Sleep – the unsung hero in the management of your health care dollar

It is common knowledge that weight and nutrition play a role in type 2 diabetes. What is far less known, however, is the link between sleep and its role in not only worsening diabetes but also in putting others at risk of developing it. According to the Centers for Disease Control and Prevention (CDC), more than 100 million adults over the age of 18 currently have diabetes or have prediabetes¹. Type 2 diabetes accounts for 90-95 percent of all diabetes cases.[1] How does this impact your business?

According to the American Diabetes Association, in 2017 diabetes cost $237 billion in direct medical costs, including indirect costs such as increased absenteeism ($3.3 billion) and reduced productivity while at work ($26.9 billion) for the employed population.[2] Narrowing this down even further shows how these numbers impact your business: diagnosed diabetics incur ~$16,750 per person in medical expenses each year, with ~$9,600 of that cost directly related to their diabetes – employees with diabetes cost 2.3 times more than they would if they didn’t have diabetes.

While these numbers are jaw-dropping, knowing what leads to diabetes is the first step toward starting effective interventions that could result in a healthier population with lower health care costs. Most companies focus their wellness efforts primarily on exercise and nutrition —a natural first step because excess weight and lack of proper nutrition are the most well-known risk factors leading to type 2 diabetes². What is less understood, and thus overlooked, is the connection between sleep, factors that influence sleep (such as stress) and type 2 diabetes.

With obesity being a prime risk factor for developing type 2 diabetes, knowing what promotes obesity is vital in combating it – and it’s not just limited to nutrition and exercise.

Let’s look at the facts:

• More than one-third of Americans are habitually sleeping less than the recommended 7 hours/night.[3]
• Almost one-third of the American population has diabetes/prediabetes.
• More than one-third of Americans are obese.[4]

It is no coincidence that diabetes, obesity and sleep deprivation are linked. In fact, all have been on the rise over the past several decades. Several studies report that people not getting enough sleep are roughly twice as likely to be diagnosed with type 2 diabetes, and those sleeping fewer than 5 hours/night greatly increase their risk of developing type 2 diabetes.[5]^{, [6],} [7]^{, [8]}

Sleep deprivation has a quick and harmful effect on hunger hormones (a.k.a., you eat more when you don’t sleep), and your body’s response to insulin ^{5, 7, 8}. Not only this, but if you didn’t get a good night’s sleep, you’re naturally more tired than normal the next day, and lack the energy and motivation to exercise. With this domino effect, it is easy to see how frequent lack of sleep can lead to insulin resistance (and type 2 diabetes).  If lack of sleep can lead to a greater risk of diabetes, it makes sense that improving the quality and amount of sleep a person gets could serve as a measure to prevent it.[9]

Since sleep is often viewed as a luxury rather than playing a vital role in one’s health, it is often one of the first things we give up during stressful seasons when people feel pressed for time.  That’s why it’s important that, as an employer, you are educated on the importance of sleep and its long-term role in well-being. Since sleep is often impacted by stress, think of when your organization has periods of higher stress or deadlines, and make a strong effort to have your upper and mid-level management promote a healthy work-life balance. This can be done by helping employees cut back on emailing after work hours, talking about the importance of sleep, as well as teaching time management techniques so sleep isn’t sacrificed when your workforce is pressed for time.

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[1] https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html

[2] http://care.diabetesjournals.org/content/41/5/917

[3] https://www.cdc.gov/mmwr/volumes/65/wr/mm6506a1.htm

[4] https://www.cdc.gov/obesity/data/adult.html

[5] https://www.ncbi.nlm.nih.gov/pubmed/19849800

[6]  Nilsson PM, et al. Incidence of Diabetes in Middle-Aged Men Is Related to Sleep Disturbances, Diabetes Care. 2004; 27(10): 2464.

[7] Knutson KL, et al. Role of Sleep Duration and Quality in the Risk and Severity of Type 2 Diabetes Mellitus, Archives of Internal Medicine. 2006 Sep 18; 166(16):1768.

[8] Gottlieb DJ, et al. Association of Sleep Time with Diabetes Mellitus and Impaired Glucose Tolerance, Archives of Internal Medicine. 2005 Apr 25; 165(8): 863.

[9] https://www.ncbi.nlm.nih.gov/pubmed/19849800

 

 

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