Professor David Hillman Sleep Health Foundation Interview

Professor David Hillman Sleep Health Foundation Interview

A new economic report commissioned by the Sleep Health Foundation has revealed sleep disorders cost the Australian economy more than $5.1 billion a year in health care and indirect costs. In addition, the reduction in life quality caused by sleep disorders has a further cost equivalent of $31.4 billion a year. The report, 'Re-awakening Australia - The Economic Cost of Sleep Disorders in Australia' highlights more than 1.5 million Australian adults, 9% of the adult population, now suffer from sleep disorders.

The report looks at the economic impact of major sleep disorders including obstructive sleep apnea, insomnia and restless leg syndrome. While around 9% of the adult population is affected by these disorders, the problem of sleep disorders is in fact greater as only individuals diagnosed with these three conditions have been considered. The report notes better diagnosis and detection, which together with increasing obesity, ageing and stress levels, are increasing the prominence of these conditions. The Sleep Health Foundation is concerned by the scale of problems associated with sleep disorders in Australia.

Professor David Hillman, Chair of the Sleep Health Foundation and director of the West Australian Sleep Disorders Research Institute commented: "Sleep disorders are debilitating and can cause significant health and relationship problems, as well as effecting productivity in the workplace and at home. Of the $5.1 billion in financial costs to Australia per year, more than $800 million is a direct cost to the health system."

"The high occurrence reflects a better understanding of sleep conditions, but also shows the growing problem of sleep disorders within the Australian population. Besides their own debilitating effects conditions like sleep apnoea can lead to more serious complications such as high blood pressure, heart disease and stroke - which can be life threatening."

The Sleep Health Foundation - Australia's first charity set up to raise awareness of the importance of sleep health - is calling for sleep health to have increased priority on the national health agenda in line with issues such as obesity, exercise, alcohol and smoking.

The Foundation is working to highlight the benefits to Australian businesses and the Government, calling for a national sleep summit to begin creating nationwide action plans. This includes:
1. Promoting greater recognition of the value of healthy sleep in Australian workplaces and homes with national preventive health planning;
2. Diagnosis and treatment: Supporting GPs in the detection, diagnosis and treatment of sleep disorders;
3. Workplace screening: For employers to play an increased role in helping diagnose sleep disorders and facilitating treatment, particularly in high risk roles in areas such as transportation, heavy machinery and shift work;
4. Research and development: Further investigation on the impact of sleep disorders on specific conditions such as diabetes and on performance in the workplace.

Professor Hillman continued: "This report considers the cost of sleep disorders alone. It does not consider the additional costs relating to inadequate sleep from poor sleep habits in people without sleep disorders. The Sleep Health Foundation wants to improve the quality of sleep for all Australians."

"Poor sleep is increasingly common amongst Australians, with one in three people regularly struggling with their sleep. It is vital that sleep disorders receive increased focus as a health priority. Now that we know the economic costs we hope that we can work with the Australian Government, GPs and employers to re-awaken Australia."

A significant issue for Australia
The new report found that $270 million per year is being spent caring for sleep disorders. However they cost $540 million per year in health care costs for associated conditions and a further $4.3 billion per year through indirect costs. This includes $3.1 billion in lost productivity and $650 million in informal care and other indirect costs resulting from motor vehicle and workplace accidents.

Sleep disorders contribute to other diseases and injuries. The proportion of each condition attributable to a sleep disorder is as follows:
10.1% of depression
5.3% of stroke
4.5% of workplace injuries
4.3% of motor accidents.

The 'Re-Awakening Australia' report, conducted by Deloitte Access Economics, also found that non-financial costs which place a dollar cost on loss of life quality resulting from sleep disorders contributed a further $31.4 billion per year to the total economic cost.

Interview with Professor David Hillman

Question: How important is sleep and how many hours sleep is recommended for an adult?

Professor David Hillman: The average requirement is eight hours, around that average some people require more and some require less although most of us require around eight hours and most of us are not getting that unless we are on holidays; there are a lot of people who short change themselves on sleep and they do it because they have other priorities such as work, socialising and family activities. Some people really push the amount of sleep required a little too hard and this could be because there is an attitude that sleep is really just a waste of time and it gets in the way of doing other things.


Question: How does lack of sleep effect the health and wellbeing of an individual?

Professor David Hillman: Those who are not getting enough sleep are shortchanging themselves quite severely and the result of that is that they are not functioning to their full capacity and they are not as productive as they think they are and they think being awake longer helps and in actual fact it is a bit of a hindrance. The way in which it hinders are:
Thinking processes aren't quite as sharp
Reaction times are slower
Not quite as vigilant, they don't notice things as well and,
More irritable.

