Sudden insomnia

During the COVID-19 pandemic, a 53-year-old patient developed insomnia. He initially thought it was related to the wave of insomnia many others were experiencing due to the stress and anxiety of living through the pandemic. But three years later, his insomnia persisted. He didn't exhibit any of the common mental health or stress-related symptoms that can cause the condition. His primary doctor suggested he try Benadryl^®, a common over-the-counter allergy medication, because it can induce drowsiness to aid sleep.

Already familiar with the medication for his seasonal allergies, it proved fairly successful in helping the patient manage his insomnia. However, after taking the medication for almost three years as a sleep aid, he became concerned about the potential long-term side effects. Benadryl is generally not recommended for long-term use due to reports of increased risks for dementia in older individuals. The patient opted to stay on the medication until he could find another effective sleep aid or determine what was causing the insomnia.

A diagnostic test sheds light

In late 2023, the patient (6'-0' tall and 175 lbs.) noticed some unexplained weight loss that continued into early 2024. His primary doctor ordered blood work to check his thyroid and adrenal gland function as a potential cause, but both were normal. When his weight dropped 12-15 lbs. with no other symptoms, his doctor referred him to a gastroenterologist (GI).

The patient's colonoscopy from a few years earlier was normal and results from his recent annual physical were excellent. As a result, the GI recommended testing for celiac disease and getting an abdomen/pelvic CT scan and chest X-ray. The celiac blood panel came back negative and results from the 2 scans showed that his internal organs were all normal. The diagnostic tests had failed to find the source of his weight loss but did help rule out things that weren’t the cause.

Diet reveals a possible clue

Curious to know more about celiac disease, the patient learned that you could test negative for the condition, but still be sensitive to gluten (non-celiac gluten sensitivity). It was also possible to not present any symptoms of either condition. He also learned that the disease causes damage to the lining of the small intestine that can result in malnutrition and trigger weight loss. So, despite testing negative for celiac disease and having no history of problems from gluten, he decided to try a gluten-free diet to test for asymptomatic gluten sensitivity.

The results he observed were surprising. While on the diet, his weight loss stabilized, and he even noticed improvement in his sleep. In fact, he was able to reduce his reliance on Benadryl as a sleep aid.

Gluten sensitivity and insomnia

The patient researched any link between gluten sensitivity and insomnia, learning that the sleeping disorder was one of the possible symptoms. Some experts believe the condition is caused by poor absorption of nutrients that are important to sleep function, such as magnesium and vitamin D. Within a couple of weeks of that discovery, the patient was able to stop taking Benadryl completely and his sleep patterns returned to normal. The patient didn't regain weight on his gluten-free diet but also didn't experience any further weight loss.

Lessons learned

The patient believes the anecdotal evidence suggests that gluten sensitivity may have been the hidden culprit behind both his insomnia and weight loss. His health experience with insomnia led him to make two important observations:

1.     Patients have to be proactive about their own wellness. That means paying close attention to changes in their bodies that can help explain health problems doctors may not see. It also means trusting their instincts and gathering more information about their health condition for better understanding. It's worth noting that the patient's own curiosity led him to discover the link between asymptomatic gluten sensitivity and his insomnia, a connection his doctors didn't make.

2.     It's important for doctors to look beyond the obvious to uncover the cause for some health concerns. This is especially the case when typical symptoms of a condition don't manifest. The patient noted that gluten sensitivity was never mentioned as a possible cause for his insomnia by his doctors. He even asked his primary doctor early on about any possible diet or nutrient deficiencies that could be related to his insomnia. But once the more common triggers for insomnia (stress and anxiety) were ruled out, the doctor's focus shifted toward managing the condition with medication versus exploring other causes. The patient believes he could have been spared three years of needless sleep disruption had the doctor done the latter.

As a result of COVID-19, telehealth became a more significant player in care delivery, and digestive health was no exception.  Read our expert insight to learn why digestive health is ripe for virtual care, and tips to build a successful virtual GI service.