Q: My 27 years old friend is unable to sleep at night from the past two months. He is facing some family related problems. He is staying alone in Chennai. To my knowledge, he has not slept at night even for an hour. In the past months, he used to sleep around 2 am and then he started sleeping at 3 am. But now he is complaining that he lost his sleep completely. Moreover, he does not want to sleep and is not ready to undergo any treatment. He told us that he used to have two sleeping pills a day. Unfortunately, it did not work and he stopped taking the sleeping pills. What would be the best treatment for his problem?

A:It seems like your friend started having this sleep problem only for the past 2 months in which case it could be most likely due to some underlying stress. In such cases it is possible that once stressors are gone the sleep disturbances may improve, however, in many cases the sleep disturbances may persist despite the stress getting better. In any case the best way for this to be treated would be to first get a comprehensive evaluation to assess the underlying stress or other medical and emotional problems rather than taking medication directly.

Under normal circumstances acute sleep loss usually leads to sleep propensity and sleep in healthy humans and thus possibly preventing any adverse consequences of total sleep deprivation. There are no human studies of complete loss of sleep so we do not know the answer for total sleep loss in humans. There are studies on partial sleep loss in humans, which indicate increased risk of metabolic disturbances (e.g., diabetes), infections, possibly cardiovascular disorders, and mood disturbances. In animal experiments when rats were sleep deprived for several days/weeks they developed skin lesions on paws and prolonged deprivation of sleep led to death.

I strongly suggest that your friend should seek comprehensive evaluation preferably by a psychiatrist who also specializes in sleep.