The document discusses insomnia, including its definition, causes, and treatments. It defines insomnia as having trouble falling or staying asleep. Insomnia can be acute (lasting days to weeks) or chronic (persisting for a month or more). Causes include disruptions to circadian rhythm, stress, psychological issues, medical conditions, neurological diseases, medications, and other factors. Rare genetic diseases like fatal familial insomnia can lead to chronic insomnia and eventual death from waking coma. Treatments include cognitive behavioral therapy and medication, but the underlying cause must be addressed for effective treatment.

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2. Insomnia: Definition, Causes (Plus A Genetic Condi-
tion That Can Lead to Waking Coma) and Treatments
Have you ever read the book entitled The Family That Couldn’t Sleep, written by D. T.
Max? It highlights the story of an Italian family, plagued by generations of a rare dis-
ease called fatal familial insomnia. Literally, the patient with the disease won’t be able
to sleep, leading to the development of hallucinations and then a waking coma. The
type where the patient is awake and able to see the slow despair that the insomnia is
doing to his body. And eventually, an inevitable death, after a few months to a year of
uncontrolled wakefulness.
Explaining insomnia and its different types
In simple terms, insomnia is a type of sleeping disorder, wherein the patient have trou-
ble falling asleep or maintaining sleep. It can of the primary type, like the fatal familial
insomnia, where it manifests as the main symptom of the diseases. Or it can also be of
the secondary type like in neurological diseases such as Parkinson’s or Alzheimer’s. In
terms of duration, we can classify insomnia into two main categories, namely:
1. Acute Insomnia
If you have trouble falling asleep for a few days to a few weeks only, that is categorized
as acute insomnia. This category includes insomnias related to disruptions in the circa-
dian rhythm (travel, graveyard shift in work or noises during sleep), stress (work-related
or relationship-related issues) and short-term diseases (sinus issues or flu). Acute in-
somnia can be treated easily, as long as the main source of the problem is resolved. So
for instance, if you develop acute insomnia due to migrating to a new country, you just
need to adapt to the local time zone in order to resolve the problem.

3. 2. Chronic Insomnia
The other type is called chronic insomnia and occurs when a patient has trouble sleep-
ing a few days in a week, persisting for around a month or more. Usually, chronic in-
somnia can be caused by an underlying condition like a psychological issue (bipolar
disorder), medical condition (sleep apnea) or neurological issue (Parkinson’s disease).
In the case of fatal familial insomnia, chronic insomnia is the main symptom that makes
the patient undergo a waking spell. With the chronic sleep deprivation, the brain even-
tually overworks and then shut downs leading to death.
The various causes of insomnia
If you have been paying attention, the causes of insomnia have been briefly discussed
above. Both acute and chronic types of insomnia can have underlying factors. Once
you have determined these underlying factors, it is easier to find treatments for the in-
somnia that the person is suffering from.

4. 1. Disruptions in Circadian Rhythm
The circadian rhythm is our body’s innate body clock. The usual cycle of humans is to
wake up in the morning, perform tasks in the afternoon and sleep during night. When-
ever this rhythm is disrupted, the sleeping cycle can also be interrupted. You might
have noticed this during international travels, whenever you visit another region that
has a different time zone from where you reside.
The circadian rhythm can also be disrupted by external stimuli. For example, call cen-
ters are abundant in developing countries such as India and the Philippines. Employees
from this sector must adhere to the time zone of the country that their company is
based in, hence they must work on graveyard shifts that disrupt their body’s circadian
rhythm. Similarly, external factors such as noise, bright lights, gadgets and television
can also induce disruptions in a supposed to be comfortable sleep.

