults have Insomnia, and 10% of these adults have chronic insomnia. 37% of individuals aged 20 to 39 years and 40% of those aged 40-59 years report some degree of short sleep duration. Overall 35% of adults report having less than 7 hours of sleep. Moreover, 20% to 40% of adults are currently suffering from insomnia. According to a report published on NCBI, 20 out 69 women in the United States who are not more than 35 years and 43 out of 68 women aged 36 years and above have insomnia. Nine out of 31 males aged 35 years and below have insomnia. Twenty out 30 males aged 36 years and above also have insomnia.

Insomnia Prevalence in Canada

According to a health report published in Statistic Canada, the general population suffering from nighttime insomnia are 8.8% of children aged 6 to 13 years, and 15.3% of teenagers aged 14 to 17 years. 25.3% of adults aged 18 to 64, and 22% of adults who are 65 years and above also have insomnia. In terms of gender, the male population suffering from insomnia are; 9.3% of males aged 6 to 13 years, 11.7% of those aged 14 to 17 years, 20.8% of males aged 18 to 64 years, and 14.4% of those aged 65 years and above. The statistics of females with nighttime insomnia are 8.1 % of those aged 6 to 13 years, 18.7% of females aged 14 to 17 years, 29.9% of females aged 18 to 64 years, and 29.1% of those aged 65 years and above.

Part
02
of three
Part
02

Insomnia Risk Factors and Current Treatments

Although we were able to find the risk factors for insomnia and current treatments for the disease, we were unable to provide data on the efficacy of these treatments even after thoroughly reviewing peer reviewed reports, health related websites, and government platforms. Our findings on the risk factors and treatments for insomnia have been outlined below.

Insomnia is the inability to fall asleep and/or stay asleep. This condition is reportedly one of the most common sleep problems that people around the world have. Globally, 1 in 3 people have insomnia while 1 in 4 Americans struggle with this condition. There are several factors that increase the likelihood of having insomnia. These risk factors are as follows:

RISK FACTORS

Age: The older an individual is, the higher the chances of having insomnia. People above 60 years old have a higher chance of having insomnia when compared to young people. Older people are more likely to have insomnia because of bodily changes they go through related to aging. In addition, most of them have medical conditions which require them to take medications. This in turn leads to lack of sound sleep. Mayo Clinic reported that almost 50% of men and women over the age of 60 go through symptoms of insomnia.

Gender: Studies report that women are more likely to have insomnia than men due to hormonal changes such as premenstrual syndrome (PMS) and pregnancy. These hormonal shifts not only affect the body, they also affect sleep patterns.
Medications & Stimulants: There are several medications (both prescriptions and over the counter) and stimulants that lead to insomnia. Some include diet pills, antidepressants, allergy medicine, drugs for high blood pressure, phenytoin (for seizure disorder), steroids, decongestants, selective serotonin reuptake inhibitors, and theophylline (for asthma). Coffee, tea, energy drinks, and most soft drinks contain caffeine which interferes with sleep. While alcohol helps people fall asleep at first, it inhibits deep stages of sleep which are important for one to get sufficient rest. Smoking also prevents adequate sleep due to the nicotine in it.
Psychological Factors: Experts have proven that being stressed is the main cause of mild insomnia. Stress can be triggered by job or family related issues, the death of a close friend, school, and several other personal problems. Insomnia is known to be one of the symptoms of depression, anxiety, and bipolar disorder.
Chronic Diseases: Chronic diseases can increase the risk of insomnia or disturb sleep. Some diseases linked to or associated with insomnia are diabetes, arthritis, heart disease, lung disease, Parkinson disease, restless leg syndrome, gastrointestinal reflux disease, Alzheimer disease, fibromyalgia, and sleep apnea.
Environmental Changes: A change in work shift, long-distance travel leading to jet lag, and a distracting sleep environment can negatively affect the body's circadian rhythm or internal clock. The circadian rhythm regulates body temperature, sleep cycles, and metabolism. Thus, a major change in environment can prevent adequate sleep.
Other Factors: Some other risk factors for insomnia include lifestyle behavior such as working out prior to sleeping and an irregular schedule.

