Sleep is the third pillar of good health, together with a healthy diet and exercise.
This is the message that the Australasian Sleep Association, Sleep Health Foundation and other stakeholders have been driving home to our political leaders. It is backed up with robust data highlighting the magnitude of health issues related to poor sleep and sleep disorders, and the marked individual, economic and social benefits associated with their effective treatment. Our efforts resulted in the Federal Government establishing a Parliamentary Inquiry into Sleep Health Awareness. The Inquiry received over 130 submissions and held public hearings around the country. The report, and its 11 recommendations, were tabled in Parliament in April 2019.
The story so far
In early 2014, ASA and the Sleep Health Foundation (SHF) joined forces to raise awareness of sleep health across all levels of society - among politicians, health professionals and the general public. In March 2014 the two organisations hosted a Parliamentary Symposium in Canberra on “Poor Sleep: A Challenge to National Health, Productivity and Safety” to bring together representatives of interested organisations to consider how to raise awareness on the contribution of sleep health to national health, productivity and safety.
In early 2017 a joint working party was established and a government relations consultant appointed to support this advocacy work. The group met with politicians of all sides to educate them on the country’s sleep health issues and to request a Parliamentary Inquiry into Sleep Health Awareness. In August that year, the SHF Deloitte Access Economics report “Asleep on the Job” was launched in Parliament House. This showed the annual cost of inadequate sleep to the Australian economy was $66.3 billion.
Through consultation with stakeholders, five major national issues were identified:
- Development of a comprehensive sleep health promotion campaign
- Development of a national school education program on sleep health
- Development of an education and training program for primary healthcare providers
- Development of guidelines and educational campaigns for improving safety and productivity in the workplace and
- A targeted call for research.
In March 2018 a range of stakeholders with interests in sleep were invited to a Sleep Summit in Sydney. Twenty-eight people attended representing varied groups, including patient support groups, government departments, associations and research groups. A communique was signed by attendees and sent to all federal politicians emphasising two key messages:
- The Australian Government needs to recognise sleep as the third pillar of health, alongside diet and exercise
- A Parliamentary Inquiry was the way to achieve this.
Two pre-Budget submissions were prepared, including costings for the recommendations put forward by the Summit.
A common comment made by parliamentarians and their staff was the negative effect that their long working hours had on the quality and quantity of their own sleep. This prompted an ASA/SHF study to objectively measure the sleep behaviours of those working in Parliament House, including Federal politicians, their staff and members of the media. The results showed that on average they slept 6½ hours, falling short of the recommended 7–9 hours per night.
On 13 September 2018 the Minister for Health, Greg Hunt announced that the Standing Committee on Aged Care and Sport Committee would inquire into and report on Sleep Health Awareness in Australia.
The ASA and SHF made submissions and encouraged members and other groups to submit to the Inquiry – a total of 131 submissions were made. Public hearings were held in Perth, Melbourne, Sydney, and Canberra. The ASA and SHF attended the public hearings as experts in the field to promote recommendations for the report. The report from the Inquiry was tabled on the final sitting day of the 45th Parliament of Australia on 4 April 2019. The recommendations in the report were consistent with the national priorities stated by the ASA and SHF and included calls for targeted funding.
Work in progress
The Government has not responded to the Inquiry report.The previous Government's response was directed towards including sleep health into the National Preventive Health Strategy which was actively in development after the tabling of the Inquiry report. SHF/ASA made a joint submission in response to the consultation paper released in August 2020. However, the draft strategy subsequently released for consultation contained virtually no mention of the important role of sleep in preventive health. The ASA and Sleep Health Foundation prepared submissions to the consultation, and encouraged members to also make submissions to correct this important omission. The final National Preventive Health Strategy 2020-2030 was released with an increased emphasis on the importance of sleep for good health.
SHF and ASA members contributed to the Productivity Commission Inquiry into Mental Health during 2020, although the draft report made no mention of sleep. Our respective responses to the draft report resulted in mentions being added to the final report about the importance of sleep to mental health, although sleep was not mentioned in any recommendations.
The ASA Medicines Sub-Committee has been working on increasing patient access to key hypersomnolence drugs. A submission to recognise armodafinil/modafinil as first line therapies for narcolepsy has not yet been successful and is pending an economic analysis to determine costs to Medicare of this change. Some minor regulatory changes have been made to eliminate some unnecessary red tape in managing treatment of hypersomnolence. The Sub-Committee has also published an article in the Medical Journal of Australia on current problems in managing narcolepsy and other central disorders of hypersomnolence: Narcolepsy management in Australia: time to wake up. The Sub-Committee also collaborated with others to write a systematic review on co-morbidities associated with narcolepsy and other central disorders of hypersomnolence: Narcolepsy: Comorbidities, complexities and future directions.
The ASA has been awarded a three-year Commonwealth grant that includes a program to help support primary care practitioners to enhance their clinical practice in sleep health. This work responds to Recommendation 9 of the Parliamentary Inquiry:
The Committee recommends that the Australian Government in consultation with the Royal Australian College of General Practitioners and other key stakeholders:
- Assess the current knowledge levels of general practitioners, nurses and psychologists in relation to sleep health, and
- Develop effective training mechanisms to improve the knowledge of primary healthcare practitioners in diagnosing and managing sleep health problems.
The SHF/ASA joint Pre-Budget submission for 2023 proposes specific responses to Recommendation 3 of the Parliamentary Inquiry:
The Committee recommends the Australian Government work with the states and territories to:
- Develop a nationally consistent approach to working hours and rest breaks for shift workers; and
- Consider whether there is a need for sleep health screenings for shift workers; and
- That this approach be based on guidelines recommended by Safe Work Australia and the Alertness CRC.