Burden of illness of insufficient sleep duration

Jean-Philippe Chaput, Julie Carrier, Célyne Bastien, Geneviève Gariépy and Ian Janssen

Lack of sleep is not a waste of time and we should be serious about it 

Insufficient sleep duration, defined as sleeping less than 7 hours per night in adults aged 18 years or older^1-3, is a recognized public health issue. In Canada, surveillance of sleep duration is now integrated into national health surveys. The most recent data from 2020 indicate that 17.2% of Canadian adults report sleeping less than 7 hours per night⁴. While a U-shaped association between sleep duration and health outcomes is generally found in adults, with 7-8 hours of sleep per day most favourably associated with health benefits⁵, the public health concern is primarily for insufficient sleep and not long sleep⁶. Key adverse outcomes associated with insufficient sleep duration include cardiovascular disease, hypertension, obesity, type 2 diabetes, depression, cognitive disorders, and accidents/injuries⁵. The high prevalence of insufficient sleep duration, coupled with its wide range of adverse health impacts, point to the urgent need to address insufficient sleep in today’s world.

Why is it important to quantify the economic burden of insufficient sleep?

To better inform policy- and decision-makers, the economic costs associated with insufficient sleep duration can be used to capture the burden that insufficient sleep places on both the health care system and the economy. Research related to the economic aspects of insufficient sleep and sleep disorders has increased in recent years. However, the economic burden of insufficient sleep duration in Canada is unknown. Knowing the health care and health-related losses of productivity costs associated with insufficient sleep duration can help to increase political engagement and motivate actions by prioritizing funding allocation to develop and implement interventions aimed at reducing insufficient sleep in the population. Moreover, estimating the extent to which costs associated with health care expenditures and health-related aspects of productivity losses would decrease if the prevalence of insufficient sleep were to improve would help justify making more investments into public health interventions that aim to improve sleep duration at the population level.

First study to quantify the economic burden of insufficient sleep in Canada

In 2022, we published a study that provided the first estimates of health care and health-related productivity costs associated with insufficient sleep duration in Canada⁷. We also estimated potential savings that would occur if the prevalence of insufficient sleep duration was reduced by 5% in the population. The estimated direct, indirect, and total costs of insufficient sleep duration in Canada in 2020 were $484 million, $18 million, and $502 million, respectively. These values represent 0.5% (direct), 2.7% (indirect), and 0.5% (total) of the overall burden of illness costs for Canada (estimated at $102 billion). The two most expensive chronic diseases attributable to insufficient sleep duration were depression ($219 million) and type 2 diabetes ($92 million). The main contributors of these health care costs were related to hospital care (for coronary heart disease and obesity), prescription drugs (for type 2 diabetes and depression), physician care (for hypertension and cognitive disorders), and mortality (for accidents/injuries). A 5% decrease in the prevalence of insufficient sleep duration (from 17.2% to 12.2%) in Canadian adults would lead to a yearly savings of $148 million⁷.

Implications

Insufficient sleep duration is an important contributor to health care spending and health-related losses of productivity in Canada. Simulation analyses conducted in 2015 show that Canada loses about 80,000 working days per year due to insufficient sleep duration, corresponding to about 9.9 million working hours⁸. Using a macroeconomic model that simulates the various agents in the economy, estimates indicate that the annual economic loss due to insufficient sleep duration in Canada is between $13.5 billion and $21.4 billion, representing 0.9 to 1.4% of the gross domestic product⁸.

Given the high prevalence of insufficient sleep in Canada and the burden it places on the health care system and the economy, efforts aimed at preventing and better addressing this public health problem are urgently needed. We hope that our study will bring more attention to the issue of insufficient sleep as an important public health problem to be addressed in our 24/7 society. Cost-effective sleep health interventions are needed to not only reduce the economic burden of insufficient sleep but also improve health, quality of life, and productivity. It is time to be serious about the negative effects of insufficient sleep and better value sleep in our society.

References

Insufficient Sleep

1. Ross R, Chaput JP, Giangregorio LM, et al. Canadian 24-Hour Movement Guidelines for Adults aged 18–64years and Adults aged 65 years or older: an integration of physical activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab 2020;45:S57-102.
2. Hirshkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation’s updated sleep duration recommendations: final report. Sleep Health 2015;1:233-43.
3. Watson NF, Badr MS, Belenky G, et al. Joint Consensus Statement of the American Academy of Sleep Medicine and Sleep Research Society on the Recommended Amount of Sleep for a Healthy Adult: Methodology and Discussion. Sleep 2015;38:1161-83.
4. Wang C, Colley RC, Roberts KC, Chaput JP, Thompson W. Sleep behaviours among Canadian adults: Findings from the 2020 CCHS Healthy Living Rapid Response Module. Health Reports (in press).
5. Chaput JP, Dutil C, Featherstone R, et al. Sleep duration and health in adults: an overview of systematic reviews. Appl Physiol Nutr Metab 2020;45:S218-31.
6. Knutson KL, Turek FW. The U-shaped association between sleep and health: the 2 peaks do not mean the same thing. Sleep 2006;29:878-9.