TREATMENTS

In order to improve sleep quality and treat insomnia, several steps need to be taken. These steps vary based on the "underlying etiology." They are as follows:
PSYCHOLOGICAL AND BEHAVIORAL INTERVENTIONS
Psychological and behavioral interventions such as cognitive-behavioral therapy are recommended for treating chronic and primary insomnia. To treat primary insomnia, appropriate sleep measures need to be taken. Good sleeping habits like avoiding heavy meals in the night and having a comfortable environment to sleep are encouraged. Most patients with primary insomnia are advised to keep a sleep diary for 7 to 14 days in order to figure out the level of sleep disturbance that occurs. This is then used to tailor the appropriate treatment. Cognitive-behavioral therapy is said to be the most effective treatment for primary insomnia. According to a study done by the Research Institute of Child Development and Education at the University of Amsterdam, cognitive behavioral therapy is highly effective for "both short- and long-term outcomes" of insomnia. The study found that there were improvements after about "six sessions of cognitive behavioral group therapy for sleep disturbances."
Cognitive behavioral therapy for insomnia includes the following:
Biofeedback: This method involves sensors which are fixed to a machine and then placed on the body in order to measure body functions like heart rate and muscle tension. The machine shows pictures and produces sounds which enables a general practitioner or clinical psychologist to notice a patient's tensed state.
Stimulus-control therapy: The main aim of stimulus-control therapy is to help an insomnia patient form an adequate and consistent sleep pattern.
Relaxation training: This is used to decrease tension and control thoughts that may be intruding and disturbing sleep. Relaxation training methods include guided imagery and hypnosis among many others.

Paradoxical intention: This is used for people who have a hard time getting to sleep but it doesn't help stay asleep.
Sleep restriction therapy: This method involves putting a limit to the amount of time in bed which then leads to minor sleep deprivation. At this point, sleep time increases.
MEDICAL TREATMENTS
Hypnotics are sleeping medications that help people sleep. While it was used more often in the past, nowadays, it is not used by a lot of people. These medications are only considered for severe insomnia, as a temporary treatment for short-term insomnia, or if cognitive and behavioral treatments do not help with insomnia. Sleeping medications are not used by a lot of people because they could have dangerous side effects. They also reportedly cover up the symptoms of insomnia without actually treating it fully. The types of prescription drugs used for insomnia are melatonin receptor agonists and benzodiazepine/ non-benzodiazepine hypnotics. Specific examples include Ramelteon (Rozerem) and Zaleplon (Sonata).
Although not highly recommended, over the counter sleeping pills can be used for insomnia, however, most of them have side effects. Experts recommend speaking to a general practitioner in order to decide if OTC drugs can be used to treat insomnia.
HOME REMEDIES
Mild cases of insomnia can be managed by trying home remedies or by making simple lifestyle changes. Meditation is an easy and natural way of treating insomnia. It can help keep out intrusive thoughts that prevent adequate sleep which in turn makes it easier to stay asleep.

Essential oils are aromatic liquids created with flowers and plants. Inhaling or rubbing essential oils like sandalwood, cedarwood, lavender, and neroli helps promote sleep. About 12 studies have revealed that these essential oils are beneficial for adequate sleep.

TREATMENTS THAT SHOULD NOT BE USED FOR INSOMNIA

In general, a general practitioner or clinical psychologist should be contacted in order to determine the best way to treat insomnia. That being said, medications such as antidepressants, barbiturates, clomethiazole, chloral hydrate, herbal remedies, and alternative treatments such as acupuncture are not recommended for the treatment of insomnia. This is because there are no studies revealing how effective these medications are for insomnia. In addition, their side effects may be too harsh on a patient with insomnia.

EFFICACY OF INSOMNIA TREATMENTS

In order to determine the efficacy of the above mentioned insomnia treatments, we first went through peer reviewed health related journals discussing insomnia. Reports were found in journals like Oxford Academic, BMJ Journals, and the US National Library of Medicine. However, these reports simply mentioned that insomnia treatments like cognitive-behavioral therapy are effective, they did not provide a specific efficacy figure to rate the effectiveness of these treatments.

Our next approach involved scouring articles published by hospitals and healthcare organizations such as Mayo Clinic and Stanford Healthcare but these articles only cited the exact same information provided in the journals we initially relied on. We proceeded to examine insomnia associations and organizations including but not limited to National Sleep Foundation, American Sleep Association, and World Association of Sleep Medicine. Again, these platforms only stated that the insomnia treatments we found were effective, no further details were provided.

