Assessment of the prevalence, risk factors of insomnia, and its effect on quality of life among young population of North region

INTRODUCTION

Insomnia is characterized as a complaint of inadequate sleep. Sleep is non-restorative and unrefreshing. It is due to the difficulty in initiating and sustaining sleep.¹ Insomnia acts as a clinical manifestation of some diseases and also occurs as a syndrome.² Young adults need to sleep for 7.0-8.5 hours. This duration is considered a proper restorative.³ Insomnia brings some adverse results to the individual and also to society. It becomes a major public concern day by day which influences the quality of life of numerous individuals around the planet.⁴ Insomnia is mostly two types according to duration: transients' insomnia and chronic insomnia. When the symptoms of insomnia remain for only a few days it is called transient insomnia. It is due to some stress, self-medication, jet lag, and due to some acute illness. Chronic insomnia is defined as the condition when insufficient sleep continues for one month or more time and also affects regular functioning.⁵ Many factors which lead a normal person to insomnia are called predisposing factors that are mostly non modifiable in nature.⁶ Insomnia is occurred due to biological factors, psychological factors, Behavioral factors, and environmental factors including genetics, individual personality traits which are responsible for physiological and cognitive hyperarousal.⁷ Some factors that are responsible for triggering insomnia is called precipitating factors (stressful life event it involves any health, family work, or school issue). Perpetuating factors that turn acute insomnia into chronic insomnia.

It involved behaviour, thoughts, and coping strategies for example day time napping, and spending most of the time in bed.⁸ if it continues for a long time it leads to some physical and mental problems. Individual's mood, behaviour, and concentration also alter. An individual with insomnia has decreased intellectual ability and cognitive functions which leads to impaired social and professional life. Deprived sleep increases the chances of dependence on alcohol, substance abuse, or drug dependence, and suicide. ⁹ As per the definition of the world health organization (WHO), the quality of life is individuals' attitude toward their position in life, within the setting of their cultural values, and according to their aims, assumptions, standards, and concerns. It explains the potential of the individual to maintain their wellbeing and satisfaction related to health, professional, and social working.¹⁰ The different investigations were done in European and Western nations. The prevalence rate found was 19.7% in the United States, 21.4% in Canada, 37% in the UK, 46.8% in Portugal, 22.8% in South Korea, and 15.3% in Turkey.¹¹ The prevalence varies according to one population to population. Insomnia study was done majorly on elder people but very rare studies on the young community population. Insomnia is a significant public worry in the community that impacts the quality of life of an individual but it remains undiscovered until it prompts genuine complexity so it is necessary for early recognition to diminish the antagonistic result.

METHODS

Research design and subjects

The observational cross-sectional survey was conducted for a period of 6 months from 2020-2021. The 232 subjects were enrolled from the general population of Bathinda, District which is the North Western part of Punjab, India with the age group of 18-35 except those who had serious trauma, and cognitive impairment.

Sample size

The sample size was calculated using software EPI info version 3.01. It was based on the previous prevalence of insomnia of about 18.5% with a 95% confidence interval and 5% margin of error¹². The sample size was calculated according to the finite population of 1388525 of Bathinda District. The sample size was calculated 232.

Material and procedure

The data was collected by using standard validated questionnaires by face to face interviews. The first part of the questionnaire consists of data about demographic detail, Age, gender, residence, marital status, income, occupation, habit related data (walking, smoking, alcohol, drinking tea, coffee at bedtime), history (family history of psychiatric disease, history of any co-morbidity and illness, psychiatric history) The second part consisted of insomnia severity index scale and quality of life satisfaction scale.

Insomnia severity index scale

The ISI (Insomnia severity index scale) was used for insomnia symptoms. It is a self-reporting screening measure of insomnia. It consists of 7 questions according to the diagnosis criteria of insomnia related to difficulty falling asleep, staying asleep, and maintaining sleep, problems waking up too early, degree of satisfaction, day time interfering in functioning. Each question is Likert type. The scoring range for each question is from 0-4. ISI was previously validated with good sensitivity and specificity and showed a 10 cut-off score for the community-based population.^{13 -14} The quality of life, enjoyment, and satisfaction questionnaire-short form (Q-LES-Q-SF) is a self-report scale consisting of 14 items related to overall satisfaction and enjoyment related to health, mood, work, household and leisure activities, social and family relationships, daily functioning, sexual desire/interest/performance, economic status, vision, ability to get around physically, overall well-being, medications, and contentment.¹³ Items were rated on a five-point Likert scale (“very poor,” “poor,” “fair,” “good,” “very good”), with higher scores indicating better enjoyment and satisfaction with life. The scoring of the Q-LES-Q-SF involves summing the first 14 items to yield a total score.¹⁵

