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How do individuals sleep around the world? Results from a single-day survey in ten countries
Abstract
To describe between-country differences in both the prevalence and type of sleep disorders seen across the globe, and to provide information on how impaired sleep impacts daytime functioning.
The study is a large-scale, global cross-sectional survey conducted on International Sleep Well Day (March 21), 2002. A standardized questionnaire was used in 10 countries under the guidance of local survey managers. In addition, the Athens Insomnia Scale (AIS) and the Epworth Sleepiness Scale (ESS) were completed. Subjects included in the study were adults from 10 countries representing different continents with clear variations in lifestyle.
The total number of questionnaires collected was 35,327. Overall, 24% of subjects reported that they did not sleep well. According to self-assessments using the AIS, 31.6% of subjects had 'insomnia', while another 17.5% could be considered as having 'sub-threshold insomnia'. According to ESS scores, 11.6% of subjects were found to be 'very sleepy' or 'dangerously sleepy' during the day.
Although there seem to be important global variations in the prevalence of insomnia, its symptoms and their management, about one in four individuals do not think they sleep well. Moreover, self-reported sleep problems could be underestimated in the general population. Overall, there is a need for increased awareness of the importance of disturbed sleep and the improved detection and management of sleep disorders.
... insomnia; Facebook; social network; online support group; content analysis ÚVOD Insomnia spôsobuje subjektívnu nespokojnosť so spánkom, čo znamená, že sa človek po zobudení necíti adekvátne oddýchnutý a únava ovplyvňuje jeho každodenné fungovanie a spokojnosť. Jej prevalencia v populácii sa pohybuje v desiatkach percent, no pacienti ju aj tak často hodnotia ako skryté ochorenie, ktoré vo veľkej miere ovplyvňuje ich život (Soldatos et al., 2005;Riemann et al., 2017). Nejde tu len o vplyv na psychické či fyzické zdravie (Bos & Macedo, 2019), ale v širšom kontexte má dosah na vzťahy, pracovnú produktivitu, dopravné nehody či ekonomiku štátu (Morin & Jarrin, 2013). ...
Procrastination is a problem in terms of fulfilling study and work obligations. The aim of this paper is to investigate the frequency of procrastination among high school and college students, as well as the relationship between procrastination and personality traits in a sample of high school and college students. The data collection was conducted in February 2022. A total of 61 230 students (Mage = 20.75, SD = 4.31), 130 undergraduate and 100 high school students participated in the study. Procrastination frequency was measured with a separate item, personality traits, via the BFI-2 XS. The data were processed through correlations and linear regression. The results indicate a negative relationship between procrastination and conscientiousness in both groups of students (high school, university). In addition, a negative relationship of extroversion and procrastination was found in university students, as well as a positive relationship of negative rumination and procrastination. However, among the personality traits, the regression model confirmed only lower conscientiousness as a predictor of procrastination. The results also point to developmental and situational specificities of procrastination.
... doi: medRxiv preprint 17.5% were considered to have 'subthreshold insomnia'. ESS scores indicated that 11.6% of subjects were 'very sleepy' or 'dangerously sleepy' during the day, while in China, up to 45.4% of respondents had experienced varying degrees of insomnia in the preceding month (Soldatos CR. 2005). ...
Recent studies suggest that 40Hz photoacoustic stimulation is beneficial for improving cognition, and is safe and effective in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). It has been reported that the healthy population responds more strongly to the 40 Hz intervention compared to MCI and AD patients. Therefore, the aim of this study was to explore the effectiveness of 40 Hz photoacoustics in preventing cognitive impairment and improving sleep quality in the healthy population.
Four weeks of 40 Hz intervention significantly improved sleep quality (PSQI) (p=0.028) and enhanced functional connectivity in the hippocampus and default mode network (DMN) (in the cognitively impaired population, functional connectivity showed a decreasing trend). These results were consistent with findings from the FDA clinical trial on MCI/AD patients that showed enhanced connectivity of the core regions PCC and mPFC within the DMN network. No serious adverse effects were reported throughout the intervention.
