“Sleep that knits up the ravell’d sleeve of care,
The death of each day’s life, sore labour’s bath,
Balm of hurt minds, great nature’s second course,
Chief nourisher in life’s feast.”

‒William Shakespeare, Macbeth

Why We Need Sleep

Shakespeare may be complicated, but the universal need for sleep is not. The “Chief nourisher” is, indeed, a major function of sleep. It scavenges toxins produced during the wakeful hours which are literally “the death of each day’s life.” It results in “hurt minds” or damage that may be irreparable. Sleep scavenges and disposes of the poisons that allow the system to be revitalized with a “second course” or another day.

Insomnia prevents this vital function of healing from occurring. It can accelerate neurodegenerative diseases like dementia and Alzheimer’s. Prolonged sleep deprivation can affect memory and cognition, and contribute to heart disease, diabetes, and mental health. Even worse, it can be fatal.

Fatal Familial Insomnia Kills

A dominant genetic disease called Fatal Familial Insomnia (FFI) is an extreme example of how sleeplessness can kill. It doesn’t appear until later in life, but it is fatal when it is triggered. There is no cure for it, and sleeping pills don’t help. According to the New York Times, people who suffer from FFI build up an “enormous sleep debt,” because the FFI gene prevents deep and restorative sleep. The toxins continue to accrue, and there is no release for them.

In fact, according to ABC News, those who have FFI are neither fully awake, nor are they completely asleep. They are in limbo between the two states, and as a consequence, they suffer from exhaustion and dementia. One hundred percent of the time, the final result is premature death.

CNN calls FFI a “family curse,” and I would agree with that assessment. Fortunately for most people, FFI is a rare occurrence. Wikipedia tells us that there are only 40 families ‒ affecting 100 people – worldwide with the disease.

Interestingly, the first formal recognition of FFI was in the early 18^th century, centuries after Macbeth was written. Yet it is obvious that Shakespeare was intuitively aware of the need for restorative sleep even back in the 16th century. That need is as clear to us now as it was then. We probably don’t suffer from a sleep disorder as severe as FFI, but still, we know that we can’t function on all cylinders when we don’t get enough sleep.

Chronic Pain Causes Insomnia

Many people occasionally suffer from insomnia, but people with chronic pain are more likely than the general population to struggle with sleep issues. While thirty percent of the general population experience sleep issues, the Cleveland Clinic reports that as many as two-thirds of chronic pain patients suffer from insomnia (although that figure may be as high as eighty percent).

Chronic pain makes it difficult to sleep. The toxins slowly accumulate. Behaviors change. Executive functioning is impaired. Insomnia, in turn, may increase pain. It’s a never-ending cycle.

Because of the dementia or impaired decision making it causes, insomnia may be part of the reason for the overuse of pain medications. In any case, we know that people experiencing chronic pain and insomnia are at increased risk of suicide and overdose (either passive or active suicide) from pills.

Recent reports that people on opioids have a shorter life expectancy may, in part, be explained by the lack of restorative sleep due to pain. Some people blame opioids for shortening the lives of people with chronic pain. Actually, insomnia may be a greater contributing factor to shorter life expectancies than the use of opioids.

Michelle Drerup, PsyD, of Cleveland Clinic’s Sleep Disorders Center, treats insomnia and pain at the same time. She has found that treating sleeplessness can help reduce pain, and she has found that insomnia and chronic pain are intertwined.

Like chronic pain, insomnia is a complex problem, and improving it often requires an interdisciplinary approach. Pain medication can be part of a treatment program, but opioids may interfere with reaching restorative sleep.

Treating Insomnia Is Essential

Long ago, Shakespeare understood that insomnia could be lethal. More recently, Stephen King picked up on the theme in his horror novel, Insomnia. Its main character becomes increasingly sleep deprived so that he loses the ability to differentiate between what’s real and what’s not. In fact, insomnia drives the man crazy. Although Insomnia is a work of fiction, this aspect of the plot is anything but fictional.

We know that insomnia is the stuff of which nightmares are made. We understand that it causes a decline in the quality, and the quantity, of life. So treating insomnia should be viewed as essential rather than as a convenience. Yes, this is something that should keep policymakers and insurers awake at night.

Photo by Hernan Sanchez on Unsplash