Statistical analysis

Data collected from the community population was evaluated by using SPSS version 22. Data was represented using descriptive statistics using frequency and percentage. A Chi-square test was used to find an association between insomnia and various factors at a significance level of ≤0.05. Quantitative continuous data were compared by using the Non-parametric Mann-Whitney test.

RESULTS

Prevalence of insomnia

The result was concluded from 232 young individuals. Among the 232 individuals, 77 (33%) had insomnia, and 155 (67%) do not have insomnia as represented in Figure 1. The prevalence of insomnia symptoms was obtained as symptoms of difficulty initiating sleep were observed in 104 individuals, difficulty staying sleep in about 88 individuals, the problem regarding the waking up too early was observed in 99 individuals (Figure 1).

Sociodemographic distribution of data

The data was collected from 232 young individuals in the Bathinda District. Subjects were categorized as urban and rural residents. It can be seen from the table1, that 37.2% of individuals belonged to an urban area and 62.8% belonged to a rural area, 49.6% were male and 50.4% were female.

According to occupation, 22.4% of respondents were employees, 33.2% were students,4.3% laborers, 15.5% farmers, 12.5% were housewives, 5.5% teachers, and 6.9% respondents were belong to another profession. 25.9% of respondents belonged to the upper class, 49.1% of respondents belonged to the middle class, and 24.6% of respondents belonged to the lower class. According to education level, 2.6% of respondents were illiterate, 12.9% of respondents had primary education, 25.0% of respondents had matriculation and 59.5% of respondents had higher education, 38.8 % respondents were married, 59.9% respondents were single and 1.3% respondent were divorced and widowed (Table 1).

Distribution of data according to lifestyle factors, medical and psychiatric history

Total of 232 subjects 78.2% were watching TV phone before going to sleep, 32.3% of respondents were not consuming any liquid, 7.3% respondents were consuming tea, and 7.3% were consuming coffee and 53% were consuming milk before going to bed. 51.3% of respondents were vegetarian and 48.7% were no vegetarian. 3.0% were smoking occasionally and 5.2% of respondents were smoking daily. 13.0% drink occasionally, 6.8% drink daily, 1.3% drink once. 31.9% of respondents did not walk, 41.4% had a stressful family event, 7.3%% had a family history of psychiatric disease, 19.2% had a medical history, 15.5% had psychiatric history (Table 2).

Association between Insomnia and various factors

There is association find between insomnia and sociodemographic factors such as profession, p value 0.022, education, p value 0.020, marital status, p value 0.005, as represented in table 3. Lifestyle factors such as watching TV phone before sleep, p value 0.020, smoking, p value 0.001, drink alcohol, p value 0.004, walk per day, p value 0.026, family history of psychiatric disease, p value 0.020, medical history, p value 0.000, psychiatric history, p value 0.000 as represent in (Table 4).

There is no association between insomnia and sociodemographic factors such as age, gender, economics, area of residence, intake of liquid before going to bed, diet taken and stressful events in the family as their calculate chi value is less than the table value and not significance at p<0.05 (Table 3-4).

Quality of life

Quality of satisfaction and enjoyment in life was determined by using the Q-les-Q scale. Nonparametric test Maan Whitney U test was used to determine the association. The total mean score was found 46.40, and the mean score value was observed at 50.34 (standard deviation of 9.0) in those who did not have insomnia more as compared to those who had insomnia at 38.4 (standard deviation of 8.35) with highly significant association was found at p value less than 0.05 (Table 5).

DISCUSSION

In this study, it was found that the prevalence of insomnia was 33%. A study by Chung et al reveal the prevalence of insomnia was about 30.08% in China.⁷ Singareddy et al describes a prevalence of 9.3%.¹⁶ and La et al described a prevalence of 10%. Ohayon et al showed a prevalence of 27.6%. Prevalence rates change with the different geographical areas and due to various factors. In this study prevalence rate found was higher than in other studies.

