It's official. Today, the Los Angeles County Coroner's Office reported that Michael Jackson died of an overdose of propofol, an anesthetic most often used during major surgery. Why he was using this drug at home is still unanswered, though reports indicate that the pop superstar hadn't properly slept for years, maybe even decades. Is it possible that Jackson's quest for shuteye may have ended his life? The same questions surround Heath Ledger, who died last year of a prescription-drug overdose. At one point, the young actor told The New York Times he was only getting two hours a night. Director Terry Gilliam told Vanity Fair that Ledger was overusing prescription sleep aids in search of rest. "It was a combination of exhaustion, sleeping medication … and perhaps the aftereffects of the flu," said the director, speculating about Ledger's death. "I guess his body just stopped breathing."
We've all suffered from a poor night's sleep. According to the National Center on Sleep Disorders Research, vast numbers of Americans (30-40 percent) report suffering from one or more nights of insomnia during any given year. But can insomnia get so bad that you actually die from it? There's very little research on what happens to the human body when it goes for extended periods without sleep—after all, no lab in the country would sign off on such experiments. From what we do know, it's highly likely that one's body would eventually just shut down. But what's more common, and troubling, is chronic insomnia, bouts of brief, fitful sleep—an hour here, three hours there—lasting beyond three weeks into months or years at a time. About 10-15 percent of Americans suffer from chronic insomnia, and while this type of condition is not deadly in and of itself, it can lead to a whole host of other disturbing mental and physical effects.
The ill effects of insomnia can be immediate after just one sleepless night. (Even not getting enough sleep per night can be dangerous: studies show that mortality rates spike in those that sleep drastically less than seven hours a night.) According to recent research by Matthew Walker, director of the Sleep and Neuroimaging Laboratory at the University of California, Berkeley, the amygdala—the part of the brain that alerts the body to be prepared in times of danger—goes haywire when a full night's sleeplessness occurs. That in turn wreaks havoc on the prefrontal cortex, which controls our logical reasoning and "fight or flight" reflex, turning us, as Walker says, into "emotional Jell-O." Memory capacity and speech control diminish; irritability spikes. At the same time, some studies have shown that cortisol, a hormone related to stress and depression and linked to cardiovascular disease, is building up in the body instead of being moderated by a good night's rest. Concentration is kaput. The muscles ache. What's worse, the external, ordinary dangers of modern life become many times more deadly: according to the U.S. Department of Transportation, there are about 200,000 car accidents a year caused by sleepy drivers, killing more people than drunk driving. Essentially robbed of its power to encode or consolidate memories after just one day, the brain quickly instead begins to mimic the profile of people with acute psychiatric disorders.
Physiologically, the human body could survive without sleep for 11 to 18 days, based on research from experiments and various other stunt-based records. Taken to extremes, the results of sleeplessness get downright grim, which is why it's been both shunned as a form of unethical research and used as torture. When lawyers for former President George W. Bush argued, in a 2005 memo, that keeping detainees awake for 180 hours—seven and a half days—didn't constitute torture, the medical researchers cited in support howled with protest, calling it "deplorable" and "nonsense." "Prolonged stress with sleep deprivation will lead to a physiological exhaustion of the body's defense mechanisms, physical collapse, and with the potential for various ensuing illnesses," responded Professor James Horne of the Sleep Research Centre at England's Loughborough University and author of Why We Sleep. Horne says the effects of prolonged sleeplessness are painful indeed. Various brain and several bodily functions go completely gunnysack. Vision goes blurry or double; nausea sets in. By a week, hypertension and body temperature run amok; the brain may be overcome with hyperemotionality, paranoia, and hallucinations.
Yikes. So aside from torture, what could keep someone up for weeks at a time? How about fatal familial insomnia (FFI), a rare genetic malady that can strike an entire household, dooming victims to a zombie state until death arrives about 15 hellish months later? D. T. Max, whose book The Family That Couldn't Sleep chronicled the eerie real-life saga of an 18th-century Italian family afflicted with FFI. "The symptoms of FFI are remarkable and grim," writes Max. "Typically, one day, the sufferer find that he has begun to sweat ... his pupils have shrunk to pinpricks and he is holding his head in an odd, stiff way ... Constipation is common, the women suddenly enter menopause and the men become impotent ... Over the ensuing months, their exhaustion is immense, beyond comprehension ... Once he can no longer sleep, a downward progression ensues...." (If, panic-stricken, you're reading this at 3:30 a.m. and sure you've got it, it would be wise to reconsider the self-diagnosis; fewer than 50 families in the world are known to carry the gene.
Ordinary, or what's known as primary insomnia, is far more common. Leaving aside obvious, easy-to-diagnose causes (jet lag, drug abuse, excessive caffeine, or alcohol intake) and those of what's called secondary insomnia (symptoms of an array of bodily ailments from sleep apnea to fybromyalgia, arthritis, cancer, Parkinson's, and others), the root cause is often psychological, its persistence due to learned behavior. "Anxiety and depression are usually highly correlated with insomnia," says Sara Mednick, assistant professor in the Laboratory of Sleep and Behavioral Neuroscience at University of California, San Diego, and author of a book on healthy sleeping habits, Take A Nap. Change Your Life. "Often it's a very normal thing—a death [of someone close], for example—but there's a sudden crisis in their life, and one starts to have sleepless nights. But it can become a learned experience, which overtakes the thing that happened." The risk of developing major depression from that point, one study showed, increases up to fourfold.
Insomnia sometimes passes—but sometime it doesn't, leading to chronic sleepless nights. Most insomniacs avoidably become, in essence, their own worst enemies, mishandling the malady through habit-forming drugs or seemingly benign but flawed methodology. "Misguided ways to cope with the sleep deprivation—such as drinking coffee, going to bed earlier, having a nightcap, or staying in bed longer in the morning—only fuel the problem," write Lawrence Epstein and Steven Mardon, authors of The Harvard Medical School Guide to a Good Night's Sleep. "As insomnia worsens, anxiety and frustration mount, leading to a vicious cycle.…"
Those desperate enough for sleep often overmedicate, Mednick says, which doesn't treat the insomnia at all. Instead, it masks the underlying issues in a narcotic haze that can lead to addiction and even more sleepless nights. Unfortunately, desperate for sleep, the insomniac has a smorgasbord of heavily marketed pharmaceutical remedies to choose from—both by prescription and over the counter. In recent years, prescription antidepressants have found some favor in treating insomnia, while over-the-counter sleeping pills (usually a form of antihistamine) remain popular too. The problem with most of these medications—especially so-called sedative-hypnotics, obtained by prescription and also known as benzodiazepines and non-benzodiazepines—is that while they might seem to give the sufferer some relief, they either disrupt or prohibit REM sleep, the restorative kind that provides great, complicated dreams and a sense of renewed vigor and optimism in the morning. You think you're asleep, but it's light, and there's the chance of developing psychological or physical dependence, not to mention a host of side effects. In all cases, these pills fail to cure the cause of the insomnia. In some cases, they prolong it. And when abused, these drugs can result in a permanent, deadly slumber.