This study is the first to validate the efficacy and safety of a 40 Hz photoacoustic intervention in a healthy population, suggesting its potential in preventing cognitive decline in a healthy population.
... Second, the decrease in outdoor activities due to social distancing measures among young people, prolonged indoor living, and increased mobile phone usage may lead to an increase in insomnia, which in turn could cause an increase in EDS the following day.The prevalence of EDS in Korea is 12.8%, and significantly higher in men (14.7%) than in women. These findings are consistent with previous studies in Korea and other countries [6,20,21]. Unlike insomnia, EDS was not significantly affected by the COVID-19 pandemic; previous studies have shown that EDS was predominantly affected by habitual snoring or sleep related problems [22]. ...
Coronavirus disease 2019 (COVID-19) pandemic has caused widespread increase in stress and affected sleep quality and quantity, with up to 30% prevalence of sleep disorders being reported after the declaration of the pandemic. This study aimed to assess perceived changes due to the pandemic in the prevalence of insomnia and excessive daytime sleepiness (EDS) in Korea, and identify the associated factors. An online survey was conducted among 4000 participants (2035 men and 1965 women) aged 20–69 years enrolled using stratified multistage random sampling according to age, sex, and residential area, between January, 2021 and February, 2022. The questionnaire included various items, such as socio-demographics, Insomnia Severity Index, and Epworth Sleepiness Scale (ESS). Insomnia was defined as difficulty falling asleep and difficulty maintaining sleep more than twice a week. EDS was classified as an ESS score ≥ 11. Insomnia was reported by 32.9% (n = 1316) of the participants (37.3% among women and 28.6% among men). Multivariate logistic regression revealed that insomnia was associated with female sex [odds ratio (OR) = 1.526, 95% confidence interval (CI) = 1.297–1.796], night workers (OR 1.561, 95% CI 1.160–2.101), and being unmarried (OR 1.256, 95% CI 1.007–1.566). EDS was reported by 12.8% (n = 510) of the participants (14.7% among men and 10.7% among women). EDS was associated with male sex (OR 1.333, 95% CI 1.062–1.674), and being employed (OR 1.292, 95% CI 1.017–1.641). During the COVID-19 pandemic, the prevalence of insomnia increased in Korea, while there was no significant change in EDS compared with pre-pandemic evidence.
Objective: The aim of the study was to examine the cross-sectional relationship between sleep duration and 12 chronic diseases (obesity risk, diabetes, asthma, renal failure, hypertensive diseases, chronic obstructive pulmonary disease, cardiovascular diseases, ischaemic heart disease, pulmonary heart disease, immunodeficiencies and immune system disorders) by transferring the data to the national electronic patient record system through wearable device technology. Materials and Methods: The data of the study were obtained from the Ministry of Health “Turkey National Personal Health Record System” (The “e-Nabız”). Between 30.03.2023 and 28.05.2023, 315448 data from 27847 people (15167 male) were collected and analysed on the basis of province, rural status, age group, gender and presence of chronic diseases and average, minimum (min), maximum (max) sleep duration. Descriptive statistics, chi-square analysis, Independent Samples t-Test, One-way Analysis of Variance and Pearson’s correlation coefficient were used. Results: The max. and average sleep duration were significantly shorter in men. Max. sleep duration decreased while the average sleep duration increased with increasing age. Participants with asthma, chronic renal failure and cerebrovascular diseases had decreased average sleep duration. The frequency of those who slept for 7-8 hours, which is the ideal sleep duration, is lower in all chronic diseases. Conclusion: Most of the common chronic diseases may affect the sleep duration times and quality, which may further affect the prognosis of these patients.
Study objectives:
Country or regional differences in sleep duration are well-known, but few large-scale studies have specifically evaluated sleep variability, either across the work week, or in terms of differences in weekday and weekend sleep.
