Unmet Needs in Treating Insomnia - Episode 6
Panelists discuss the broad range of impact insomnia has on a patient’s health and quality of life.
Michael J. Thorpy, MD:We’ve talked a lot about the symptoms of insomnia, the causes, the prevalence, and how to diagnose it. But what are the real consequences of insomnia? What does insomnia do to people that makes it important for us to treat these patients? Erin, would you like to respond?
Erinn E. Beagin, MD: I’ve alluded to this a little already: a lot of the consequences of insomnia are on quality of life as well as comorbid conditions. We know that patients who have chronic insomnia, in general, can have an increased systolic and diastolic blood pressure. They’re not necessarily obtaining that nocturnal dip in blood pressure that we normally see. There’s definitely an increased risk of hypertension and cardiovascular disease. There’s an increased risk of diabetes in people who have chronic insomnia. Obviously, we also talked about an increased risk of comorbid psychiatric conditions, and that insomnia may predispose that patient or predicate them to develop depression or anxiety later on. There’s an increased risk of atrial fibrillation in patients who have chronic insomnia.
The other big thing is quality of life—fatigue, sleepiness, not engaging with family and friends as much. Studies have shown that people who have chronic insomnia are less likely to receive promotions at work. They may be more prone to errors and accidents at work. Interestingly enough, with the promotion things, it’s not necessarily that their performance is down; it’s just their engagement with the work. Their confidence in going into work and saying, “I’m doing a good job performing at 100%, so you should give me a good review and a promotion.” If there’s increased absenteeism from work, they say, “I didn’t sleep. I can’t be on top of my game. I’m not going into work today.” If there’s increased family tension, they say, “I’m not sleeping. My husband is waking up because I’m padding around the house.” Thus, there’s increased tension psychosocially with other relationships. There are some data coming out that there might be an increased risk for dementia, increased amyloid-beta levels in the brain, in patients who have chronic long-standing insomnia. We really need to pay attention and realize that there can be detrimental effects in the long term on the patient’s health.
Michael J. Thorpy, MD:One area that is of particular interest because of the pandemic is that insomnia can affect the immune function. In fact, some studies have shown that vaccinations in people with insomnia don’t lead to as good an antibody response as in people who are good sleepers. Thus, it’s very important for our immune system that we get good night’s sleep.
Nathaniel Fletcher Watson, MD: Another issue—I’m glad Erinn brought up the workplace-related issues because those are so important and often get overlooked—is absenteeism and presenteeism, which is showing up but not engaging. Then also health care utilization, that’s a big 1. If we look at a macroeconomic perspective on insomnia, health care utilization goes up in people who have insomnia. It’s economically consuming resources within our health care system that could be deployed elsewhere if we could get these issues addressed. It’s a problem that touches on many aspects of our lives.
Karl Doghramji, MD: Michael, the interesting question is, why does all of this happen? How are these consequences mediated? We tend to think of sleep deprivation or poor sleep as the cause, but there are some data suggesting that they’re the pathophysiological basis of insomnia, which may be causing some of this. This tendency is for central nervous system and peripheral nervous system hyperactivation, overactivation, sympathetic hyperactivity, hypothalamic-pituitary system hyperactivity. This, in turn, can lead to things like oxidative stress and some other dysfunctions on a cellular level as a result of insomnia. It’s a disease that’s quite global in nature involving the entire body.
Transcript edited for clarity.