Not as strange as it sounds. We share a common core of genes with drosophila melanogaster, the fruit fly--about 60% similarity according to the National Human Genome Research Institute. A recent NPR podcast featured, Dragana Rogulja, PhD. Assistant Professor in Neurobiology at Harvard Medical School. Insomnia can be studied in animals and insects--with a little genetic manipulation they too can experience different types of insomnia. "Genetically, we can separate these different aspects of sleep regulation. So, in other words, we can find factors that specifically regulate how we fall asleep, factors that regulate how we stay asleep, factors that regulate how we wake up, etc." --Health News by NPR
When it comes to sleep, fruit flies are a lot like people. They sleep at night, caffeine keeps them awake, and they even get insomnia.
Medicalization describes a normal biologic behavior that has transitioned to a medical diagnosis in search of a cure or pharmacologic intervention. I am confident that the data is capable of establishing when sleeplessness officially became Insomnia costing $100 billion in healthcare utilization and loss productivity. The FDA does establish regulatory requirements to evaluate dependence pharmacology described in the article Prediction and Prevention of Prescription Drug Abuse: Role of Preclinical Assessment of Substance Abuse Liability. It is critical to create awareness around the risks associated with specific classes of drugs, especially those prescribed for patients with "insomnia".
Unfortunately, insomnia is now characterized as an unmet medical need. Many of the harms of medical management such as suicide ideation, addiction, and overdoses are trumped for the management of a potential cultural artifact of an aging population, escalating role of technology, less than optimal physicial activity, and many factors that may benefit from nonmedical strategies.
The table presented here suggests a few determinants that may be addressed prior to pharmacologic interventions. When we look for data and drill down in more granularity, practical approaches with favorable risk benefit analyses inform balanced care in many patients.
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In a world of "evidence-based" medicine I am a bigger fan of practice-based evidence.
Remember the quote by Upton Sinclair...
“It is difficult to get a man to understand something, when his salary depends upon his not understanding it!”
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