Methods:
Sleep measures, obtained over 50 million night's sleep from ∼220,000 wearable device users in 35 countries, were analysed. Each person contributed an average of ∼242 nights of data. Multiple regression was used to assess the impact country of residence had on sleep duration, timing, efficiency, weekday sleep variability, weekend sleep extension and social jetlag.
Results:
Nocturnal sleep was shorter and had a later onset in Asia than other regions. Despite this, sleep efficiency was lower and weekday sleep variability was higher. Weekend sleep extension was longer in Europe and the USA than in Asia, and was only partially related to weekday sleep duration. There were also cross-country differences in social jetlag although the regional differences were less distinct than for weekend sleep extension.
Conclusions:
In addition to regional differences in sleep duration, cross-country differences in sleep variability and weekend sleep extension suggest that using the latter as an indicator of sleep debt may need to be reconsidered. In countries exhibiting both short sleep and high weekday sleep variability, a culturally different means of coping with inadequate sleep is likely. Country or region differences in culture, particularly those related to work, merit closer examination as factors influencing the variability in normative sleep patterns around the world.
Cognition is central to the experience of insomnia. Although unhelpful thoughts about and around insomnia are a primary treatment target of cognitive behaviour therapy for insomnia, cognitive constructs are termed and conceptualised differently in different theories of insomnia proposed over the past decades. In search of consensus in thinking, the current systematic review identified cognitive factors and processes featured in theoretical models of insomnia and mapped any commonality between models. We systematically searched PsycINFO and PubMed for published theoretical articles on the development, maintenance and remission of insomnia, from inception of databases to February, 2023. A total of 2558 records were identified for title and abstract screening. Of these, 37 were selected for full-text assessment and 12 included for analysis and data synthesis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We identified nine distinguishable models of insomnia published between 1982 and 2023 and extracted 20 cognitive factors and processes featured in these models; 39 if sub-factors were counted. After assigning similarity ratings, we observed a high degree of overlap between constructs despite apparent differences in terminologies and measurement methods. As a result, we highlight shifts in thinking around cognitions associated with insomnia and discuss future directions.
Previously, insomnia and adverse lifestyle were prevalent among truck drivers, but the association between the two remains unknown in this particular occupational cohort. This study aimed to examine the relationship between insomnia and lifestyle-related diseases among truck drivers. We investigated 875 male truck drivers of the Japan Truck Association, Akita branch, as of July 2020. The definition of insomnia was based on the International Classification of Sleep Disorders, Third Edition (ICSD-3). Data from a self-administered questionnaire were merged with health records and health insurance claims data of 2020. In total, 40.1% had either one of the lifestyle-related diseases including hypertension (29.7%), diabetes mellitus (11.7%), and dyslipidemia (24.8%), whereas according to ICSD-3, 13.2% had insomnia. Multivariate logistic regression models demonstrated that individuals with insomnia had approximately 2-fold increased risk of having at least one lifestyle-related disease (p < 0.001), hypertension (p = 0.0027), diabetes mellitus (p = 0.0654) and dyslipidemia (p < 0.001). Occupational characteristics including daily driving hours, driving distance, and travel days were not associated with any lifestyle-related diseases except for an association between short-haul and at least one disease. In conclusion, insomnia is significantly associated with increased risks of lifestyle-related diseases among male truck drivers in Japan.
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While sleep positively impacts well-being, health, and productivity, the effects of societal factors on sleep remain underexplored. Here we analyze the sleep of 30,082 individuals across 11 countries using 52 million activity records from wearable devices. Our data are consistent with past studies of gender and age-associated sleep characteristics. However, our analysis of wearable device data uncovers differences in recorded vs. self-reported bedtime and sleep duration. The dataset allowed us to study how country-specific metrics such as GDP and cultural indices relate to sleep in groups and individuals. Our analysis indicates that diverse sleep metrics can be represented by two dimensions: sleep quantity and quality. We find that 55% of the variation in sleep quality, and 63% in sleep quantity, are explained by societal factors. Within a societal boundary, individual sleep experience was modified by factors like exercise. Increased exercise or daily steps were associated with better sleep quality (for example, faster sleep onset and less time awake in bed), especially in countries like the U.S. and Finland. Understanding how social norms relate to sleep will help create strategies and policies that enhance the positive impacts of sleep on health, such as productivity and well-being.