5. 2. Stress
Another factor that can induce sleep deprivation is stress. Someone who constantly
thinks about his or her problems prior to sleeping might experience less of an urge to
sleep. The brain overworks, which would then lead to insomnia. In some cases, the
person might turn to unhealthy lifestyle patterns such as eating heavily during the night
or drinking caffeine, which can also lead to sleep deprivation.
If a person recently experienced death in the family, that can also result in a stress-in-
duced insomnia. The grief and trauma might render one sleep deprived or maybe the
thoughts of the memories can lead to the unwillingness to sleep. Relationship issues
and even work-related problems fall under this category as well. For students, the on-
set of an exam or upcoming report in school can provide for stress to and lead to in-
somnia.
3. Psychological Issues

6. Psychological disorders can also be the cause of insomnia. It is not exactly known
whether psychological disorders prelude insomnia or vice versa. It is proved though
that some mental disorders coexist with the symptom of insomnia. So this includes
diseases like bipolar disorder, depression and schizophrenia. The presence of insomnia
can also indicate an underlying psychological issue in some cases.
For instance, it was found that insomnia was one of the earliest signs that parents were
able to notice with their bipolar children. In fact, around 74% of the patients manifested
insomnia or sleep disturbance as early as 3 years and below. In another study, re-
searchers were able to distinguish bipolar disorder from other conditions such as
ADHD due to the manifestation of the symptom of insomnia in the former. This coexist-
ing relationship is another important factor to look for when it comes to determining the
cause of sleep disturbance.
4. Medical Conditions

7. Insomnia can also occur due to underlying medical conditions. In acute cases, condi-
tions such as fever, sinusitis, colds and coughs can cause disturbances in sleep. This
is especially true for very young children who seem to be affected by interrupted sleep
whenever they are suffering from minor clinical conditions that were mentioned above.
But even adults can experience sleep disturbances during bacterial or viral infections.
Other medical conditions like arthritis, asthma, angina and cancer can also cause dis-
turbances in sleep. The commonality between these diseases is they cause some form
of pain. With pain, the patient finds it hard to sleep or to find a comfortable position at
least. Thus, the cycle of sleep deprivation and insomnia can also occur. We can also
categorize common sleep disorders such as sleep apnea or restless leg syndrome
here.
5. Neurological Issues
In neurological diseases, a common symptom is chronic insomnia. The degenerative
Parkinson’s disease, apart from the patient losing control over his motor movements,
also manifests symptoms of sleep disturbance. It was found that sleep fragmentation is

8. the most common type of sleep disturbance that Parkinson’s disease patients experi-
ence. Unfortunately, not too many studies have been focused around this area in the
disease progression.
With regards to the chronic insomnia experienced by patients with fatal familial insom-
nia, it has to do with their genetic makeup. Turns out, the prions of these patients have
inherent mutations that only manifest the symptoms during the middle ages of the af-
fected individuals. Examinations of the brains of the deceased patients revealed that
severe neuronal loss and atrophied areas are evidences of the dreaded disease. The
mutation leads to the chronic insomnia which then leads to the death of the patient.
6. Other Factors
Certain medications can also cause insomnia. While these medications can help treat a
certain underlying condition, their side effects can include sleep disturbance. For ex-
ample, prednisone, which is a popular asthma and allergy medication, is known to in-

9. duce insomnia in patients taking it. In this study, patients revealed that they experi-
enced insomnia after a short-term treatment with the medication. Other medications
that have a side effect of insomnia are fluoxetine, ritalin, statins and sertralines.
Sudden surges in hormones, occurs during pregnancy and before menstruation, can
also lead to sleep disturbances. Frequent ingestion of caffeinated products such as
coffee, tea and soft drinks can also cause insomnia. Age and gender can also be me-
diating factors for developing insomnia. As people age, the possibility of developing
insomnia increases. It was also proved that females are more at risk of developing in-
somnia than males.
To treat insomnia, we need to go deep down and find the un-
derlying issue
More often than not, insomnia is a manifestation of a more serious underlying issue. It
could be simple, like a lifestyle change, or it could be complicated, like treating a neu-

