The nightmare of sleepless nights.

The nightmare of sleepless nights

The isomniac's worst nightmare has been reported in the Oct. 16 NEW ENGLAND JOURNAL OF MEDICINE. Italian and U.S. researchers detail the case of a 53-year-old man who, in effect, died from insomnia. And though this case is an isolated one, it enabled the physicians to gain insight, through an autopsy, into some possible brain mechanisms involved in insomnia.

After a lifetime of relatively normal sleep (five to seven hours a night), the patient rather abruptly began to lose sleep at age 52; within a few months after the problem started, he was down to only one hour a night. During subsequent hospital admissions, the man's progressive deterioration became increasingly evident--he sank deeper and deeper into a vegetative stupor, his speech became unintelligible, his movements erratic and he was soon unable to perform simple tasks. He did not respond to sleep unable to perform simple tasks. He did not respond to sleep medications. In his exhausted, debilitated state, he developed a lung infection and, eventually, died.

An autopsy revealed that the man had lost 95 percent of the large neurons, or brain cells, within two nuclei of the thalamus, according to Elio Lugaresi and his colleagues of the Unversity of Bologna (Italy) Medical School, who performed the study along with scientists from Case Western Reserve University in Cleveland. Moreover, the researchers found a similar thalamus deterioration in the brain of one of the man's sisters, who apparently had died in the same way. In a number of his relatives, in fact, researchers were not able to detect any brainwave sleep pattern in electrocephalograph tests.

The role of certain parts of the thalamus in sleep had been proposed previously but "was later ignored or rejected," according to Lugaresi and his colleagues. But, they write, these new findings do "indicate that the . . . thalamus has a role in integrating and expressing sleep, autonomic functions and neuroendocrine circadian rhythm."