We found several studies on the efficacy of cognitive-behavioral therapy for insomnia but these studies were obstructed by paywalls. While summaries of their findings were provided, specific figures on the efficacy of insomnia treatments were not offered. We infer that the main reason there was no data on the efficacy of cognitive-behavioral therapy, home remedies, prescription drugs, and OTC pills for insomnia has to do with the fact that there are numerous drugs and methods in these categories and the efficacy of each one might be different.

CONCLUSION

The main risk factors for insomnia include age, gender, medications & stimulants, psychological factors such as stress, chronic diseases, and environmental changes. To treat insomnia, cognitive-behavioral therapy should be the first-line of action. Other recommended treatments include sleeping prescription drugs, over the counter pills, essential oils, and meditation. Unfortunately, we were unable to find the efficacy of these treatments.

Part
03
of three
Part
03

Global Burden/Cost of Insomnia

Each year, insomnia translates to a cost of around USD 100 billion worldwide, with a large fraction of this cost traceable to indirect costs, including reduced productivity and absenteeism. As 70% of people with a persistent form of this sleep disorder do not seek medical treatment or help, the disorder is often undiagnosed and untreated. Nevertheless, the global markets for insomnia treatment and sleep testing services are large, amounting to USD 5.26 billion and USD 7.56 billion, respectively. Though the global insomnia diagnosis market size and the portion of the sleep testing services market accounted for by insomnia could not be reliably determined with publicly available information, details on the impact of insomnia on mortality and morbidity were found. Experts disagree on whether insomnia increases or has no effect on the risk of mortality, and insomnia appears to be strongly associated with angina and depression in Brazil, Russia, India, China, and South Africa (BRICS).

METHODOLOGY

Searching through scholarly literature, private and government health sites, market research reports, news articles, and medical organization sites, we readily found the global burden or cost of insomnia, the percent of people whose insomnia is left untreated, and the size of the global insomnia treatment market. Materials published by pharmaceutical company Idorsia, Oxford Academic, Persistent Market Research, Reuters, Washington State University, ScienceDirect, Statistics Canada, Healthline, the American Academy of Family Physicians, and The Sleep Wellness Institute were among the sources we found useful. The parts that were trickier to find were the size of the global insomnia diagnosis market and the global impact of insomnia on mortality and morbidity.

To find the size of the global insomnia diagnosis market, we first checked if market research firms have released reports on the subject. This step led us to Market Research Future's report on the global sleep testing services market, which unfortunately covers not just insomnia but several other sleep disorders as well. We proceeded to search for academic or scholarly literature, through press and database searches, but our efforts were to no avail. Our searches on Google Scholar, for example, did not yield the desired result. While there are a lot of literature on insomnia, we were unable to find information that would help us determine the size of the global insomnia diagnosis market. Searching within the sites of sleep-specific organizations and publications such as the World Sleep Society, the National Sleep Foundation, Sleep Research Society, the American Academy of Sleep Medicine, the European Sleep Research Society, and the American Sleep Association did not help either.

Regarding the global impact of insomnia on mortality and morbidity, we used nearly the same research strategies. We conducted press searches and scholarly literature searches and scoured private and government health information sites. All we were able to find, however, were whether insomnia increases the risk of mortality and whether insomnia is associated with certain diseases or conditions. The scope of the studies we found regarding this topic is not global, but the findings were based on data from different parts of the world. No monetary metrics were provided.

COST OR BURDEN

The global cost or burden of insomnia is approximately USD 100 billion each year, according to pharmaceutical company Idorsia, whose target diseases include insomnia. Insomnia is the primary cause of absenteeism and decreases in productivity at work. Compared with people with normal or healthy sleep, people with insomnia have three times higher tendency to lose concentration during the day and two times higher tendency to suffer from reduced energy levels. They have three times higher tendency to feel down or depressed as well. Insomnia starts a vicious cycle of stress, negative thought patterns, and worse sleep. Relationships may be impacted as well, as people with insomnia tend to be irritable, demotivated, and less social. The risk of injury and accident is also higher among people with insomnia, as lack of sleep leads to driver fatigue and driver fatigue compromises driving speed and accuracy. In the United States, 100,000 vehicle accidents happen each year as a result of "drowsy driving," while in the United Kingdom, fatigue leads to GBP 115 million to GBP 240 million in costs related to work accidents.

