We talk a lot about the dangers of poor sleep, the risks to health, mental and physical well being and performance, and to quality of life. One serious consequence of poor sleep that sometimes gets overlooked? The risk it poses to accidental death.
A recent study puts in stark relief the dangers that insomnia can pose by increasing the risks for unintended fatal injury. Researchers in Norway undertook a large-scale evaluation of the relationship between symptoms of insomnia and the risk of fatal accidental injury. Their study included 54,399 men and women between the ages 20-89, all of whom participated in a public health study during the years 1995-1997. Researchers collected data on participants over a 14-year period, collecting survey data about the presence of insomnia symptoms, including problems falling asleep, trouble staying asleep, and experiencing poor quality sleep. To identify possible links between insomnia and accidental fatal injuries, researchers examined data on insomnia symptoms in relation to data obtained from Norway's National Cause of Death Registry. Over the 14-year study period, they identified 277 fatal injuries and 57 fatal motor vehicle injuries among the study population.
Researchers found insomnia was a significant factor in accidental fatal injuries, both injuries that involved motor vehicles and those that did not. They found that the greater the number of insomnia symptoms present, the greater the risk was for both fatal injury and fatal motor vehicle injury. In their analysis, researchers made estimates of the proportion of fatal injuries that could have been prevented if insomnia symptoms had not been present.
For fatal accidental injuries:
• Eight percent could have been prevented in the absence of problems falling asleep
• Nine percent could have been avoided without the presence of problems staying asleep
• Eight percent could have been prevented in the absence of poor quality sleep
Among motor vehicle fatalities, the proportion of preventable death was estimated to be even higher:
• 34 percent motor vehicle deaths could have been prevented in the absence of problems falling asleep
• 11 percent of these deaths could have been avoided without the presence of problems staying asleep
• 10 percent of motor vehicle deaths could have been prevented in the absence of poor quality sleep.
These findings highlight another important aspect of the public health problem that insomnia and its symptoms pose. How do the symptoms of insomnia play such a role in increasing accident risk? Another new study points to some answers. Researchers at Université Laval, Quebec examined cognitive impairment in people with insomnia, and found significant deterioration to both attention and episodic memory. Episodic memory is a form of recall that deals with individual recollection of events and their contextual details, including places, times, and emotions. Diminished attention is very likely to be a factor that could contribute to accidental fatalities--and it is entirely possible that compromised episodic memory could play a role as well.
With nearly a third or more of adults estimated to experience insomnia symptoms, the danger that these sleep problems pose -- not only to health and performance but also to the risk of accidental death--are widespread and significant. Diagnosing and treating insomnia is critically important to public health and safety. We've seen tremendous progress in the treatment of insomnia, both in pharmacological and non-pharmacological therapies.
The newest pharmaceutical treatment for insomnia is a medication, Belsomra, created by Merck. Belsomra recently received approval by the FDA for use in treating difficulty falling asleep and staying asleep. This is an entirely new type of sleep medication, known as an orexin receptor antagonist, which works differently than other prescription sleep aids. This medication interrupts the signaling activity of orexin, a chemical in the brain that promotes wakefulness and alertness. Unlike other sleep medications that seek to turn on the brain's sleep switch, this new form of medication turn's the brain's wake switch off. The complaint I hear from my patients more often than any other is that they have trouble sleeping because they "can't turn off their brain." I believe this new form of medication has significant potential to help people struggling with this form of insomnia symptom.
Other important therapies exist to help reduce or eliminate the difficult symptoms of insomnia. Cognitive behavior therapy is one. CBT has been shown tremendously effective in reducing the symptoms of insomnia. CBT for insomnia works by changing both behaviors as well as attitudes and feelings about sleep. In a series of structured sessions with a therapist or counselor, patients work to identify thoughts and behaviors that hinder sleep, and then to replace those behaviors with habits that promote sound sleep. Over time, feelings about sleep -- frustration, anxiety, fear -- fade away. I use CBT in my practice on a regular basis with my patients, and it has proven tremendously successful in alleviating insomnia. CBT often includes specific behavioral strategies that can reduce frustration and improve a patient's sleep routine, including:
Sleep restriction. This involves limiting time in bed to actual time spent sleeping, and gradually increasing sleeping time until it is a healthy range. Sleep restriction helps to avoid the frustrating and anxiety-producing routine of lying in bed trying to fall asleep, without success.
Sleep hygiene education. Sleep is deeply affected by lifestyle factors, including diet, exercise, substance use, and sleep environment. Developing knowledge and awareness of these factors and how to adjust them can make a big difference to sleep quality.
Cognitive restructuring. This involves a review of attitudes and beliefs about sleep and work to re-frame those thoughts in more positive ways. Mediation and relaxation training. Specialized relaxation techniques can provide relief for anxiety and help make falling asleep and staying asleep easier.
The most important thing you can do if you're experiencing trouble sleeping, or symptoms of insomnia, is to seek help. Getting the right treatment can help you sleep better -- and can keep you safer.
Michael J. Breus, PhD
The Sleep Doctor™