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Chronic Insomnia Disorder in Australia Chronic Insomnia Disorder in Australia A REPORT TO THE SLEEP HEALTH FOUNDATION 1,2 1. Appleton Institute, CQUniversity Australia 44 Greenhill Amy C Reynolds Road, Wayville SA 5034 3,4 Sarah L Appleton 2. School of Health, Medical and Applied Sciences, CQUniversity Australia 4,5 Tiffany K Gill 3. Adelaide Institute for Sleep Health: A Flinders Centre of Robert J Adams 3,4 Research Excellence, Flinders University, Bedford Park, SA. 4. The Health Observatory, Adelaide Medical School, The University of Adelaide, SA. 5. South Australian Health and Medical Research Institute, Adelaide, Australia Chronic Insomnia Disorder in Australia A Report to the Sleep Health Foundation Amy C Reynolds1,2, Sarah L Appleton3,4, Tiffany K Gill4,5 & Robert J Adams3,4 1. Appleton Institute, CQUniversity Australia 44 Greenhill Road, Wayville SA 5034 2. School of Health, Medical and Applied Sciences, CQUniversity Australia 3. Adelaide Institute for Sleep Health: A Flinders Centre of Research Excellence, Flinders University, Bedford Park, SA. 4. The Health Observatory, Adelaide Medical School, The University of Adelaide, SA. 5. South Australian Health and Medical Research Institute, Adelaide, Australia This work was supported by the Sleep Health Foundation, an Australian not‑for‑profit organisation devoted to improving sleep health, and an unrestricted grant from Merck Sharp & Dohme (Australia) Pty Limited which had no part in conception, planning, execution or write‑up of it. Publication and graphic design by Flux Visual Communication www.designbyflux.com.au July 2019 2 Chronic Insomnia Disorder in Australia EXECUTIVE SUMMARY Sleep problems are common and costly to the Australian community. One common sleep condition is insomnia. Chronic insomnia disorder is broadly were responsible for the survey defined as a perceived difficulty design and analysis. The survey with sleep initiation, consolidation, was conducted online; methodology duration, or quality despite adequate was approved by the University opportunity to sleep, plus subsequent of Adelaide Office of Research daytime impairment, that occur at Ethics, Compliance and Integrity’s least three times per week, lasting Human Research Ethics Secretariat at least three months. The daytime (H‑2018‑214). consequences encompass a wide variety of issues, including significant Sleep problems remain prevalent distress or impairment in social, across the community, irrespective occupational, educational, academic, of age and gender. Around 60% of behavioural or other important areas people report at least one sleep of functioning. symptom occurring 3 or more time per week, and this is consistent The prevalence of chronic insomnia across age groups. However, the disorder is presently unclear, type of symptom varies with age. as there are limited studies that Older people are more likely to have have examined the prevalence difficulty maintaining sleep, while and correlates of insomnia using younger adults have trouble initially definitions which correspond to getting off to sleep. Self‑reported the contemporary classifications of daytime impairments related to sleep the International Classification of are more common among female Sleep Disorders (ICSD‑3) and/or the respondents and younger adults. Diagnostic and Statistical Manual of Mental Disorders (DSM‑V). The Most people who fulfill diagnostic primary aim of this study was to criteria for chronic insomnia do not determine the prevalence of insomnia report a prior diagnosis of insomnia. disorder in the Australian population Overall, insomnia according to according to established current current diagnostic criteria is more diagnostic criteria, and examine common in older Australians. This socio‑demographic and other occurs despite no apparent change in correlates of insomnia in Australia. prevalence in overall sleep symptoms across age, and a decline in daytime The survey was conducted between symptoms with age, in the population March and April 2019 on behalf more broadly. The main influence on of the Sleep Health Foundation this is that older adults are far more among 2,044 adults aged 18 likely to report adequate opportunity years and over across Australia, to sleep than younger adults. This with representativeness for age, indicates that much of the sleep sex, location and an indicator of problem among younger adults can socio‑economic status. Researchers be attributed to circumscribed sleep from Flinders University, The opportunities from external social University of Adelaide and the pressures and behaviour patterns. Appleton Institute of CQUniversity A Report to the Sleep Health Foundation 3 Prevalence of insomnia by different definitions 400 14.8% (303) 300 12.2% (250) 200 7.5% (153) 100 NUMBER OF PEOPLE NUMBER OF 0 