Overview
1.1
In Australia, almost four in every ten Australians are regularly not having enough quality sleep. For some people this is due to a clinical sleep disorder, however, for others it is due to work patterns or lifestyle pressures. While people may understand that sleep is necessary, it is not always prioritised and the effects of insufficient sleep are not always considered.
1.2
In his book Why We Sleep, Professor Matthew Walker suggested that ‘society’s apathy towards sleep has, in part, been caused by the historic failure of science to explain why we need it—sleep has remained one of the last great biological mysteries.’
1.3
While the purpose of sleep may have been a mystery, Dr Allan Rechtschaffen, a pioneer in sleep medicine, stated that ‘if sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process has ever made.’ The mistake, as Professor Walker describes it, did not lie with evolution but instead with scientists who were searching for a single explanation for the purpose of sleep.
1.4
The evidence from more recent research is that the functions of sleep are many and varied. Professor Walker suggests ‘there does not seem to be one major organ in the body, or process within the brain that is not optimally enhanced by sleep (and detrimentally impaired when we do not get enough).’
1.5
Sufficient, quality sleep is therefore an essential requirement for a person’s wellbeing. For adults, between seven and nine hours of quality sleep is the generally accepted amount for healthy cognitive and physical health.
1.6
It is estimated that 7.4 million Australians are regularly not gaining the recommended amount of sleep. In 2016-17, it was estimated that this inadequate sleep was costing the Australian economy $26.2 billion, mostly due to reduced productivity. If the impact of lost health and wellbeing is included the estimated cost rises to $66.3 billion.
1.7
Regular inadequate sleep has significant health impacts and has been associated with an increased risk of developing conditions including obesity, diabetes, cardiovascular disease and cancer. In particular, Obstructive Sleep Apnoea (OSA), a prevalent sleep disorder, appears to increase the risk of a number of serious conditions including high blood pressure, heart disease, and stroke.
1.8
In addition, adequate sleep is essential for mental health and wellbeing and inadequate sleep has been associated with increased rates of depression and the development of dementia. Chronic insomnia in particular regularly co‑occurs with other mental health conditions such as depression and anxiety.
1.9
There are a number of lifestyle factors that are linked with increased risk of inadequate sleep. The use of digital devices and electronic media late in the evening is linked to disrupted sleep and is increasingly an issue of concern in relation to the sleep health of children and young adults.
1.10
In addition, some workplace practises can influence a person’s sleep health. In particular, shift work, with shifts changing between the day and night, may have a negative impact on a person’s quality of sleep. This may have serious immediate and long-term consequences, particularly in industries that involve driving, heavy machinery, and/or medical procedures.
About the Inquiry
Objectives and Scope
1.11
On 13 September 2018, the Minister for Health, the Hon Greg Hunt MP, referred the Inquiry into Sleep Health Awareness in Australia (the inquiry) to the Standing Committee on Health, Aged Care and Sport (the Committee).
1.12
The Committee considered issues related to inadequate sleep and sleep disorders as part of the inquiry. These included:
The prevalence and causes of inadequate sleep and sleep disorders, as well as diagnosis, management and treatment options;
The links between sleep health and physical and mental health conditions;
Impacts of fatigue in the workplace and on the road, as well as how shift work and other workplace practices can effect sleep quality and duration; and
Community awareness of sleep health issues, and further research into sleep that may be needed.
Inquiry Conduct
1.13
The inquiry was launched via a media release on 13 September 2018, with submissions to be received by 18 October 2018.
1.14
The Committee also invited submissions from relevant federal, state and territory ministers, and public health organisations, peak bodies, sleep centres and academics.
1.15
The inquiry received 138 submissions and 30 exhibits. These are listed at Appendix A and B respectively.
1.16
The Committee also held four public hearings, which are listed in Table 1.1. The names of individuals and organisations which appeared at these public hearings is listed at Appendix C.
1.17
Members of the Committee also conducted a site inspection of a sleep centre at the Sir Charles Gairdner Hospital in Perth and participated in a sleep study at the Centre for Sleep Science at the University of Western Australia.
Table 1.1: Public Hearings Held
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29 January 2019
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Perth, WA
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5 February 2019
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Sydney, NSW
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6 February 2019
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Melbourne, Vic
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11 February 2019
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Canberra, ACT
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Previous Reports on Sleep Health
Deloitte Access Economics ‘Asleep on the Job’ Report
1.18
In August 2017, Deloitte Access Economics released its report Asleep on the Job: Costs of Inadequate Sleep in Australia (Asleep on the Job report), which had been prepared for the Sleep Health Foundation.