The many affects are a downside in terms of productivity and less safe in terms of operating vehicles or machinery on the road or whilst at work. Also, social interactions aren't quite as deft which also includes irritability. Even though people who have had a lack of sleep are still functioning they aren't doing it as well as if they were properly rested.


Question: Is it important to catch-up on sleep before and after a late night?

Professor David Hillman: Definitely, the brain has a capacity to carry a sleep debt forward, it acts as a bank. If you are in sleep debt, you can and need to repay that sleep debt by sleeping in the next day or spending an extra hour or two in bed, the next night.

Lying in bed awake is not a particularly productive use of time but time spent asleep is time well spent. It is very hard to oversleep and generally if people need more hours in bed it is because they're paying back a sleep debt.

There are some people who have quite long sleep requirements amongst us, teenagers generally need about nine hours a night whilst ten year olds need ten hours of sleep a night and babies need 17 or 18 hours spread over night and day.

There are also some people amongst us that are quite short sleepers and they can get away with five or six hours sleep and still function normally but most of us need the genuine eight or nine hours sleep because that's the way they're structured and it is a genuine need. Those who are short sleepers do seem to judge those who need more sleep as 'lazy' and that's unfair and incorrect. We have some people who believe they only need four or five hours sleep but in actual fact they need more and they're the type of people who are often high-performers but don't get away with their lack of sleep in terms of irritability.

We need to understand the need for sleep for ourselves and understand the need for sleep of those around us, as a community.


Question: Can you talk about sleep disorders?

Professor David Hillman: There is an important distinction between sleep disorders and lack of sleep; basically you can put sleep problems into two main baskets, one is sleep disorders (sleep apnea, insomnia and other things which affect the quality of sleep and no matter how much one tries they cannot get to sleep and feel properly refreshed, which requires professional help) and the other is people who just don't have enough sleep.


Question: How can sleep disorders be treated?

Professor David Hillman: There is a lot of help out there in terms of professional help, first begin with a GP who will refer the patient onto a sleep specialist or psychologist - there are lots that can be done to treat chronic sleep disorders.

A sleep psychologist can reorganise sleep hygiene principles and there are a whole lot of sleep psychologists around Australia who can teach ways of changing thinking in regards to sleep which is called cognitive behavioural therapy. On the Sleep Foundation website we have a link to a state-by-state list of sleep specialists on the Australasian Sleep Association website: www.sleep.org.au and they are the national body of sleep professionals.

Sleep disorders affect 1 in every 10 adults, 5-6% of the adult community have snoring and sleep apnea problems, whilst a lot more snore than that, 5-6% have snoring that needs treating. Another 3% of the adult population has primary insomnia in terms of a sleep disorder not secondary insomnia caused by temporary upset (bereavement process or chronic pain). Another 10% of the population have restless sleep syndrome which involves leg restlessness and disruptive sleep. On top of that there is another huge percentage (approximately 20% of the community) that just has poor sleep habits and don't take sleep seriously enough.

Sleep is not a waste of time; you cannot burn the candle at both ends or train yourself to get away with not enough sleep because you are doing yourself a disservice, it is not good for your health, wellbeing, safety, productivity or behaviour to people around you.


Question: What are your thoughts of sleeping medication?

Professor David Hillman: We don't like sleeping tablets, they are strictly for the short term, sometimes medication is necessary in the short term to give people confidence that they can get to sleep but really non-drug treatments are the way to go. Four or five sessions with a sleep psychologist can be enough to put people on the right path again; it's not an indefinite involvement but a short term way of thinking about things differently to get the brain where it needs to be to sleep.

For some people, like me, sleep is an automatic process - you go to bed and go to sleep and it's all very lovely. For others, they have lost the skill and need to relearn it.

There are some obvious errors such as television in the bedroom, mobile phone on or even going to bed with a head full of worry. If you are a worrier, it is quite useful to have 'worry time' before you go to bed and this time might be reviewing the day's activities and writing down a plan for tomorrow and then you can set the day to rest before getting into bed.
Those that don't have sleep concerns need to be sympathetic about those that do.


Question: Does lack of sleep affect women and men differently?

Professor David Hillman: We have recently surveyed this type of problem amongst Australian adults and we have looked at it by gender and age group; 30% of the sample overall complained of imperfect sleep and waking on a regular basis at least several days a week or daily and not feeling refreshed. Amongst that 30% group would be those with sleep disorders I have referred to. When looking at younger women of working age through to those in their mid 40's then the results increase to 40% complaining of imperfect sleep.


