Why It’s More Critical Than Ever to Support Mental Health and How Insurers Can Help
In March 2021 I wrote a conversation-based CDA blog post with Ian Bridgman, executive director of The Claim Lab and a Council for Disability Awareness Board member, about the COVID-19 pandemic’s impact on working Americans’ mental health. Bridgman indicated he was surprised with one trend in particular:
“One of the data items that surprised me,” Bridgman shared, “was sleep and the linkage we see between sleep and poor mental health. Not so much that there was a link, but the degree of the correlation. Everyone knows surviving on less than four hours sleep makes for a long day. Just try doing that day after day; but what can we do about it? Sleep is worthy of its own blog!”
Following our blog post, Carol Harnett, The CDA’s president, hosted us on The CDA’s Financial Health and Income Network podcast to talk more about the topic of sleep, mental health, and absence from work.
Click here to listen to the podcast.
What’s Keeping You Up at Night?
[0:55] The New York Times reported in a June 8, 2021 article by Anahad O’Connor that “the number of people complaining of insomnia skyrocketed during the pandemic, rising from 20 percent of adults last summer to nearly 60 percent in March [2021].”
Sleep and the beginning of the obesity epidemic
[2:25] During the 1990s and first decade of this century the rising prevalence of obesity was often characterized as an epidemic. One of the most cited drivers? Lack of sleep.
Lack of Sleep, Disability, and Return to Work
[8:25] Bridgman described how he “stumbled upon” the impact of sleeplessness:
“About three years ago, we started collecting data on sleep through the work we do with our psychosocial questionnaires. [In these vehicles] we basically try and identify what other complicating factors there might be in trying to get someone back to work who has a disabling condition. We ask, for example: On a scale of one to five, do you get an uninterrupted night’s sleep?
“And so we started looking at this data after we got a few thousand claims in, and we started to do correlations on it. And we saw there was a huge correlation between lack of sleep and poor mental wellbeing.”
Sleep, depression, and chronic pain
[10:02] Bridgman continues: “We learned that poor sleep and major depression are irrevocably intertwined.
“And sleep isn’t just an issue for mental health claims; it also plays a role in claims where chronic pain is a factor.
“There’s a really interesting study that’s just come out from the University of Toronto that goes into detail about how not only does lack of sleep influence pain but also how, if you can improve sleep, you can reduce pain. That’s a really interesting point.”
And the preferred treatment for insomnia is not what you’d expect it to be
[11:19] Sedative-hypnotic prescriptions can help you get a good night’s sleep, but they need to be used with a great deal of caution. Also known as sleeping pills, these medications can have serious side effects, including the possibility of dependence and addiction. According to the American Academy of Sleep Medicine guidelines, the preferred treatment for insomnia is cognitive-behavioral therapy for insomnia, or CBT-I.
“There is nothing good or bad, but thinking makes it so”
[14:39] Cognitive-behavioral therapy is a way of “teaching people coping skills to come to terms with their anxiety or depression” without necessarily taking medication. This approach can be applied to insomnia issues (CBT-I). CBT-I is much more widespread in Canada than in the U.S.
Schott has a temporary brain freeze as he tries to quote a key line from Hamlet Act 2, Scene 2 (“There is nothing good or bad, but thinking makes it so.”) and goes on to describe the ABC model that’s at the heart of CBT that he was taught with a group of lay peer counselors.
The basic idea behind the ABC model is that “external events (A) do not cause emotions (C), but beliefs (B) and, in particular, irrational beliefs (IB) do.”
Treating insomnia might impact the disability claims experience
[21:51] The Claim Lab developed a new sleep questionnaire that will help clients get more granular information on claimants’ sleep habits and issues to better correlate that data with claim outcomes. The premise is to flag claims that could potentially be complex or longer in duration, and provide appropriate assistance as early in the claims process as is possible.
Schott notes that a focus on individual claimants, while necessary, might not be sufficient. He pointed to research that is beginning to show how organizational culture and social determinants of health can also influence quality of sleep.
If you don’t take away anything else, remember these two rules [28:12]
• Bridgman: Use your bed for only two things, sleep and sex, and nothing else.
• Schott: If you wake up in the middle of the night and it takes you more than 20 minutes to fall back to sleep, get out of bed and do something else (instead of lying there obsessing over why you’re still awake).
Click here to listen to the podcast.
Recommended Resources
Webinars
• “Sleep, mental health , and workplace wellness,” produced by Spring Health and featuring Dr Lauren Hale of Stony Brook Medicine. The webinar gives a good overview of the topic from an employer perspective.
• “Will Pandemic Sleep Troubles Lead to Wave of Chronic Insomnia?” hosted by the medical news site MedPage Today and featuring Dr Michael Grandner, director of the Sleep and Health Research Program at the University of Arizona. The webinar covers a lot of interesting material here around sleep-science research and recommendations for optimizing sleep.
Books
• Why We Sleep, by Matthew Walker, PhD
• The Mystery of Sleep, by Meir Kryger, MD
• Wild Nights, by Benjamin Reiss
• The Sleep Revolution, by Arianna Huffington
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