While insomnia is a disorder, it’s just as commonly a symptom, which most people and physicians don’t grasp, said Dr. Atul Khullar, medical director at the Northern Alberta Sleep Clinic.
A lot of times, not sleeping is essentially the body breaking down because of a separate disorder, risk factor or residual symptom of a mental-health concern, he added during a session at Benefits Canada’s 2019 Vancouver Mental Health Summit on Dec. 12.
A big problem is the cognitive brain and how we trick ourselves into not sleeping. “This leads to decreased productivity and increased health-care costs. We know it’s not good to not sleep. Economically — and this is quite substantial — the individual with insomnia’s health-care costs are almost quadruple and much greater than a good sleeper’s.”
Read: A look at employers’ role in the battle against insomnia
Addressing sleep concerns requires a wide range of tools, said Dr. Khullar, noting simple, cost-effective fixes may cover a large percentage of concerns. “You’re never going to cover everything, we know this. We just want to know what works, what’s consistent, what’s going to get people healthier, happier and more productive.”
Sleep disorders fall into a number of categories, he said, highlighting sleep apnea as one of these. In fact, many plan sponsors have shifted their coverage of sleep apnea machines, even though clear evidence shows mild sleep apnea can reduce quality of life and productivity. “It’s a little inconsistent and what’s important is that your benefits plan gives messages to your employees. If you’re covering health, exercise and wellness, they feel it’s important. If you’re inconsistent, not covering certain things, they don’t feel it’s a priority.”
Even if the insomnia problem is treated, it may not make someone a good sleeper, but it will reduce the burden, said Dr. Khullar. Referencing a Norwegian study on good versus bad sleepers, he said the people who didn’t sleep well were five times more likely to go on permanent work disability and two to three times more likely to take sick leave than those who slept well.
Read: Sleep a serious issue with major productivity costs for employers
The issue with insomnia workups is they aren’t easy, he added, noting access to proper assessment is one of the best things plan sponsors can facilitate. A lot of problems are related to sleep disorders, so early assessment for mental health and insomnia is important. “It’s critical at the very beginning to get a solid assessment because too many physicians wait — and the longer someone’s off work, the less likely they are to come back.”
It’s crucial to offer cognitive behavioural therapy in some way, shape or form, since it can help change sleep behaviours and patterns, said Dr. Khullar. The No. 1 treatment for insomnia isn’t a drug, he added, it’s CBT, and it doesn’t matter how the CBT is delivered. “There are a million different ways, especially now with advanced technologies. The point is, deliver it.”
Once an individual begins looking at their sleep, they may uncover mental-health issues, he noted. As well, people have difficulty admitting their mental-health issues, so it’s vital to understand how these two areas connect. Sleep might be the more acceptable way that someone manifests their mental-health issue, he added.
Read: Why employers stand to gain by helping their employees sleep
Where people are prescribed medications to help them sleep, the No. 1 benefit for their mental health is taking that medication, since they can’t achieve quality of life improvements or functional recovery without following the plan, said Dr. Khullar. But where people experience side-effects, they aren’t going to take them, he added. “Many people don’t take their anti-depressants for a number of reasons, but a big one is because of the side-effects.”
Plan sponsors can’t cover everything, he noted, but the option to cover some newer treatments can actually help. “Often, [plan members] end up being stuck with what’s covered under their benefits plan. Maybe you include exemptions, not everyone can get them, but they should be available because otherwise people use [over-the-counter] products, which can actually be very dangerous.”
Read more from the 2019 Vancouver Mental Health Summit.