Academic journal article Scandinavian Journal of Work, Environment & Health

Sleep Disturbance and the Older Worker: Findings from the Health and Employment after Fifty Study

Academic journal article Scandinavian Journal of Work, Environment & Health

Sleep Disturbance and the Older Worker: Findings from the Health and Employment after Fifty Study

Article excerpt

Chronic insomnia is common. The complaint is often defined in terms of sustained difficulties in falling and staying asleep, early morning wakening, awakening unrefreshed, dissatisfaction with sleep, and consequent daytime tiredness (1). Estimates of its prevalence vary substantially by definition and setting. However, in population surveys, about 30% of adults report sleep problems at a given time (2-4), while 6-15% meet formal criteria for an insomnia disorder (4). The high prevalence extends to the subset of the population who are in work (5, 6), a substantial minority of whom take hypnotic medication (5).

Sleep disturbance has been linked with adverse health, including anxiety, depression and widespread pain (1, 3, 7, 8), coronary heart disease (7, 9), and mortality (10). In the workplace, it has also been linked with impaired productivity (7, 11, 12), absenteeism (7, 13) occupational accidents (7, 13) and health-related job loss (14). In the province of Quebec alone, annual indirect costs of insomnia-related absenteeism and lost productivity in 2008 were estimated at almost CAN$6 billion (15). Thus, the economic burden of the condition is considerable, and it is important to prevent.

Established personal risk factors for insomnia include female sex, poor mental health, physical comorbidity and pain, financial worries, and low education (1, 3, 4, 7, 16). Among risk factors in the workplace, attention has focused principally on shift working (7, 12, 17, 18) and combinations of workplace demands, support, control and job stress (7, 12, 17, 19-22).

Only occasionally, however, have estimates been made of the population attributable fractions (PAF) associated with different occupational risk factors for insomnia to assess their relative importance (22). Moreover, some potentially avoidable risk factors, such as coworker relationships, have received little attention. Also, studies have rarely focused on older workers, among whom the occupational causes of sleep disturbance may vary from younger colleagues. One of the few such investigations, a study of French utility workers (23) reported improved sleep quality after planned normal retirement, notably in workers retiring from jobs that carried high demands and low rewards. As demographic trends in developed countries now require people to work longer rather than retire, research on avoidable occupational determinants of insomnia among older workers is all the more pertinent.

In this report, we provide new data on the descriptive epidemiology of sleep disturbance in midlife, explore the relative importance of different occupational risk factors for insomnia among older workers, and also assess associations with self-reported ill-health.

Study population and methods

Our analysis used baseline data from the Health and Employment after Fifty (HEAF) study, a large population-based cohort of older adults resident in England. A report on design, methods, and recruitment has been published elsewhere (24). In short, 8134 adults born between 1948-1962 (target age range 50-64 years) were recruited from 24 geographically-dispersed English general practices contributing data to a research database, the Clinical Practice Research Datalink (CPRD). Subjects who returned an initial questionnaire are being followed up annually through further questionnaires and by record linkage. Ethical approval was received from the NHS Research Ethics Committee North WestLiverpool East.

At baseline, the questionnaire included items on personal circumstances, employment conditions and the work environment, sleep disturbance, sickness absence from work and self-assessed health.

We assessed sleep disturbance through a four-part question based on work by Jenkins et al (25) and used in another population-based British study (3): "How much have you been troubled by sleep problems in the past 3 months? (a) Difficulty falling asleep? (b) Difficulty staying asleep? (c) Waking up too early? …

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