Sleep disturbances are one of the most frequent health problems in old age, among which insomnia stands out. It is characterized by difficulty falling asleep, staying asleep, frequent awakenings, or waking up too early and not having restful sleep, which may be a risk factor for cognitive impairment and depression, affecting functionality and quality of life. Insomnia is a very complex multifactorial problem that requires a multi- and interdisciplinary approach. However, it is frequently not diagnosed in older community-dwelling people, increasing the risk of psychological, cognitive, and quality of life alterations. The aim was to detect insomnia and its relationship with cognitive impairment, depression, and quality of life in older community-dwelling Mexicans. An analytical cross-sectional study was carried out in 107 older adults from Mexico City. The following screening instruments were applied: Athens Insomnia Scale, Mini-Mental State Examination, Geriatric Depression Scale, WHO Quality of Life Questionnaire WHOQoL-Bref, Pittsburgh Sleep Quality Inventory. The frequency of insomnia detected was 57% and its relationship with cognitive impairment, depression, and low quality of life was 31% (OR = 2.5, 95% CI, 1.1–6.6. p < 0.05), 41% (OR = 7.3, 95% CI, 2.3–22.9, p < 0.001), and 59% (OR = 2.5, 95% CI, 1.1–5.4, p < 0.05), respectively. Our findings suggest that insomnia is a frequent clinical disorder that is not diagnosed and a significant risk factor for cognitive decline, depression, and poor quality of life.
The aim of this investigation was to study the geographic variation in sleep complaints and to identify risk factors for sleep disturbances in three European countries: Iceland (Reykjavik), Sweden (Uppsala and Goteborg) and Belgium (Antwerp). The study involved a random population of 2,202 subjects (age 20–45 years) who participated in the European Community Respiratory Health Survey. The subjects answered a questionnaire on sleep disturbances. Participants in Iceland and Sweden also estimated their sleep habits and sleep times during a period of 1 week in a sleep diary. Habitual (≥3/week) difficulties inducing sleep (DIS) were reported by 6–9% and early morning awakenings by 5–6% of the subjects. The estimated number of awakenings and the prevalence of nightmares was significantly lower in Reykjavik. Participants in Reykjavik went to bed at night and woke in the morning approximately 1 hour later than participants at the Swedish centers (p < 0.001). Symptoms of gastroesophageal reflux (GER) were associated with DIS (odds ratio [OR] = 2.7), nightmares (OR = 4.4), longer sleep latency and frequent nocturnal awakenings. Smoking correlated positively to DIS (OR =1.8) and estimated sleep latency. We conclude that the prevalence of DIS was fairly similar at these four European centers but that there was a variation in the prevalence of nightmares and nocturnal awakenings. The significant correlation between reported GER and subjective quality of sleep should be followed up in studies using objective measurements.