In Canada, the cost of insomnia is pegged at CAD 5,010 per person each year, with almost 90% of this cost traceable to indirect costs, including reduced productivity and absenteeism. In the United States, on the other hand, the burden of insomnia on the country's economy is estimated at USD 63 billion per year, inclusive of costs associated with health care, lost productivity, workplace errors, and work accidents. Over 5.5 million family physician visits in the country can be attributed to insomnia. According the Sleep Wellness Institute, 70 million Americans spend a total of USD 150 million each year "on a variety of methods to either help them fall asleep at night or keep them awake during the day."

PERCENT UNTREATED

According to Idorsia, insomnia is typically under-diagnosed and under-treated. Approximately 70% of people with persistent insomnia do not seek medical help, even though people experiencing sleep disturbance for over a few weeks are advised to do so. The government of Canada also reports that in their country, insomnia is frequently unrecognized and untreated due to reasons relating to assessment and management. An article published in the benchmark journal Sleep shows that among Medicare beneficiaries in the United States, untreated insomnia leads to increased health care utilization rates and costs across inpatient care, emergency care, prescription fills, and other points of service.

Fore Pharma has released a report detailing the estimates and projections of insomnia prevalence, insomnia diagnosis rate, and insomnia treatment rate across key markets including the United States, France, Germany, Spain, the United Kingdom, Italy, and Japan. Unfortunately, the report is paywalled.

IMPACT ON DIAGNOSIS AND TREATMENT

The impact of insomnia on diagnosis and treatment can be seen in the size of the global markets for insomnia treatment and sleep testing services. Persistence Market Research projects that the size of the global insomnia treatment market will grow at a CAGR of 5.2% during the period 2018-2026 to reach USD 7.5 billion by 2026. As the calculation below shows, this forecast means that the size of the global insomnia treatment market in 2019 is around USD 5.26 billion. In 2017, over-the-counter drugs accounted for around two-thirds of the global insomnia treatment market.

0.052 = ((USD 7.5 billion/x)^(1/7))-1
x = USD 7.5 billion/(1.052^7) = USD 5.26 billion

A report by Market Research Future, on other hand, shows that the size of the global sleep testing services market in 2017 was USD 5.9 billion. This size is expected to grow at a CAGR of 13.2% during the period 2019-2023; therefore, the size of the global sleep testing services market in 2019 is around USD 7.56 billion.

USD 5.9 billion x 1.132 x 1.132 = USD 7.56 billion

The portion of this market accounted for by insomnia could not be ascertained, however, as the full version of the report is behind a paywall. The market is inclusive of the following sleep disorders: insomnia, obstructive sleep apnea, restless leg syndrome, narcolepsy, circadian rhythm disorders, and rapid eye movement (REM) sleep disorders.

IMPACT ON MORTALITY

Insomnia has no measurable impact on mortality, according to a meta-analysis published in Sleep Medicine Reviews. The meta-analysis found that the chances of mortality do not differ between people with symptoms of insomnia and people without. This finding supports the use of cognitive therapy as a "frontline non-pharmacological treatment" for the disorder to dispel patients' fears about insomnia affecting their longevity. Dr. Sairam Parthasarathy of the University of Arizona College of Medicine argues, however, that persistent insomnia, the type that has occurred for at least six years, results in increased risk of death. His study, which followed 1,409 people for 20 years, was published in the American Journal of Medicine.

IMPACT ON MORBIDITY

Insomnia is highly associated with the presence of at least four chronic conditions in Brazil, Russia, India, China, and South Africa (BRICS), according to a study published by doctoral fellows at the International Institute for Population Sciences in India. The study found a significant association between insomnia and angina or insomnia and depression in all five countries. It also found a significant association between insomnia and arthritis in China, India, and Russia and a significant association between insomnia and diabetes or asthma in India.

