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Inside the Brain of Insomnia

As a sleep physician, I’ve been amazed at how many of my patients with sleep problems have told me that their minds just won’t stop racing when they lie down to try to fall asleep. How can this be? They are active all day, and by nighttime they are physically exhausted.

One would think that the minute their heads hit the pillow, they would be out. Instead, they just lie there and become aware of all the weird thoughts, unavoidable worries, things they forgot to do during the day, or tasks they must complete tomorrowoften provoking anxiety. The brain must settle down to enter into sleep and for these patients their minds are not relaxing. As a doctor, I’m trained to think about all the different things that could be causing my patients’ problems. This is the first step in prescribing a treatment. First, you need to understand what you are trying to treat. Why is their mind racing? Could this be some strange manifestation of a stroke?  A seizure? An unusual infection?

As I was taught in medical school, in most cases it’s not a rare or unusual diagnosis; it’s “just” insomnia.

What is insomnia?

And if it’s so common, shouldn’t there be some underlying reason why it is happening? Why does insomnia manifest itself the same way for all my patients?

For years, medical researchers struggled with understanding a medical, chemical, or physiological explanation for what was causing insomnia.

I remember seeing some patients who told me point blank they didn’t sleep at all at night, even though their sleep study told me their brains were asleep at night. I looked at their sleep reports and everything seemed normal. Then, looking up from the report, I would see the patient in front of me saying, “Doc, I didn’t sleep.” I would look at the report again. Yep, normal, I would think. Then, I looked up again at the patient. “Nope, I didn’t sleep,” they would repeat. Back and forth I would go with nothing seeming to make sense.

Understanding insomnia

As a physician and researcher, I knew there had to be a better way to understand the cause behind these racing thoughts: something that aligned more clearly with what the patients were telling me in the office.

Around this time, a revolution in understanding the brain was taking place. Newer and more refined ways of brain imaging became available, like taking snapshots of activity in the brain at any point in time. Scientists could now tell which part of the brain controlled certain movements, certain thoughts, and even certain feelings people were having.

I wanted to understand what the brain was doing while we sleep. How does this relate to how we feel upon awakening? How does it become disturbed in insomnia? I adapted these new brain imaging methods to take these snapshots of brain activity while people were asleep. These studies showed that during healthy sleep, the brain really does rest, and in a big way. There are massive reductions in brain activity when we sleep at night, especially in the most evolved areas of the brain like the frontal cortex. This part of the brain sits right behind the forehead and is the part we use the most while we’re awake and solving problems. Indeed, the absence of sleep leads to profound deficits in these areas of the brain while we are awake.

Using brain imaging

With the understanding of what the brain should be doing during sleep, I then tackled the question of what was going wrong in those individuals who reported

Insomnia Brain Image
Insomnia Brain Image

problems with their sleep. Unsurprisingly, the brain images for these individuals showed that their brains remained very active while they were sleeping. This was especially true in areas of the brain such as the frontal cortex, which should have been getting the most rest. What’s more, when we took snapshots of their brains while they were awake, there were large deficits in how the front brain was functioning. The picture became clearer and the complaints I heard from patients made much more sense.

Even though their brains were measured to be sleeping, large areas of the brain continued to work much too hard. They weren’t shutting off. This finally explained what my patients had been telling me all along. “Doc, my mind keeps racing and I don’t think I’m sleeping at all at night. I feel like my mind just keeps going all through the night.” Based on the brain imaging studies, this was clearly true.

Armed with a clearer understanding of what’s happening in the brains of those suffering from insomnia, I began the development of a treatment that would be free of side effects to help those suffering from insomnia.

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