Los trastornos del sueño constituyen una entidad clínica de gran impacto sanitario y socioeconómico. En España existen datos epidemiológicos aislados, careciendo hasta la fecha de estudios que abarquen la globalidad de trastornos del sueño en población adulta.MétodoSe entrevistó a una muestra de 1.500 individuos adultos de la ciudad de Madrid durante el primer semestre de 1990, empleando un cuestionario clínico que incluía datos sociodemográficos, hábitos, trastornos del sueño, e información sobre patología somática y psiquiátrica. Se analiza la influencia del sexo, la edad y la situación laboral en la prevalencia de los distintos trastornos.Resultados1.131 sujetos (75,4%) completaron la entrevista. Un 22,8% (IC 95%: 20,4-25,4) refería padecer alguna dificultad con el sueño. El insomnio aparecía en el 11,3% (9,5-13,3) de los entrevistados, con un predominio en mujeres, edades avanzadas y niveles socioeconómicos más bajos. Dentro de los trastornos de excesiva somnolencia, un 11,6% (9,8-13,7) de la muestra se quejaba de somnolencia diurna y un 3,2% (2,2- 4,4) de hipersomnia, siendo infrecuentes los ataques de sueño y la parálisis del sueño. En lo concerniente a las parasomnias, las pesadillas aparecían en el 12,3% (10,4-14,4) de la muestra. La prevalencia del sonambulismo, los terrores nocturnos y la enuresis oscilaba en torno al 1%. El ronquido diario estaba presente en el 11,9% (10,1-14,0) de los encuestados. Un 1,1% (0,6-2,0) refería padecer pausas respiratorias durante el sueño.ConclusionesSe estima una elevada prevalencia de trastornos del sueño en la población adulta de la ciudad de Madrid. Las cifras son en general comparables a estudios realizados en otros países, comentándose las diferencias encontradas.
Purpose– To compare the self-reported estimation of sleep quality evaluated by the Pittsburgh Sleep Quality Index (PSQI) and life quality assessed by the Quality of Life Index (QLI). Background– The PSQI comprised 19 questions and assessed a wide variety of factors relating to sleep quality. The QLI consisted of 10 items for self assessment of different dimensions of life quality. Subjects– A representative Austrian sample (n=1049) aged above 15 years. Procedure– Interviews in the homes of the participants. Results– 32.1% could be classified as poor sleepers (37% females, 26.5% males). Sleep quality decreased with increasing age, especially in women. Overall quality of life was highest in younger (15–29 years) and lowest in elderly subjects (over 50 years). Life quality decreased with increasing age. Between subjective sleep quality and quality of life a moderate, significant correlation was found (r2=0.6721). Conclusions– Complaints about a bad quality of sleep could be used as a screening method in the exploration of patients' quality of life (QoL).
The development and use of a new scale, the Epworth sleepiness scale (ESS), is described. This is a simple, self-administered questionnaire which is shown to provide a measurement of the subject's general level of daytime sleepiness. One hundred and eighty adults answered the ESS, including 30 normal men and women as controls and 150 patients with a range of sleep disorders. They rated the chances that they would doze off or fall asleep when in eight different situations commonly encountered in daily life. Total ESS scores significantly distinguished normal subjects from patients in various diagnostic groups including obstructive sleep apnea syndrome, narcolepsy and idiopathic hypersomnia. ESS scores were significantly correlated with sleep latency measured during the multiple sleep latency test and during overnight polysomnography. In patients with obstructive sleep apnea syndrome ESS scores were significantly correlated with the respiratory disturbance index and the minimum SaO2 recorded overnight. ESS scores of patients who simply snored did not differ from controls.
The study examined the prevalence and correlates of insomnia in a representative sample (n=3030) from the general population of Japan. Using a structured questionnaire, we found that the overall prevalence of insomnia during the preceding month was 21.4%, including difficulty initiating sleep (DIS: 8.3%), difficulty maintaining sleep (DMS: 15.0%), and early morning awakening (EMA: 8.0%). Multiple logistic regression analysis showed that older age, being unemployed, lack of habitual exercise, poor perceived health, psychological stress, and being unable to cope with stress were associated with an increased prevalence of insomnia. These findings indicate that the prevalence of insomnia in the general population of Japan is comparable to that reported in Western countries, and that insomnia is associated with multiple psychosocial factors.
