Stress, Unattended Snoring Among Adverse Sleep Trends Most Prominent in the Past Year

Cases of COVID-19 now on the decline but the early months of the pandemic were conversely dominated by widespread uncertainty amid rising cases and significant feelings of stress and anxiety. In fact, one survey conducted in February and March 2020 found that nearly 7 in 10 employees cited the period as the most stressful time of their entire professional career.

In the same survey, titled “America’s State of Mind Report,” there was a 14.8% increase in sleep medication prescriptions in the United States. The impact of the pandemic on sleep has been reported widely from health workers on the frontlines to generation Z and millennials who are going to bed later than any other generation after quarantine.

To mark National Sleep Awareness Week and World Sleep Day, a new survey issued this week by ResMed as part of the Sleep for a Better Tomorrow initiative sought to further examine US sleep trends in the past year.

Polling 1000 Americans 18 and older in February 2021, the survey found that half of participants (50%) reported stress or worry as negatively impacting their sleep over the past year. When stratifying for gender, more women (35%) reported worse sleep quality than men (26%), with stress and anxiety selected most prominently among women as causes of impaired sleep.

Another finding of the report spotlights an emerging trend of the past year, deferral in care. Among the 58% of Americans who said they snore in the survey, 72% are not concerned if it could be related to an underlying health condition. With snoring indicated as the top symptom of sleep apnea, these populations may be at greater risk for hypertension, heart failure, and heart rhythm disorders, which are all associated with obstructive sleep apnea, the most common form of sleep apnea.

Several notable findings were also reported:

• 35% of respondents say they are having a harder time falling asleep or waking up
• 32% say they are sleeping less than over the last year
• 26% started taking naps more often
• more people working from home (39%) amid the pandemic reported improved sleep quality than those who haven’t worked from home (21%)

“COVID-19 has impacted all aspects of our lives, including our sleep health, leading many people to struggle to get the recommended seven to nine hours of sleep at night,” Carlos M. Nunez, MD, chief medical officer for ResMed, said in a statement.

In an email exchange with The American Journal of Managed Care^® (AJMC^®), Nunez discusses implications of the survey findings further, particularly the importance of heightening awareness of sleep disorders among US physicians and adhering to therapies associated with better sleep outcomes, such as continuous positive airway pressure (CPAP) therapy.

AJMC^®: One notable finding of the survey was that nearly half of survey respondents said their doctor had not asked them about their sleep quality in the past year. Is this common? And how may unaddressed sleep issues affect overall well-being?

Nunez: Through the survey, we found that almost half of patients said their doctor had not asked them about their sleep quality in the past year. This is concerning, as a truly restful night’s sleep is a key component of health that should not be ignored. Unfortunately, it is probably all too common as the average US-educated physician only receives a few hours of formal education in sleep medicine during medical school.

One of the most common sleep disorders, sleep apnea, affects more than 50 million in the United States, yet 80% remain diagnosed and untreated. However, undiagnosed and untreated sleep apnea is associated with many serious health conditions like type 2 diabetes, heart disease, stroke, and even a shortened lifespan.

AJMC^®: 78% of those who reported snoring in the survey are not concerned about whether it could be tied to an underlying health condition, such as sleep apnea. With a deferral in care reported widely amid the pandemic, do you foresee more intensified cases of sleep apnea, such as obstructive sleep apnea, coming as more people seek care? And how can patients and physicians optimally assess for this often undiagnosed condition?

Nunez: We’ve already seen sleep apnea testing and diagnosis rates returning to prepandemic levels over the past few months as COVID-19 restrictions change and vaccines have started rolling out. Plus, cloud-connected CPAP devices have helped patients and physicians alike maintain care and treatment throughout the pandemic.

The impacts on adherence when a patient uses digitally-connected CPAP therapy are worth calling out: 87% of CPAP users are adherent on therapy when remotely and self-monitored versus roughly 50% on non-cloud connected devices.

Patients who use ResMed devices can self-monitor their CPAP use through myAir, a mobile app that provides nightly data on their treatment, and health care providers can quickly access that data through AirView, a cloud-based platform for remote patient monitoring, that shares clinical insights with providers and helps reduce costs related to patient follow-up.

To assess for sleep apnea, it’s helpful to know the associated symptoms–like snoring, excessive fatigue, difficulty concentrating, morning headaches, among others. Ultimately, speaking with a physician about any symptoms or concerns is recommended. SleepforBetterTomorrow.com also provides a free sleep apnea assessment for patients.

It’s critical that physicians speak more often with their patients about their sleep health and patterns. Many physicians feel short on time when speaking with patients, but by addressing sleep health and potential sleep disorders like sleep apnea with your patients sooner rather than later, you could be helping address other potential comorbidities.

AJMC^®: Any other thoughts?

Nunez: Part of the hurdle of educating patients about sleep apnea is overcoming the stereotype that comes with CPAP therapy. CPAP devices are constantly getting smaller, quieter, more comfortable, smarter, and easier to use, allowing for a more restful sleep. It’s important that we share this with patients, as it could help support adherence and better health outcomes.