Can you die of insomnia?

Research performed on rats in 1989 showed that complete sleep deprivation for two to three weeks caused the rats to die. The longest medically documented period that anyone has gone without sleep was Randy Gardner,a 17-year-old high school student in San Diego,who stayed awake in 1964 for 11 days during a dance competition. He did not suffer any ill effects except sleepiness; following the dance,he slept for 14 hours and completely recovered.

These examples,however,are of sleep deprivation,which is very different from insomnia. It is very unusual for someone to have a complete absence of sleep for over a few days because of insomnia.

There is an extremely rare genetic disorder known as Fatal Familial Insomnia,or FFI,which has caused undue concern for many who suffer from poor sleep. The condition has been identified in some 40 families across the world,affecting only about 100 people.

It leads to panic,anxiety,hallucinations,rapid weight loss,complete sleep loss,dementia and eventually death.

The disorder is due to a neurological degeneration of the brain and is linked to a rare abnormal protein called a prion.

Fatal Familial Insomnia begins in midlife and can result in death within one to two years. What needs to be remembered is that FFI is extremely rare,and unless a family member died of insomnia,one is not likely to have any predisposition to this disorder.

For the vast majority of people,chronic insomnia will not directly lead to death. But a lack of sleep can put one at a greater risk for developing other serious medical conditions that do have increased mortality. Consistently sleeping less than six hours a night has been linked to impairments in cognitive functioning,specifically a loss of concentration,memory and hand-eye coordination. Patients with chronic insomnia report problems performing daily tasks and often have increased absenteeism from work and school,and poor sleep has been linked to increased motor vehicle and workplace accidents.

Studies have shown that people with insomnia also have a greater risk of developing depression or anxiety disorders. Insomnia is likewise linked to increased risks for heart disease and hypertension,as well as increases the risk for obesity,diabetes,colon cancer,breast cancer and headaches.

As a result,treatment is critical for those with chronic insomnia. It is also important to stop worrying that you might die of it,as this will only serve to worsen your sleep.

Does insomnia have an underlying cause?

The origins of insomnia has caused a lot of debate over the years. One can have an underlying condition and insomnia. But once the original condition is treated,the insomnia may remain and require its own treatment.

Older schools held that insomnia was always secondary to some underlying condition,such as a medical,psychiatric or psychological disorder. But sleep specialists now believe that,in a minority of patients,insomnia occurs without any known underlying disorder.

Furthermore,when a medical condition exists along with insomnia,it does not necessarily mean that the two are linked. Therefore,sleep specialists now refer to the association as “comorbid,” or existing alongside,rather than “secondary,” which implies one condition causes the other. So someone might have insomnia comorbid with depression,but it does not necessarily mean that the depression caused the insomnia. The depression might have resulted from the insomnia,or be unrelated. Treating the “underlying” diagnosis may not alleviate the insomnia.

In many cases,insomnia has a variety of triggers. It may be the onset of a medical or psychiatric disorder,for example,or starting a new medication. Stress may also cause insomnia. The stress may be positive,such as the birth of a baby,a new job or marriage,or negative,such as financial concerns,bereavement or working odd hours.

Although many patients can link the start of their insomnia to a particular cause,others have a form of insomnia with no underlying connection to another disorder. This disorder,called psychophysiological insomnia,is often seen in patients who were light sleepers much of their lives and who tend to place great emphasis on,and worry about,sleep.

Even when an underlying medical or psychiatric disorder,such as depression,is successfully treated,resolution of the underlying condition doesn’t guarantee the sleep disturbances will go away. Continuing sleep trouble suggests that the insomnia exists as a separate disorder and is not simply a symptom of another condition.

positive behaviours

The situation is often made worse because,over time,people who can’t sleep often develop strategies to help them either get more sleep at night or cope during the day with sleep loss. Such strategies might include increased use of caffeine,prescription or over-the-counter medications,alcohol,napping,sleeping in or going to bed early,calling in sick to work,putting extra pressure on oneself to sleep,and so on. These behaviors,which may help at first,actually serve to make the insomnia worse in the long run.

In such cases,the insomnia may require its own separate treatment. Cognitive behaviour therapy,a prescription medication or a combination of the two can be very helpful. This is a non-drug approach based on the concept that chronic insomnia — lasting longer than four weeks — is sustained by many physical and behavioural factors that are generally unrelated to short bouts of insomnia. The factors that maintain chronic insomnia then become the focus of treatment.

The experts are from Sleep-Wake Disorders Center at Montefiore Medical Center in the Bronx