10. rological disease first. But the verdict would always be the same, find the source of the
problem and hopefully, treat the patient off the insomnia. In some rare cases, despite
finding the source of the problem, the patient might not be treated off the insomnia be-
cause the issue is in the genetic makeup of the person already. There are two ap-
proaches to treating insomnia which are:
1.Cognitive Behavioral Therapy
This type of treatment can work for acute insomnia triggered by disruptions in the cir-
cadian rhythm, stress and unhealthy lifestyle patterns. Cognitive behavioral therapy in-
volves changes in the way you perceive and maintain sleep. Usually, you need the aid
of a therapist in order to allow for these changes to slowly be a habit in your life. When
you change the way you perceive sleep, you treat the overlying symptom of insomnia.
The therapist would assess the underlying conditions as to why insomnia manifests as
one of the symptoms of the patient. If, for example, it was found that the patient con-
stantly engages in gadget use prior to sleep, the therapist can modify the sleep sched-
ule of the individual. Many studies have already highlighted that there is a direct rela-
tionship between cellphone use and insomnia, like this one.
In one study, one group of patients suffering from chronic insomnia was given cognitive
behavioral therapy. The other group was given the same treatment along with medica-
tion. The results were positive for both groups, although the latter group received
slightly higher positive results. In the end, the researchers concluded that even with just
cognitive behavioral therapy alone, patients suffering from insomnia might experience
sleep improvements.
The use of cognitive behavioral therapy for patients suffering from insomnia due to
psychological, medical or neurological conditions has mixed results. In this review of
studies, in certain psychological conditions such as depression, bipolar disorder, post-
traumatic stress disorder and psychotic disorder with co-morbid insomnia, the results

11. were positive. Cognitive behavioral therapy was able to significantly reduce the sleep
disturbances of patients with such underlying conditions. But if you search for other
studies, the results are mixed, though this is again, an understudied area.
2. Medication/s
There are different types of medications that one can use to treat insomnia. However,
it’s important to note that if your insomnia is caused by an underlying condition, then
you need to treat the condition first. If you’re suffering from chronic pain due to arthri-
tis, which causes your sleep disturbance, then you need to take pain medications to
treat the pain instead. If you’re suffering from a short-term illness such as flu, you can
take over-the-counter medications for it instead of treating the insomnia, which is only
an overlying symptom of the real condition.
In some conditions such as cancer or neurological disorders, despite treating the dis-
ease, the symptom of insomnia might still manifest. It is then that you can rely on med-
ications specifically made for insomnia. Commonly prescribed medications are benzo-
diazepines, which induce the production of GABA and results in sedation to the pa-
tient. Under this category, you can find brands such as estazolam, flurazepams and
quazepams.
Other medication alternatives are non-benzodiazepines, which work on the same area
of the brain, by inducing the release of GABA. They are selective though to the GABA-
A receptors and pose less dependency risks for the patient. In some cases, for acute
insomnias, melatonin supplementation can also work. Since this increases melatonin
levels in the body, a natural sleep-inducing hormone, this can work for people who
have problems falling asleep. Anti-histamines are sometimes used as well for acute in-
somnia, as one of their side effects is sedation and drowsiness.
In reality though, medications only treat the symptom of insomnia. Thus, if you are suf-
fering from a condition that only manifests insomnia as one of its symptoms, you’re not

12. really treating the source of the disease. Further, insomnia medications work for the
short-term only and are not indicated for long-term use, where dependency and ad-
verse side effects might occur.
And finally, in some conditions, such as Parkinson’s disease and fatal familial insomnia,
there are no known treatments for them yet. Thus, treating their symptoms would prove
to be of no use. The problem lies in the genetic mutations of the individual. Treatments
can prolong the life of the person, or even somehow alleviate the insomnia, but not re-
ally treat the person fully.
Insomnia might be a symptom of your disease or it might be
your disease
But the reason that insomnia occurs goes deeper. Sleep disturbances can occur be-
cause of environmental factors or intrinsic factors. For whichever reason, it’s important
to know the underlying conditions that make insomnia appear. Only then can we treat
it, whether by therapy or by medication. So first, make sure you remove all extrinsic
factors that could be triggering your insomnia. If those factors do not seem to be the
culprit to your insomnia, you could take the medical route and get the opinion of a
trained professional to help determine the intrinsic factors that could be triggering your
insomnia.
Do you know someone suffering from insomnia? What steps did he or she take to treat
the symptom? If you’re suffering from insomnia, was this blog post helpful to you? If it
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