Sources
Sources

From Part 01
Quotes
  • "An estimated 33% to % 50% of general population is affected by insomnia."
  • "people over the age of 60 years are at a greater risk of insomnia"
Quotes
  • "approximately 25% of adult population already suffer from sleeping disorders, of which around 6-10% have been diagnosed with insomnia."
Quotes
  • "37% of people aged 20 to 39 report some degree of short sleep duration, and 40% of people aged 40 to 59 report the same. Overall, 35% of adults report receiving fewer than 7 hours of sleep within a normal 24-hour interval."
From Part 03
Quotes
  • "Insomnia is a leading cause of absenteeism and reduced productivity at work. The estimated global cost of insomnia is around USD 100 billion each year."
  • "Insomnia is often under-diagnosed and under-treated. It is estimated that around 70% of people with persistent insomnia never seek medical help."
Quotes
  • "A total of 151 668 beneficiaries were found to have insomnia. Compared to controls (n = 333 038), beneficiaries with insomnia had higher rates of HCU across all point of service locations. Rates of HCU were highest for inpatient care (rate ratio [RR] 1.61; 95% confidence interval [CI] 1.59, 1.64) and lowest for prescription fills (RR 1.17; 95% CI 1.16, 1.17). "
  • "Similarly, compared to controls, beneficiaries with insomnia demonstrated $63,607 (95% CI $60,532, $66,685) higher all-cause costs, which were driven primarily by inpatient care ($60,900; 95% CI $56,609, $65,191). Emergency department ($1,492; 95% CI $1,387, $1,596) and prescription costs ($486; 95% CI $454, $518) were also elevated among cases relative to controls."
Quotes
  • "As suggested by a recent conducted research study by Persistence Market Research, the global insomnia treatment market is projected to register a promising CAGR of 5.2% in terms of value during the forecast period 2018-2026. By the end of 2026, the market will possibly reach over a value worth US$ 7.5 billion."
Quotes
  • "The Global Sleep Testing Services Market is anticipated to hold a market value of USD 5.9 billion in the year 2017 and is expected to grow at a CAGR of 13.2% during the forecast period. Sleep testing services are used to diagnose sleep disorders by recording heart rate, breathing patterns, brain waves, eye movements, leg movements, etc."
Quotes
  • "The report provides insights into Insomnia epidemiology, Insomnia diagnosed patients, and Insomnia treatment rate for top seven pharmaceutical markets. The study measures key indicators such as prevalence of Insomnia derived from epidemiological analysis, percentage of patients diagnosed with Insomnia, and percentage of patients treated with a therapy. "
Quotes
  • "In Canada, the individual economic burden of insomnia is estimated at $5,010 per person per year, with nearly 90% of this amount attributed to indirect costs such as work absenteeism and reduced productivity."
  • "Despite its high prevalence and burden, insomnia is often unrecognized and untreated because of barriers to its assessment and management."
Quotes
  • "Estimates put the burden of insomnia on the U.S. economy at a whopping $63 billion per year in lost productivity, increased health care expenses and costs associated with workplace errors and accidents."
Quotes
  • "The purpose of this review was to evaluate the strength of evidence for a relationship between risk of mortality and frequent and ongoing insomnia using a meta-analytic strategy."
  • "There was no difference in the odds of mortality for those individuals with symptoms of insomnia when compared to those without symptoms."
Quotes
  • "Dr. Sairam Parthasarathy, a sleep specialist at the University of Arizona College of Medicine, is the co-author of one of the studies that was included in the meta-analysis."
  • "He said he didn’t think the analysis was a “fair representation” of data from his 2015 study in The American Journal of Medicine."
  • "That study found that people with persistent insomnia — six or more years — had an increased risk of dying from cardiovascular or lung disease, or from any cause, compared to people without insomnia."
Quotes
  • "In the present study, angina, arthritis, and, depression was significantly associated with sleep problems in the majority or all of the countries. In line with the findings of Koyanagi et al., we found that in all the countries studied; insomnia had a highly significant association with the presence of four or more chronic conditions. "
Quotes
  • "Insomnia accounts for more than 5.5 million visits to family physicians each year. "
Quotes
  • "As many as 25 percent of Americans endure an occasional bad night of sleep, and approximately 10 percent have a chronic problem with insomnia. Each year 70 million Americans spend approximately $150 million on a variety of methods to either help them fall asleep at night or keep them awake during the day."