Nowadays, Insomnia is becoming a very common problem among people of all ages. In the past, elderly people have struggled with sleep disorders, but now we are concerned with the young population (Johnson 2018). In recent years, under the heavy pressure of school work and various diseases occurred among teenagers, insomnia is becoming more of a common problem. Insomnia among teenagers can cause difficulty to fall asleep, poor sleeping quality, short duration of sleep, memory and concentration loss (Kryger et al. 2002). As a result, people are constantly finding ways to solve this problem and enabling teenagers with insomnia to go back to their normal life.
Earlier theories imply that iron deficiency anemia is linked to restless legs syndrome (RLS), a disorder that may result in severe sleep onset insomnia. Studies suggest that low body storage of iron may lead to RLS (Sun et al. 1998). According to a research conducted by Sleep Disorders Centre in St. Boniface General Hospital, insomnia in adolescents and teenagers is not a disease but the symptom. In this study, researchers endeavoured to found the cause of the symptom, hoping that by treating the cause, we could solve the problem of insomnia.
The method of this experiment is to study three different cases of three different teenagers. The first one is a 14-year-old male student with a four-month history of insomnia. The second case is a 19-year-old female student with a seven-year history of insomnia. The third is a 14-year-old male student with a six-month history of insomnia. These three teenagers were evaluated with comprehensive polysomnography including the recording of EEG, submental EMG, EOG, EKG, right and left anterior tibialis EMG, SpO2 (using fiberoptic ear oximetry), chest wall motion and abdominal motion (using inductance plethysmography), measures of airflow (oronasal capnometry and nasal pressure), and sound (for snoring) using standard techniques. The result shows that by conventional definition, none of these patients have anemia. However, all results are the same with abnormal iron metabolism. Consequently, after the measurement, the patients are been studied on the cause of iron deficiency and started on iron supplementation.
In Case 1, the patient is a male student who could not stop moving and it is very hard for him to fall asleep at night. The researchers measured his Epworth Sleepiness Score (a subjective measure of sleepiness), sleep latency, sleep efficiency, PLMs index and arousal index of the patients. After the measurement, the patient was instructed to take 300 mg ferrous sulfate by mouth twice a day. After four months of treatment, the symptoms of RLS disappeared completely and insomnia was resolved. The patient’s behavior of frequent sleeping in day time is resolved and his average grade at school went from 45% to over 90%.
The patient in Case 2 is a female college student who have RLS symptom five nights a week. She fell asleep during day time every day and had dreams in every nap. After doing the same measurement as Case 1, the result was similar with that of narcolepsy, and the iron study result was consistent with iron deficiency anemia. Thus, the patient was instructed to have 5 months of 300 mg of ferrous sulfate by mouth, which, as a result, leads to the abolition of her insomnia. Modafinil, a stimulant, was also taken by this patient to resolve narcolepsy, improving day-time alertness.
In Case 3, the patient is a male student who has had insomnia for 6 months and has difficulty to get up in the morning. As the result, he missed 90% of his school days and drop out of school in the end. Before insomnia, the patient has other complex problem like IgA deficiency, recurrent infections, peptic ulcer disease and a presumably benign chronic frontal lobe mass. After the measurement, the patient was started on ferrous sulfate (300 mg twice daily) iron replacement therapy. After six months of treatment, the problem of RLS and insomnia was completely resolved.
The author did not admit to any limitations in this study. However, there are ways to improve the study and make the result more reliable. One way would be to repeat this study multiple times and see if the data resembles each other. Three cases are not enough of a sample size to suggest convincing data. However, the author did say that teenagers differ from each other and the cause of insomnia among these three teenagers may not apply to all. In Case 2, narcolepsy was also likely present. Insomnia has many causes, but a few that require special consideration in this age group.
A patient complaint or a symptom, insomnia is not a disease as the general public used to perceive. The main challenge to cure insomnia is to find the cause and corresponding treatment. Iron deficiency can be one of the causes but there are still other causes varies from person to person. Consequently, future studies are needed to found the other causes and resolve the problem of insomnia in more teenagers.
References:
- Johnson Kyle P. 2018. Insomnia in children: treatment strategies. Journal of the American Academy of Child & Adolescent Psychiatry. 57(10):S21.
- Sun ER, Chen CA, Ho G, Earley CJ, Allen RP. 1998. Iron and the restless legs syndrome. Sleep. 21(4):371-377.
- Kryger MH, Otake K, Foerster J. 2002. Low body stores of iron and restless legs syndrome: a correctable cause of insomnia in adolescents and teenagers. Sleep Medicine. 3(2):127–132.
