Sleep Disorders

Insomnia

Insomnia is the most commonly reported sleep complaint across all stages of adulthood. An estimated 30 million American adults suffer from chronic insomnia, and up to 57% of noninstitutionalized elderly experience chronic insomnia. In the United States, total direct costs attributable to insomnia are estimated at $12 billion for health care services and $2 billion for medications. Emerging evidence suggests that being female and old age are two of the more common risk factors for the development of insomnia; other predisposing factors include excess worry about an existing health condition, lower educational level, unemployment, and separation or divorce. Insomnia is comorbid with anxiety and depressive disorders and may lead to the development of psychiatric disorders. Insomnia is correlated with high levels of medical use and increased drug use, as well as increased psychosocial disruption including poor work performance and poor memory.

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a medical condition characterized by repeated complete (apnea) or partial (hypopnea) obstructions of the upper airway during sleep. It is prevalent in 2% to 4% of working, middleaged adults, and an increased prevalence is seen in the elderly (∼ 24%), veterans (∼ 16%), and African Americans. Being an obese male is the number one major risk factor for OSA. The risk of OSA increases significantly with increased weight, and more than 75% of OSA patients are reported to be more than 120% of ideal body weight. Other risk factors that can contribute to OSA include anatomical abnormalities of the upper airway (e.g., large uvula, enlarged tonsils, large neck circumference). Estimates of health care costs for OSA patients are approximately twice that of matched, healthy controls. This cost difference is evident several years prior to the diagnosis. OSA is associated with a higher mortality rate.

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