The strength of this study was that it was conducted on the general population and there were expanded possibilities of the variability of results acquired.^17-18 Age was not a significant factor in this study as there were only age criteria 18-35. In other studies, Yang et al also found that age was not significant.¹⁹ Gender was also not significantly associated with insomnia. Prevalence rate was equal in both males and females. Similar result was found by Olfson et al, Choueiry et al they found that area of residence, economics status was not also significant with insomnia. The prevalence rate was equal in urban or rural residence having the different income.^4,20 The finding of this study was that beyond their gender the occupational, educational and marital status influence the prevalence of insomnia. The housewives had more prevalence of insomnia, the possible reason for that was family distress and emotional health. The prevalence was more in those who were married. One point of view is a negative marital relationship, the household environment influences sleep, conflicts in the relationship, demands lead to stress, disturbing mental health as well as physical well-being. Regarding the education level, those who were illiterate and primary study had more prevalence of insomnia. One possible explanation was that a lower level of education leads to greater work-related stress and neglect of proper sleep hygiene.^21-22

The finding of this study was that those who watched TV for more than 3 hours and 2-3 hours had a high prevalence of insomnia. The result by other researchers also found a similar result Serrano et al. The possible explanation for that was watching TV leads to exposure to bright light which contributes to delayed sleep induction due to the effect on sleep-inducing hormones.^23-25 The finding of this study was that dietary intake and liquid intake (coffee, tea, milk) before going to bed were not significantly associated with insomnia. But the opposite result was found by Ali et al drinking caffeinated beverages before sleep increased the rate of prevalence of insomnia. This was due to the biological effects of substance use.¹¹ The finding of this study was that alcohol was significantly associated with insomnia. The prevalence of insomnia was more in those who drink alcohol daily. A similar result was found by Wong et al, Ali et al and Singareddy et al. The possible explanation for that is drinking a large quantity of alcohol disturbs sleep quality and quantity. It affects sleep latency. Long-term and continue use leads to psychological disturbance. More future investigation is required to evaluate this link.^{11, 16, 26} The prevalence of insomnia was more in those who smoke daily than non-smokers. A similar result was found by Blank et al and Chen et al.²¹ The possible explanation for that is due to the stimulating nature of tobacco. There is a complex relationship between sleep disturbance and smoking.²⁷ The finding of this study was that, those who regularly walk had fewer chances of insomnia. Those who did not walk daily had more prevalence of insomnia. Similar results suggested by Xiang et al. Many human experimental studies proved that exercise or walking during day time increases deep sleep, and decrease the chances of awakening during the night. This improved the quality of sleep. Regular exercise and walking are necessary for the prevention of insomnia.^{22, 28} The finding of this study was that who had a family history of psychiatric disease and had a psychiatric disease (anxiety, depression) was significantly associated with insomnia. Similar results by Weyerer et al and Choueiry et al. The mentally disturbed person has poor psychological functioning and poor health.^4,29 The prevalence of insomnia was more in those who had medical co-morbidities such as diabetes, hypertension, and musculoskeletal disorder. Similar result was found by Ali et al, and Basu et al that current medical disorders such as hypertension, diabetes, and asthma had more chances of developing insomnia. The explanation for that is medical co-morbidities lead to uncomfortable body sensations, psychological distress, and sometimes treatment side effects.^11,30,31 The quality of life enjoyment and satisfaction was good in those who did not have Insomnia as compared to those who had insomnia. Many other studies also found that insomnia impaired the quality of life.^{32, 33}

CONCLUSION

It was found that One-third of the young population had insomnia. Education, profession, marital status, watching TV phone before sleep, alcohol intake, smoking, walking, family history of psychiatric disease, medical history, and medication history is highly associated with insomnia. It was concluded that those who did not have insomnia had a good quality of life as compared to those who had Insomnia. Strengthen this study; this study adds breadth to research about insomnia disorders among the general population. There is very rare research on insomnia among young individuals most of the research was focused on insomnia among older people or research are focused on patients in a clinical setting but insomnia has remained undiagnosed in public until it leads to serious complication. There must be educational programs for young individuals for providing information regarding promoting sleep.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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