Many people with trouble sleeping (PWTS) report that their insomnia causes strain on their romantic relationships, according to results reported by the Wake Up America Survey.
In 2021, Idorsia Pharmaceuticals US, Inc, launched the Alliance for Sleep, which is a multidisciplinary committee with the goals of researching and promoting awareness about sleep and sleep disorders in the United States (US). The Wake Up America Survey is an annual online survey conducted in partnership with The Harris Poll. Adults and health care providers living in the US were invited to participate. The second annual survey, conducted between August and September 2022 comprised 1098 adults with insomnia or trouble sleeping without sleep apnea or substance abuse, 1005 adults who are partners of a person with trouble sleeping, 301 primary care providers (PCPs), and 301 sleep specialists.
In general, PWTS report being inundated with suggestions on how to improve their sleep. These strategies include using melatonin, over-the-counter sleep aids, cannabidiol or marijuana, avoiding alcohol or caffeine, sleep hygiene, using a noise machine, and meditating, among others. However, none of these strategies are monotherapies for insomnia recommended by the American Academy of Sleep Medicine (AASM).
Even though current guidelines do not recommend using these strategies for treating insomnia, most PCPs and PWTS thought melatonin (~70%) and sleep hygiene (>66%) were recommended to treat insomnia.
Investigators also found a disconnect between PWTS and their health care providers (HCPs), in which most PCPs reported asking patients about sleep quality during routine clinical care (67%) but only a third of PWTS reported being asked (36%).
Some of the discrepancy between PWTS and HCPs may be due to bias, in which almost half of PWTS thought there was stigma about medication for sleep, 45% reported a reluctance to seek medication treatment, and 30% a hesitance in talking about sleep with their clinician because of stigma.
Trouble sleeping has long-reaching effects outside the health care setting. Most PWTS (53%) reported that their poor sleep contributed to stress on their relationship, by causing arguments (41%) in general, at least once a month (31%), or constantly (23%). According to both PWTS and their partners, approximately 33% said they argued about how sleep affected the troubled sleeper’s mental or physical health, their partner’s sleep, or their relationship.
In addition, trouble sleeping often caused their partners to “pick up the slack” of the troubled sleeper’s household duties (41%) or to sleep in separate beds (31%).
Overall, researchers found that the results of this survey indicated that PWTS are often misinformed about appropriate treatment strategies and available resources for improving sleep. The lack of focused conversation between patient and HCP likely contributes to a perpetual cycle of misinformation and poor sleep outcomes.
We spoke with Ruth Banca, MD, who is board certified in sleep medicine and psychiatry and is the chair of Behavioral Medicine at Wake Forest Medical School and serves as the co-chair of the Alliance for Sleep.
What were the motivations behind the Wake Up America Survey?
Those of us in the sleep field have known for a long time that insomnia is a serious problem. Insomnia is a difficulty falling asleep or staying asleep and having the perception that the quality of your sleep is generally not good. We know from lots of research that it leads to significant problems both with mental and physical health, yet, in general, I think there’s a sense that insomnia is not really very important. It’s something you should just be able to take care of yourself, that it’s not a serious health problem. I think a big issue for us in the sleep field is to make the public and other HCP colleagues aware that this really is a significant medical issue.
What were the aspects of the survey results that you found most surprising?
Surprising in a good way, to me, was how many people attributed their relationship problems to sleep problems. We know that insomnia has a significant impact on your mental health and your mood. Certainly, if you’re irritable and out of sorts, that’s going to really impact your relationship with your significant other and the people around you. People really attributed some of the difficulties they were having in interpersonal interactions with their sleep.
Some of the things that were surprising in not such a good way were things like how many, not only PWTS, but also HCPs, felt like melatonin was an appropriate treatment for insomnia. There are some things that melatonin can be helpful with, particularly sleep scheduling problems, like if you can’t fall asleep at the right times of day, melatonin is something that sort of helps train your rhythms. But it’s not really an effective treatment for insomnia.
What do you think the disconnect is between the perception of HCPs who thinks that they are asking about sleep and the PWTS who think that they’re not being asked?
It really highlights that we’re not doing a good job in health care asking people about their sleep and doing appropriate things to help them with their sleep. One thing to keep in mind is that the PWTS and the HCPs were not the providers of the PWTS. They were 2 different groups. It might be that the HCPs we assessed maybe are providers who asked more about sleep than the providers the PWTS saw. But I think there actually is more to it than just that. Sometimes we think we ask our patients about aspects of their health, but maybe we’re not really listening, or we think we’re asking about things, but they’re not hearing us.
What do you think needs to be done to start addressing the large unmet need about insomnia in the United States?
First of all, getting the message out to both, PWTS as well as HCPs, that insomnia is a significant health issue and that there are effective treatments. The other thing is trying to get people to understand that addressing sleep problems is a comprehensive lifestyle treatment. It’s not just about good sleep hygiene rules or taking melatonin, it’s really about comprehensive lifestyle treatments and behavioral therapy. We know that cognitive behavioral therapy is an effective treatment for insomnia, yet most people don’t know how to do it or have access to it. There’s also appropriate use of medications, in cases where that’s needed, and identifying other factors that are contributing to sleep problems.
Do you have any specific advice for the partners of someone who has trouble sleeping?
That was another interesting thing from this survey. I’m not sure that there’s ever been a survey of partners of PWTS, outside of the field of geriatrics. I think it’s very frustrating for partners living with someone who’s having a sleep problem, particularly if the partner doesn’t have a sleep problem, they can’t always understand why their partner is having trouble. That can lead to frustration because the partners don’t know what to do to help the person. I think what’s important for people to understand is that if you have a partner with a sleep problem, it’s really no different than having a partner with some other medical problem. We don’t blame people if they have diabetes, heart disease, or high blood pressure, because it is a medical problem. I think, if we can raise awareness that this isn’t just something your partner is doing on purpose or that they should just be able to fix it by themselves, it can be an important first step in supporting the person with trouble sleeping.
What are your plans for the future of the survey?
We’re going to try to keep doing yearly surveys. As we learn more about sleep and understand the impact of sleep problems on people, we can start to dispel myths and create more awareness. I think the other thing to do, in our professional organizations and academically, is to do a better job training future HCPs about how to diagnose and treat a whole range of sleep disorders. Insomnia can be a disorder in and of itself, but it can also be a symptom of many other sleep disorders that have other types of specific treatments.
The Alliance for Sleep has lots of great ideas and we’re already starting to think about what kinds of things we want to ask in next year’s survey.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Wake Up America Survey. The Alliance for Sleep. Accessed December 23, 2022. https://www.wakeupamericasurvey.com/