Sleep has been described as the third pillar of health along with diet and exercise. Sleep serves numerous vital functions related to health and well-being. Unfortunately, poor or inadequate sleep is highly prevalent among Western adults.1
Sleep disorders such as insomnia, lack of sleep opportunity, sleep apnea, and circadian rhythm disorders can lead to sleep deprivation and fatigue. Sleep deprivation has been found to have a negative impact on mood, cognition and performance, motor function, and it increases the risk for anxiety and depression.2,3,4 Sleep deprivation and obstructive sleep apnea (OSA) increase the risk for obesity, heart attack, and diabetes.5 The prevalence of sleep deprivation among American workers is high, affecting about 40% of the workforce population.6 The economic costs of sleep disorders to society and businesses are enormous. Insomnia’s direct costs, including medical services, sleep medications, and hospitalizations, have been estimated to be about $13.9 billion annually.7 When one factors in indirect costs, such as presenteeism and resulting depression and substance abuse, the amount skyrockets to about $100 billion.8 OSA also places a substantial financial burden on the healthcare system, with the cost of untreated OSA in the United States estimated to be $67 to 165 billion.9
About the Intervention
The intervention, called ProjectZ, is an internet-based, cognitive behavioral therapy (CBT) designed to help identify and address significant sleep disorders in employee populations. The intervention offers each participating employee an individualized, self-paced, structured, online CBT program of strategy modules to address their particular sleep issues.
The primary objective of the present study was to assess the effectiveness of the intervention in increasing employee productivity and to determine if there was a positive return on investment (ROI). Secondary objectives were (1) to assess the benefit of the intervention in alleviating symptoms of insomnia and sleep deprivation and (2) to determine the prevalence of significant sleep issues in a diverse workforce population. Employee satisfaction data were also collected. The intervention’s outcome measures included the Work Limitations Questionnaire (WLQ), the Abbreviated Insomnia Measurement Scale (AIMS), and the Sleep Deprivation Index (SDI). The WLQ is a validated instrument developed by Debra Lerner and colleagues for calculating the level of workplace limitation or presenteeism.10 The global score on the WLQ can be used to calculate the ROI for participating employers.
The intervention was offered to 1,125 employees at Morrison Healthcare, a division of Compass Group, as part of their “Eat, Move, Sleep” campaign. Among 815 employees who completed the initial screener, 73.4% had at least one significant sleep issue, 49.7% had two or more sleep issues, and 29.0% had at least three major sleep issues. Insomnia, sleep deprivation, and elevated sleep apnea risk were three of the most important sleep issues and had a prevalence of 21.2%, 48.5%, and 34.7%, respectively.
Pre-CBT Baseline/Post-CBT Endpoint Findings
A total of 91 employees completed the final assessment, which allowed for a pre/ post-CBT comparison on the primary and secondary objectives. Of those who completed the assessment, 68% were female and the mean age was 43.2 years. Median time to complete the intervention was 40.1 days (5.7 weeks). The mean pre-CBT baseline WLQ score was 3.27%, which was reduced to 2.00% by the final assessment. This represents an overall reduction in workplace limitation of 38.8%.
When accounting for employee number, salary, degree of productivity improvement, and program cost, the calculated ROI was 8.5x. The number of employees with a positive insomnia score was reduced by 69.2% ,and the number of employees with a positive sleep deprivation index was reduced by 73.0%. The majority of employees found that they learned more about sleep (98.9%), knew how to apply the knowledge to their circumstance (97.8%), felt the program was personalized (97.8%), believed their sleep was improved (83.5%), and believed that their overall health or well-being had improved (78.0%).
In summary, significant sleep issues are quite common in the workforce. Addressing these issues with a comprehensive online sleep CBT program was associated with significant improvements in employee productivity and a positive ROI. The intervention was also effective at resolving symptoms of clinically significant insomnia, and sleep deprivation. The program was very well received by employees and represents a highly scalable and cost- effective solution.
Dominic Munafo, MD, is Chief Medical Officer, Optisom & Sleep Data. Lisa Roberson, RD, is Corporate Director of Wellness & Sustainability, Morrison Healthcare. Mercedes C. Lyson, PhD, is Assistant Professor of Medicine, Tufts Medical Center.
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