1.19
The Asleep on the Job report estimated that there are 7.4 million Australian adults who do not regularly get enough sleep. The financial costs associated with inadequate sleep were estimated to be $26.2 billion in 2016-17 and included health system costs, productivity losses, informal care costs and other financial costs. In addition, the cost of lost wellbeing due to inadequate sleep was estimated to be $40.1 billion in 2016-17.
1.20
In addition to financial costs, the Asleep on the Job report outlined other consequences associated with inadequate sleep in Australia. These consequences included deaths (due to falling asleep at the wheel or from an industrial accident due to lack of sleep); reduced workplace productivity (due to reduced working days and reduced productivity while at work); and a loss of wellbeing.
1.21
The tightening of regulations in sectors where ‘sleep is irregular but responsibility is high, such as defence, transport and health’ was put forward as a policy recommendation. In addition, the Asleep on the Job report recommended changes to shift work; greater attention by police to tired and fatigued drivers; the provision of software that filters blue light for government agency employees; and education and awareness campaigns.
Report to the Sleep Health Foundation: 2016 Sleep Health Survey of Australian Adults
1.22
In 2016, Professor Robert Adams, Dr Sarah Appleton, Professor Anne Taylor, Professor Doug McEvoy, and Professor Nick Antic, on behalf of the Sleep Health Foundation, conducted a Sleep Health Survey of 1011 adults across Australia.
1.23
The objective of the Sleep Health Survey was to ‘assess the scale of the health and social consequences of insufficient sleep and sleep disorders in Australia.’
1.24
The results of the Sleep Health Survey indicated that inadequate sleep and poor sleep quality were common issues, affecting 33 to 45 per cent of adults. The Sleep Health Study further stated that sleep problems may be increasing in the community.
1.25
The consequences of sleep problems identified in the Sleep Health Survey included negative impacts on work performance and productivity, and an increased risk of driving accidents due to drowsiness. The Sleep Health Survey stated that ‘overall, the picture emerges of a nation whose health, social life and productivity is suffering from lack of quality sleep’.
1.26
The Sleep Health Survey also put forward that sleep-related problems are not currently prioritised in health care policy and stated:
Despite the relationship to general health and to key national priorities such as obesity, cardiovascular disease and diabetes, healthy sleep is not a national health priority or given a high priority in healthcare policy. The data in this report indicates this situation deserves to be rectified.
Access Economics ‘Wake Up Australia: The Value of Healthy Sleep’ Report
1.27
In October 2004, Access Economics released its report Wake Up Australia: The Value of Health Sleep (Wake Up Australia report) which had been prepared for Sleep Health Australia.
1.28
The Wake Up Australia report estimated that in 2004, over 1.3 million Australians experienced sleep disorders, which had an economic cost of $10.3 billion. The sleep disorder (OSA) was identified as most common, with insomnia also being highly prevalent.
1.29
The Wake Up Australia report highlighted that sleep disorders can have wide ranging health and social impacts and stated:
These [sleep] disorders contribute to a range of other health and social problems, with substantial health and economic impacts – accidents and injuries, other chronic illnesses, production and consumption losses, and second generation effects, particularly from childhood sleep disorders.
1.30
The Wake Up Australia report made four recommendations to ‘address the current fragmented and under-resourced sleep health landscape’, including education and awareness raising; research and development; cost-effective prevention, treatment and management options; and the establishment of a National Sleep Health organisation to coordinate a national action plan.
Report Structure
1.31
Chapter 2 outlines the prevalence of insufficient sleep; the causes of insufficient sleep, including lifestyle and behavioural factors; and the impacts of insufficient sleep including health impacts, accidents and economic costs.
1.32
Chapter 3 outlines the causes, symptoms and prevalence of sleep disorders; potential links between sleep disorders and other health conditions; and personal experiences of living with these conditions.
1.33
Chapter 4 discusses the impact of fatigue and impaired alertness in the workplace and on the road, with particular emphasis on industries that use shift work.
1.34
Chapter 5 discusses the diagnosis and treatment of sleep disorders; the accessibility and affordability of sleep medicine; the role of primary care and other healthcare workers in the provision of sleep health services.
1.35
Chapter 6 discusses awareness of sleep health and hygiene in the general community; the education provided to healthcare workers regarding sleep health issues; and research relating to sleep health.