By Brandon Peters, MD
How much is a good night of sleep worth? What is the price you would pay to finally sleep well? These can be difficult questions to answer, and as someone who works in sleep medicine with a high degree of altruistic intent, it is a challenge to strike the right balance. How does one offer support and guidance to improve sleep without cashing in on someone’s misery? Let’s review some of the costs associated with untreated insomnia and then discuss the rationale for the pricing of the online CBTI program called Insomnia Solved.
In 2014, the Behavioral Risk Factor Surveillance System (BRFSS) poll reported that 83 million American adults obtain insufficient sleep, defined as less than 7 hours per night. This represents about 1/3 of the adult population. This is meaningful because less than 7 hours of sleep per night is associated with increased risks of:
High blood pressure (Hypertension)
Diabetes
Heart disease
Stroke
Obesity
Poor mental health
Early death
The most acute risk is that of falling asleep while driving. In 2013, the National Highway Traffic Safety Administration estimated that drowsy driving was responsible for 72,000 crashes, causing 44,000 injuries and 800 deaths. The Centers for Disease Control (CDC) estimate the economic impacts of all motor vehicle crashes was $200 billion in 2000.
One leading contributor to drowsy driving is untreated sleep apnea. According to the American Sleep Apnea Association, it is estimated that 80% of moderate and severe obstructive sleep apnea remains undiagnosed. The American Academy of Sleep Medicine reports the diagnosis and treatment of obstructive sleep apnea would lead to economic savings exceeding $100 billion annually.
Chronic insomnia, characterized by difficulty falling or staying asleep, affects 10% of the population. It is associated with fatigue, poor concentration, mood problems (anxiety or depression), and pain complaints. Insomnia costs in the United States are at least $30 billion per year and up to $107 billion per year when treatment for other medical problems are added in. Insomnia also takes a toll on the economy in terms of lost work time productivity, estimated at $63.2 billion in the U.S. in 2009.
To put it succinctly: Poor sleep costs Americans 100s of billions of dollars in economic losses and hundreds of lives annually.
To treat insomnia, many have turned to the use of sleeping pills. According to the CDC, between 2005 and 2010 about 4% of adults 20 and older had used a sleeping pill in the previous month. IMH Health tracks drug data and reports 59 million sleeping pills were prescribed in 2012, up from 56 million in 2008. Market research revealed a tripling in sleep aid prescriptions from 1998 to 2006 among young adults aged 18-24. These drugs, too, are not without their costs.
A study in 2012 published in the British Medical Journal showed people taking sleeping pills were five times as likely to die over 2 1/2 years compared to those who did not. There were higher rates of falls and hip fractures, and an association noted between heavy medication use and a higher incidence of cancer. Overall increased mortality has been noted in multiple studies. More concerning, recent studies suggest the long-term use of antihistamines and benzodiazepines may lead to an increased risk of dementia.
What is someone with insomnia to do? The American College of Physicians (ACP) recommends the use of cognitive behavioral therapy for insomnia (CBTI) as the first-line treatment for chronic insomnia, even before the use of sleeping pills. Unfortunately, this resource is not widely available, and one-on-one therapy with a psychologist can be expensive, often costing thousands of dollars. Moreover, there aren’t enough specialists trained in CBTI to meet the high need that exists.
The creation of Insomnia Solved came out of this need. As both an online course and paperback book, it attempts to provide additional access. It is not for everyone, and sometimes extra help is needed, such as evaluation for coexisting sleep disorders like sleep apnea. One challenge in creating this resource is how much to charge for access to the program.
Good sleep should be accessible to everyone, regardless of their financial means. It should not be reserved for the well heeled who can afford the best advice, most comfortable mattress, and newest gadgets. I have often contemplated ways to provide the resources of Insomnia Solved at little or no cost to users. Advertising makes many things online free, yet to this point the program has remained free of ads and commercial influence. Currently, the program is priced much less than similar online courses (approximately 25% to 50% of the cost of leading competitors) to aid accessibility. It is not, however, free. This is intentional.
The price is meant to be enough to get some buy-in from the user. A little financial pinch may provide a commitment and motivation to follow through in its use. Something that is obtained for free, with little consequence, is just as easily tossed aside and forgotten without a second thought. The cost is not meant to be punitive—for those who do not find it useful, a generous refund policy is in place. When it works, it is worth far more than the price paid.
It should also be noted that many months 100% of the revenues generated by the online program and paperback are put back into advertising to get the word out there. When balancing the books, this is often a break-even affair. There is a greater good that is created by these efforts, however. Insomnia can be resolved with these techniques, to the benefit of the individual and society as a whole. As much as possible, the financial gains are used to get more people the help that they need. That, to me, is priceless.
Brandon Peters, MD, is the writer on sleep for Verywell.com, a neurology-trained sleep medicine specialist at Virginia Mason Medical Center in Seattle, and adjunct lecturer at the Stanford Center for Sleep Sciences and Medicine.