Qn: “Could insomnia be a sign of mental issues? I find so many workmates complaining of sleeplessness lately”
A few months ago we saw a student who was complaining of the recent onset of insomnia. She was at university and in a state of panic. She had gone to a pharmacy and asked for a sleeping pill. She was given some which at first gave her “great sleep”. With time, however, she found that she needed an increasing number of sleeping pills to get the same experience of “great sleep”.
Her problems were many. Her grades had dropped, she felt drowsy all the time, and her gait was unsteady. She had been given an overdose of the sleeping pills over a period of a few weeks and now she presented with the multiple complaints.
Doctors are trained to take a careful history before prescribing any medication. During the evaluation, it became evident that the girl had started to suffer from insomnia when she started taking massive amounts of coffee. She had not told the pharmacist this because he had not asked.
She was treated for the insomnia simply by stopping coffee. In this rather extreme example, the insomnia was due to coffee and not a mental illness. She also stopped taking sleeping pills
On the other extreme, a diagnosis of a Bipolar Mood Disorder was made in a student who presented with the same symptoms of insomnia.
In her case, the onset was gradual and was not related to coffee. She had failed her second year exams in law school a few weeks after her mother’s death. In the early stages of her illness, she was noted to be sleeping rather little. It seemed to her friends that she was busy studying for the supplementary exams that were due. She slept late and got up early. At first, nobody paid any attention to this new sleeping habit.
Some concern was raised when she did not go to bed until after midnight and often got up by 3am. She seemed busy all the time, doing everything else but study. She cleaned her room (many times), played loud music and sent endless emails. Most of the emails were long and rambling and her friends stopped reading them. Many friends blocked her number because she made frequent calls at odd hours and when she got through, would only stop talking when she ran short of airtime.
She was grandiose in her plans. She said she would pass her exams with flying colours, and would graduate at the top of her class. None of the teachers had her level of intelligence, she often repeated. She planned to have a big graduation party and had already decided on the man she would marry, in which church.
She spoke with haste and seemed to stumble on her words. Red lipstick complimented her red nails. Her clothes were brightly coloured and matched her shoes and hand bags. She was irritable and often shouted (or screamed) at anybody who got in her way.
Her parents were called in by her friends and at the hospital, a diagnosis of a manic episode was made. She slowly got better on treatment, which included sedating her with medication.
The history given by the parents indicated that at 18 years, she had been treated for insomnia. At the time the insomnia was associated with extreme sadness, feelings of hopelessness and bouts of tearfulness. She had attempted suicide twice. She was treated and got better.
With the two episodes, one manic and the other depression, a diagnosis of a Bipolar Mood Disorder was made and she continues with treatment. She graduated, got married and has two children.
These are the extremes of cases of insomnia. One due to coffee, the other due to mental illness. In the middle, many other cases of insomnia exist, and range from anxiety, to grief reactions among other causes. In all cases, make sure you know the true cause of the insomnia before embarking on any form of treatment.