Question: Why is it that those who don't have sleeping disorders are having imperfect sleep and waking on a regular basis?

Professor David Hillman: I think it is because life is so exciting for some and we have a number of things available to us and women are particularly in tune with social media and are always switched on. It is a matter of having regular sleep habits and a good routine for separating overnight time which is for sleep from the daylight hours which are for activity and organising the transition between the two sensibly. Stimulus control is the other big issue for those with sleep restrictions and by that I mean making sure the stimuli are right for sleep; for instance if you are trying to go to sleep in a noisy environment where there is not great light exclusion at the wrong time of the day then your chances of sleeping is much less than if you have the perfect sleep environment. Exercising close to bedtime is highly stimulating and gets the adrenaline going which causes difficulties in falling asleep.


Question: Can you explain how sleep disorders cost the Australian economy more than $5.1 billion a year in health care and indirect costs?

Professor David Hillman: It is a lot, people often ask if I am sure that it is costing Australia that much. Deloitte Access Economics conducted this report and they have a good health economics team and they are quite independent which shows the value of this report. When you look at all the assumptions they have made, they have struck a very conservative line on this, where there has been doubt they haven't factored it in. A good example; when you talk about productivity there are two things to think about, one is absentee (which is absence from the workplace due to a sleep disorder and that can be calculated easily) what they haven't been able to put a cost estimate to, even though we know it is a big issue, is present-absentees which is being in the workplace and not functioning properly (where you've had a poor sleep and when you arrive at work and you don't have the sharp edge you normally have).

An example of being present in the workplace but with less productivity due to lack of sleep is when a truckie may have to pull over in account of his sleepiness or an employer notices the lack of productivity or an accident is caused because the operator was sleep deprived - that is where the big costs start to arise.

About $280 million of the $5.1 billion a year in direct financial costs is the cost related to looking after sleep disorders themselves. Another $500 million relates to other health problems directly caused by sleep disorders; including the risk of heart disease (about 4-5% of heart disease can be traced back to sleep disorders); depression and the health related costs of accidents fits in this same area of the lack of treatment of sleep disorders. If you treat the sleep disorder properly there would be costs that didn't exist.

A large part of the remaining 4.2 billion per year is cost related to productivity. This $5.1 billion a year in direct financial costs is from sleep disorders it doesn't attempt to take into consideration those who are just not sleeping properly because of poor choices which is another huge cost on top of the $5.1 billion.

Sleep is not one of our national preventive health priorities and it needs to be tackled because a part of a healthy lifestyle is a healthy sleep; a standard needs to be set for the nation.

Our message is not a killjoy, don't have a good time - it is 'let's bounce into work and our social life and be attractive good company' by getting a good night's rest.


Question: Can you talk about what the The Sleep Health Foundation does?

Professor David Hillman: The Sleep Health Foundation is a newly founded community-based charity strongly supported by clinicians and scientists. Its purpose is to raise awareness of sleep health issues and to promote their prevention and control through advocacy, public education and support of research.

At www.sleephealthfoundation.org.au we have a lot of different information about sleep. We have more than 50 different brochures at the website and we've worked really hard to make the brochures attractive, easy to read, reliable and freely downloadable.


About sleep disorders
1. Obstructive Sleep Apnea (OSA) is a common yet serious condition which causes interruptions in breathing during sleep. OSA is frequently associated with heavy snoring, choking and gasping during sleep, excessive daytime sleepiness, and serious health complications such as hypertension, cardiovascular disease and stroke. It is estimated that approximately 4.7 per cent of the Australian population suffer from OSA, with two times more men than women affected. However a large number are undiagnosed.
2. Insomnia is said to be present when an individual regularly finds it hard to fall asleep or stay asleep. It has several patterns. There may be trouble getting to sleep initially, or a tendency to wake early with trouble achieving sleep. Most people have experienced insomnia symptoms at some time of their lives. Approximately 3 per cent of the population suffers from long-standing primary insomnia and at any given time around 10 per cent of people have at least mild insomnia from a variety of causes.
3. Restless Leg Syndrome (RLS) is a movement disorder characterised by uncomfortable sensations in the legs or sometimes the arms which is relieved by movement. The resulting restlessness often interferes with sleep. As many as 2 to 5 percent of the population may be affected, with varying degrees of intensity.

The report 'Re-Awakening Australia' was commissioned by the Sleep Health Foundation conducted by Deloitte Access Economics and funded by untied grants from Philips Home Healthcare Solutions, Resmed Asia Pacific Ltd and Fisher and Paykel Healthcare.

Interview by Brooke Hunter