The WHO Collaborative Study on Psychological Problems in General Health Care examined the frequency, form, course and outcome of psychological problems in general health care settings. A total of 25,916 general health care attenders at 15 sites in 14 countries were screened using the 12-item General Health Questionnaire (GHQ-12). Of those screened, 5,438 were assessed in detail using a Primary Health Care version of the Composite International Diagnostic Interview (CID1-PHC) in conjunction with the Brief Disability Questionnaire, the Social Disability Schedules, a self rated overall health status form and the 28-item General Health Questionnaire. The analysis has shown that sleep problems were common at all sites with: 26.8% of all patients having some form of sleep problem and 15% of the patients examined had trouble falling or staying asleep. Of those with sleep problems, 51.5% had a well-defined International Classification of Diseases 10th Revision (ICD-10) mental disorder (such as depression, anxiety, somatoform disorders or alcohol problems) and 48.5% of those with sleep problems for at least two weeks or more did not fulfil the criteria for any well defined ICD-10 diagnosis. Persons with sleep problems reported a degree of disability in the performance of their daily activities and social roles even when they had no symptoms of psychological disorders. When such symptoms were present the disability was significantly increased.
To determine the prevalence of insomnia traits in a population and the effect of these traits on health-related quality of life participants (aged 53-97 yrs) were interviewed as part of the 5-year follow-up examination (1998-2000) of the Epidemiology of Hearing Loss Study. Participants were interviewed at the study office in Beaver Dam, WI, by telephone, or at their residence. Participants were asked to what extent they experienced difficulty getting to sleep, waking up at night and having a hard time getting back to sleep, and waking up repeatedly during the night for any reason. A response of "often" or "almost always" was coded as positive for an insomnia trait. The Short Form Health Survey (SF-36) was administered to assess mental and physical function. 26% of the population reported one insomnia trait, 13% reported two, and 10% reported three. All 8 domains and the Mental and Physical Component Summary scores of the SF-36 decreased significantly (F-test for linear trend statistically significant at p
The epidemiology of severe insomnia and its effect on quality of life and healthcare consumption was assessed in a survey of the general population of five northern European countries. Applying established consumer sampling techniques, insomnia sufferers were selected from the general population using a questionnaire, conducted by face-to-face interview, and severity of insomnia was ranked (severe, mild/moderate, no sleep complaint) using a specific algorithm. Population samples were matched according to case control methodology for age, gender and geographical region. A second questionnaire gathered information on sleep problems, quality of life (SF-36 scores) and healthcare consumption. The prevalence of severe insomnia ranged from 4% to 22%, was higher in females than in males, but did not increase significantly with age. Patients with severe insomnia had been experiencing sleeping problems for a median of 2-6 years. In all countries, insomnia had a negative impact on quality of life, and the degree of impairment in quality of life was directly related to the severity of insomnia. Individuals with severe insomnia also showed a higher level of healthcare consumption. Despite this, severe insomnia did not appear to feature prominently in the doctor-patient relationship.
This study was the first nationwide population-based study to estimate the prevalence rates of sleep disturbance and hypnotic medication use in the general Japanese adult population. In 1997, 2,800 Japanese adults aged 20 years and over were randomly selected from the 1995 Census and 1,871 were examined using the Pittsburgh Sleep Quality Index. The respective estimated overall prevalences of insomnia (INS), difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), poor perceived quality of sleep (PQS) and hypnotic medication use (HMU) were 17.3%, 8.6%, 12.9%, 17.8%, and 3.5% in males and 21.5%, 12.6%, 16.2%, 20.2% and 5.4% in females. Among males, DIS (OR = 2.76) and PQS (OR = 2.12) were associated with never having married. DMS was associated with being 60 years and older (OR = 2.68) or divorced/separated (OR = 3.74). Among females, DMS was associated with being widowed (OR = 1.65), unemployed (OR = 1.60), 40 to 59 years old (OR = 0.57) or never having married (OR = 0.39). DIS was associated with being widowed (OR = 1.67) or unemployed (OR = 1.58). HMU was associated with advancing age (OR = 8.26-10.7), being widowed (OR = 2.12) or never having married (OR = 2.84). PQS was associated with advancing age (OR = 0.63-0.50). Our study showed sleep disturbance and hypnotic medication use were prevalent among Japanese adults and some sociodemographic factors contributed to them.