Self-reported insomnia DSM-V ICSD-3 (previous doctor diagnosis) Insomnia Insomnia In addition, daytime sleepiness as Insomnia is associated with Relatively few Australians speak the only daytime impairment is far lower income, financial stress, to healthcare professionals about more common among older adults. unemployment, and retirement in the sleep, despite almost half of the This suggests the insomnia phenotype Australian population. In addition, with population reporting inadequate differs across age groups, with the the ICSD‑3 criteria, which are inclusive sleep. Furthermore, sleep is often “hyperarousal” phenotype much less of people in whom pain affects sleep, only discussed as a secondary issue common in the elderly. insomnia prevalence is higher in those during a consultation for other unable to work due to disability. reasons. Use of any form of treatment Similarly, female respondents for insomnia is uncommon, even are much less likely than male The prevalence of insomnia is among those who report daytime respondents to report adequate relatively unaffected by activities in impairments or who have discussed opportunity to sleep (43% versus 60%), the hour before bed, with similar rates sleep problems with a health particularly in the 25 to 44 year age in those who routinely use technology, professional. Usage rates identified group. This contributes to the lower work, eat, drink alcohol or are on in this survey indicate a need for prevalence of chronic insomnia in social media frequently compared to greater education or awareness and female respondents. those who do not. expanded access, to promote use of the gold standard treatment in One of the primary differences Single item questions about diagnosed insomnia, i.e. cognitive behavioural between DSM‑V and ICSD‑3 chronic insomnia disorder do not therapy for insomnia (CBTi), as Insomnia criteria is the consideration capture all individuals who meet self‑reported usage is low, and cost is of patients with pain which either diagnostic criteria and should be a consideration limiting its use. prevents sleep onset, or contributes avoided as indicators of insomnia to wake after sleep onset, as the two in future studies as they likely differ slightly on inclusion criteria. underrepresent prevalence in the population. 4 Chronic Insomnia Disorder in Australia TABLE OF CONTENTS 3 EXECUTIVE SUMMARY 10 Chronicity of sleep difficulties 14 Worry about sleep 6 INTRODUCTION 10 Clinically significant distress 14 Chronicity or impairment in functioning 6 Prevalence of clinical 14 Opportunity to sleep by age insomnia according to clinical 10 Adequacy of habitual sleep and sex opportunities diagnostic criteria is unclear 15 Overall prevalence of chronic 6 Help‑seeking behaviours 10 DSM‑V specific exclusion of insomnia disorder in the and treatment response coexisting medical conditions Australian population for insomnia are not well 11 DSM‑V reference to 16 Sociodemographic understood coexisting mental health characteristics of individuals 7 Ongoing monitoring of sleep conditions and substance use meeting diagnostic criteria problems in the Australian explaining sleep problems; for chronic insomnia disorder community rationale for retaining in Australia participants with mental 18 Motivations for seeking help health and substance use 7 AIMS from a Healthcare Provider in the definition of chronic for Sleep 8 METHODS insomnia disorder 9 Definitions of Insomnia used 19 Use of sleep aids, apps and for Analyses (ICSD‑3 and 12 RESULTS therapeutic approaches DSM‑V) 12 Prevalence of insomnia in Australians with chronic according to diagnostic insomnia disorder 10 Detailed notes about criteria (DSM‑V and ICSD‑3) identifying Insomnia in the 19 Sleep disruption in the survey 13 Prevalence of insomnia broader community sleep symptoms and 10 Difficulties Initiating or 20 REFERENCES insomnia‑related daytime Maintaining Sleep (DIMS) manifestations LIST OF LIST OF TABLES FIGURES 17 Table 1: Distribution of 19 Table 4: Prevalence 13 Figure 1: Prevalence ≥1 insomnia (%, n) classified by of sleep aid, app, sleep symptoms (3+ times/ DSM‑V and ISCD‑3 criteria and therapeutic week) reported by the in relation to participant engagement by sample across age groups demographics insomnia in the 15 Figure 2: Prevalence of Australian population 18 Table 2: Prevalence of ≥1 daytime symptoms (3+ insomnia (%, n) in relation to 19 Table 5: Prevalence times/week) reported by the activities conducted in the (%, n) of sleep sample across age groups hour before attempting sleep disruption 15 Figure 3: Overall (experienced ≥3 18 Table 3: Factors prompting prevalence of chronic nights/week) participants (n=613) to insomnia disorder in the discuss sleep problems with Australian population a health practitioner (n=2,044) A Report to
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