Elsevier

Sleep Medicine

Volume 11, Issue 5, May 2010, Pages 452-457
Sleep Medicine

Original Article
Effects of insomnia and sleep medication on health-related quality of life

https://doi.org/10.1016/j.sleep.2009.09.011Get rights and content

Abstract

Objective

This study, using Short-Form 8 (SF-8), was undertaken to assess the effects of insomnia and sleep medication use on quality of life (QOL) in 2822 people (ages 20–97 years) in a rural population. Factors associated with deterioration of the mental component summary (MCS) score and physical component summary (PCS) score were investigated.

Methods

Questionnaires asked participants’ basic information and included assessments using SF-8, the Pittsburgh Sleep Quality Index (PSQI), and a 12-item version of the Center for Epidemiological Studies Depression scale. Results of PSQI supported the classification of subjects as good sleepers, good sleepers using sleep medication, insomniacs, and insomniacs using sleep medication.

Results

Insomnia was associated with low scores of MCS and PCS. Nevertheless, sleep medication use was associated with low PCS scores only. Good sleepers using sleep medication had significantly higher MCS scores than either insomniacs or insomniacs using sleep medication, but lower scores than good sleepers. Similarly to insomniacs using sleep medication, good sleepers using sleep medication had significantly lower PCS scores than either good sleepers or insomniacs.

Conclusions

Sleep medication was useful to improve mental QOL. That usage, however, might degrade the physical QOL, possibly because of the medication’s adverse effects.

Introduction

Insomnia is well known as a common disorder [1], [2], [3] with a prevalence of about 20% among the general population [4], [5]. Major symptoms of insomnia are poor nocturnal sleep and impaired daytime functioning during wakefulness [6]. In the 2nd edition of International Classification of Sleep Disorders (ICSD-2) [7], daytime impairment as well as nighttime sleep difficulties – difficulty initiating sleep, difficulty maintaining sleep, waking up too early or sleep that is chronically nonrestorative or poor in quality – are emphasized among the diagnostic criteria.

Reports describing clinical populations show that patients with chronic insomnia commonly complain of subjective daytime impairments including mood disturbances, concentration problems, elevated fatigue, and sleepiness [6], [8]. Regarding objective daytime impairments, these patients show impairments in tasks evaluating vigilance, working memory, and motor control [9], [10]. These various daytime dysfunctions attributable to insomnia are presumed to degrade quality of life (QOL), an evaluation of general daytime functioning [11], [12]. Reportedly, degradation of QOL, as evaluated using the standardized 36-item Short Form Health Survey of the Medical Outcomes Study (SF-36), is associated with insomnia’s severity [13]. Because QOL is a complex and multidimensional term, it can reflect the lifestyle, health status, and socio-environmental background of subjects. Although such factors should be analysed when evaluating QOL, few reports have described an association between insomnia and QOL in a general population with due consideration of these demographic factors.

Results of previous studies revealed the use of sleep medication for insomnia by approximately 5–8% of the general population [1], [14], [15]. The relative frequency among the general population of people with at least occasional use of sleep medication is approximately 3–11% [1], [16], [17]. Several studies conducted in clinical settings have revealed that the use of sleep medication improves not only sleep quality but also daytime ability to function and a sense of physical well being of patients with insomnia [18], [19]. In addition, long-term nightly pharmacologic treatment of primary insomnia with any hypnotic has been reported to enhance both mental QOL and physical QOL [20]. Contrary to those reports, others have described sleep medication as having no significant effect on next-day psychomotor performance or QOL [21], [22]. Furthermore, differences in the effects of sleep medication between mental and physical QOL among the general population have not been clarified yet.

In the series of Daisen sleep health care studies, we first reported the prevalence of restless legs syndrome (RLS) among residents in rural areas and the negative impact of the disorder on QOL [23]. Secondly, we presented data related to the influence of insomnia and sleep medication use on depressive symptoms [unpublished observations]. For the present study, we used the 8-item Short Form Health Survey of the Medical Outcomes Study (SF-8) – a simpler version of SF-36 that is nevertheless as useful as SF-36 for evaluating QOL [24], [25] – to clarify the above-described issue of the association between insomnia, sleep medication use, and QOL. This study was designed to evaluate QOL among the general population in a rural community using SF-8, particularly addressing the impact of insomnia and sleep medication use on the mental component summary (MCS) score and physical component summary (PCS) score.

Section snippets

Subjects and procedures

The ethics committees of Tottori University approved this study. All subjects gave their informed consent to take part in this investigation.

This survey was conducted as a part of the above-described Daisen sleep health care studies undertaken in a rural community in Tottori prefecture in western Japan [23]. The total population of the town was 6643 in 2004, with 5528 residents aged 20 years or older (2521 men and 3007 women). Major industries in this area are agriculture, farming, and tourism.

Sample characteristics

Demographic characteristics of the sample population are presented in Table 1. The sample comprised 1222 men (43.3%) and 1600 women (56.7%) with mean [SD] age of 57.4 [17.7] years (range 20–97 years). The mean family size in this cohort was 4.6 [1.6]: 120 subjects (4.3%) lived alone and 1210 responders (43.9%) lived with more than five family members.

Differences in scores of MCS and PCS between the insomniac group and good sleepers group

Supplementary Fig. 1 (in online supplementary material) portrays comparisons between the MCS score and the PCS scores of the insomniac group’s

Discussion

Leger et al. reported that chronic insomniacs showed lower scores of SF-36 than good sleepers in all eight domains. The more severe the insomnia symptoms were, the worse the QOL [13]. Compatible with their results, our results showed that both the MCS scores and the PCS scores were significantly lower for insomniacs than for good sleepers in the study area population.

Results of multiple logistic analysis show that depression and age are associated with the deterioration of physical QOL and

References (47)

  • S. Fulda et al.

    Cognitive dysfunction in sleep disorders

    Sleep Med Rev

    (2001)
  • J. Najib

    Eszopiclone, a nonbenzodiazepine sedative-hypnotic agent for the treatment of transient and chronic insomnia

    Clin Ther

    (2006)
  • M. Ohayon

    Epidemiological study on insomnia in the general population

    Sleep

    (1996)
  • J.K. Walsh et al.

    Prevalence and health consequences of insomnia

    Sleep

    (1999)
  • S. Weyerer et al.

    Prevalence and treatment of insomnia in the community: results from the Upper Bavarian Field Study

    Sleep

    (1991)
  • D.E. Moul et al.

    Symptom reports in severe chronic insomnia

    Sleep

    (2002)
  • International classification of sleep disorders. Diagnostic and coding manual

    (2005)
  • M. Varkevisser et al.

    Chronic insomnia and daytime functioning: an ambulatory assessment

    Behav Sleep Med

    (2007)
  • J.D. Edinger et al.

    Psychomotor performance deficits and their relation to prior nights’ sleep among individuals with primary insomnia

    Sleep

    (2008)
  • M. Varkevisser et al.

    Chronic insomnia and performance in a 24-h constant routine study

    J Sleep Res

    (2005)
  • G.K. Zammit et al.

    Quality of life in people with insomnia

    Sleep

    (1999)
  • D. Leger et al.

    SF-36: evaluation of quality of life in severe and mild insomniacs compared with good sleepers

    Psychosom Med

    (2001)
  • S. Englert et al.

    Differences in self-reported sleep complaints in elderly persons living in the community who do or do not take sleep medication

    J Clin Psychiatry

    (1998)
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