Insomnia is costing us billions of dollars every year -- and not just for those of us who are staying up at night. In the mid-1990s, the treatment of insomnia was estimated at $10.9 billion annually, reduced productivity was $41 billion annually, and, conservatively speaking, fatigue-related car accidents was $1.75 billion annually. These staggering amounts have only increased since that time. A more recent analysis indicates that on an individual basis, the annual per-person costs are more than 10 times greater for adults with insomnia versus good sleepers. While these costs are obviously hard to fully comprehend and appreciate, one thing is clear: Insomnia is expensive -- and we all pay in one way or another.
Given the exorbitant expense, it is not clear why more is not being done to address insomnia. The pharmaceutical industry has poured fortunes into developing medications as treatment. And, to be sure, medications can be a useful aid in the short-term. But for most, when the medications stop, the relief stops. Others refuse to take sleep meds, or have other medical reasons for avoiding them.
There are alternatives to medication -- and one, in particular, has been shown to be remarkably effective: cognitive-behavioral therapy. It is not only possible but desirable to teach people how to manage their sleep problems, and in the process provide long-term success. But more research is needed. And research requires money. Researchers need funding to develop, improve, sustain, and disseminate long-term insomnia solutions like CBT.
Medical research is big business in this country. But historically very little of this money has gone to insomnia research. For decades, those with insomnia were regarded as "silent sufferers," often going undiagnosed, even when seeking help. Fortunately, this situation has changed, thanks to heightened media attention, increased interest from drug makers, and -- crucially -- improved sleep science research.
But at the risk of sounding dramatic, this science is in peril. Not because research being conducted in the field is poor or of deficient quality. Quite the opposite, in fact. It is because the funding for this research is drying up and getting almost impossible to obtain.
The challenge to secure funding for research is not limited to insomnia. The National Institutes of Health (NIH), the largest funder of medical research in the world, has the difficult task of identifying and funding the highest quality research proposals to advance the medical field. NIH resources, in part, lead to new diagnostic tools, better treatments, and more effective devices. However, funding challenges have dramatically increased in the past decade with stagnant budgets and ever increasing competition for grant dollars. Over the past 15 years, total submissions to NIH for funding has increased 32 percent while the overall success rates of securing grant funding has decreased by 42 percent. Funding lines at some NIH institutes are rumored this year to be as low as the fifth percentile. It is hard to imagine how science and scientists survive in the U.S. at these rates.
But for insomnia research, the future is more bleak. Fewer insomnia studies are being funded by NIH, and the interest seems to be waning even further. To provide some perspective, a brief, and albeit unscientific, review of the number of NIH-funded studies revealed this: Using NIH's Research Portfolio Online Reporting Tools (RePORTER), a quick search for the term "insomnia" entered into the RePORTER tool -- which searches project titles, abstracts, and scientific terms of current grants -- resulted in 194 entries. Compare this to "schizophrenia" (1,827 entries), "depression" (3,939), "diabetes" (6,883), and "cancer" (22,577). Granted, one would expect (and perhaps even hope), that there would be more research on "cancer" than "insomnia." But 11,500 percent more?
The irony, of course, is that funding has declined as the prevalence of insomnia has risen. Treatment costs have also been increasing. And, to make matters worse, decreased research is occurring just as we are beginning to understand the myriad costs, consequences, and connections that insomnia has on individuals and society, such as depression, weight gain, cardiovascular disease, and diabetes, to name a few.
With approximately one-third of the U.S. population suffering from symptoms of insomnia, it is frustrating that so little funding is allocated toward sleep research, especially given the significant psychological, health, and already mentioned financial ramifications. Clearly, greater resources are needed to address one of the most frequent health complaints in our country (second only to pain -- 3,049 entries).
Now is a particularly daunting time to discuss problems of NIH funding. Budget sequestration seems certain to make a bad situation even worse, as NIH struggles with harsh, indiscriminate cuts to its own funding levels. But the upshot, sadly, will be less research and more sleepless nights -- both for the insomniacs and the sleep scientists.
For more by Dr. Lee Ritterband, click here.
For more by Dr. Frances Thorndike, click here.
For more on sleep, click here.