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In April of 2007, a 31-year-old woman woke up from a nap on her couch and rubbed her eyes. But instead of feeling rested and refreshed, she felt even worse than when she'd gone to sleep.
She had a pounding headache and the light that was coming through her window seemed impossibly bright. Her mouth was dry from thirst and hunger pangs wracked her stomach. The woman stretched and sat up. She was sore all over. It hurt just to reach for her phone on the coffee table. She turned her phone on and when she saw the time and date, her eyes went wide. She'd slept for 53 hours straight.
The woman tried to resist the fear that was now rising in her mind. She hadn't had anything to eat or drink in days. Her body had been wasting away while she slept, and she'd been powerless to break free. If this happened again, she might never wake up.
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From Ballin Studios and Wondery, I'm Mr. Ballin, and this is Mr. Ballin's Medical Mysteries, where every week we will explore a new baffling mystery originating from the one place we all can't escape, our own bodies. If you enjoyed today's story, please bring a to-go container to the Follow Buttons wedding and use it to pack up the entire cake before the bride and groom have any. This episode is called Sleep Addict.
In the fall of 2005, 29-year-old lawyer Anna Sumner leaned her elbows against her large wooden desk and stared at her computer screen. It was hard not to let her mind wander. She could see downtown Atlanta, Georgia right from her office window. Anna yawned and stretched and then forced her eyelids to stay open. It was already 5 p.m., but she still had an important brief to finish before she could go home.
Her attention wandered again, this time to the framed diplomas that hung on her wall. She had an undergraduate degree from Princeton, and she had received her law degree from Duke. She'd studied very hard in school and now had worked her way up the ranks at a very prestigious law firm. She was proud of everything she'd accomplished. Anna leaned back in her chair and kicked off her high heels. She was exhausted. Then again, she was always exhausted.
In high school, she used to skip hanging out with friends just to go to bed early, which left her feeling totally isolated. During college, she routinely skipped breakfast to sleep in and then showed up to class so hungry she couldn't even focus. Once, she'd flown cross-country for a friend's wedding and then accidentally slept through the entire thing. Finding the energy to get through law school had been a constant struggle, and it was even harder as a young lawyer at a big firm where so much was expected of new people.
Sometimes, she feared that her constant fatigue was damaging the career she had sacrificed so much for. It was beyond frustrating. Anna had slept for at least 12 hours the night before, yet here she was, not feeling rested. It was like she was moving through a fog at all times. She always needed more sleep, but she knew she needed to keep working.
Anna stood up and shook her arms, trying to get her blood moving. She opened her eyes as wide as she could. She shook her head back and forth and sat back down, determined to finish her work. But as soon as she started to type, her eyelids grew heavy again and Anna nodded off, her cheek resting on the keyboard. The next thing Anna knew, she was slowly waking up. Her back ached from being hunched over in her chair. Her computer screen had gone to sleep too. She shook the mouse and the screen lit up and she looked at the time.
It was 6 a.m. Anna had just slept for 13 hours. She was completely disoriented, still wearing yesterday's clothes, and her brief was not finished.
Anna immediately felt a knot form in her throat. She had been successfully hiding her sleepiness problem ever since she was a teenager when it began. She'd always been able to arrange her schedule to accommodate her constant need to sleep. But now that she had a job with a lot of responsibilities, she just didn't have that same flexibility.
Anna had always prided herself on having a good work ethic and self-control, but now she realized that this was something she really just couldn't control. Sometimes when Anna felt really tired, she would think to herself, "If I don't sleep right now, I feel like I could actually die." She knew that was not normal. This problem had gone on long enough and it wasn't going to get better unless she sought out some help.
A few days later, Anna drove to the Emory Clinic Sleep Center in Atlanta. It was inside an old, faded building undergoing significant renovations. In fact, there was still construction going on outside. Anna plugged her ears as she walked past jackhammers slamming into concrete.
She checked in, and a few moments later, a gray-haired, round-faced doctor walked her back to a large exam room with chairs and a bed. He adjusted his glasses and then introduced himself as Dr. David Rye, the lead neurologist at the clinic. He motioned for Anna to take a seat and asked her about her symptoms. And she told him that she basically craved sleep the same way a drug addict craves a fix. No matter how much she slept, she never felt rested,
and the constant exhaustion was totally debilitating. Dr. Rai nodded understandingly and suggested they begin with a very basic test. He asked Anna to simply take a nap, right there in the exam room. And so Anna laid down on the bed. She could still hear the loud construction noises going on outside, but it didn't bother her. Within moments, she was asleep.
But just a few minutes later, Dr. Rai shook her awake, and then he diagnosed her with a disorder called hypersomnia. This is a catch-all term for extreme unexplained sleepiness. It's thought that up to 5% of the entire population experiences it, though rarely at the level Anna was. So while it was a diagnosis, it really wasn't that specific.
But for Anna, who'd never seen a doctor for her sleep problems before, having any diagnosis was progress. And she was even more optimistic when Dr. Rai suggested a treatment plan.
He explained that in most cases, extreme tiredness is caused by a lack of energy-promoting chemicals in the brain with names like dopamine and norepinephrine. It's like having a car with no gas in the tank. So he prescribed stimulants for Anna. These medications increase the level of these energy-promoting chemicals the same way that caffeine does. For patients like Anna, it can feel like they have a full tank of gas again.
And Anna was so excited about her stimulants that after she left the doctor's office, she went straight to the pharmacy. When she got there, a pharmacist handed her a paper bag with a couple of prescription bottles inside, and Anna didn't waste any time getting her first dose. Sitting in her car in the parking lot, she opened one of the bottles, shook a pill into her hand, and swallowed it. She couldn't wait to feel better.
A few months later, Anna grabbed a stack of papers off the desk in her office. Her hands shook slightly as she slipped the papers into her shoulder bag. She stood up from her desk chair and suddenly a wave of nausea washed over her. She'd taken her prescription stimulants that morning and had been taking them every day since Dr. Rye prescribed them.
In some ways, the stimulants were working. She could get through a full day of work without needing a nap. But the side effects from the medication were terrible. She felt jittery and sick to her stomach, like she'd had way too many cups of coffee. She was losing weight because she never had any appetite. And even though she had felt kind of okay for a while while on this medication, she was now starting to crave sleep again.
As she walked outside and unlocked her car, all Anna could think about was getting home and going to bed. She got into her car, pulled out her phone, and called Dr. Rai. She told him about the side effects she was feeling and now how her craving for sleep was starting to come back. Dr. Rai assured her that this was actually normal. He told Anna her body was building up a tolerance to the drugs and he'd simply prescribe her a higher dose.
Anna was nervous about this. The stimulants were already giving her such bad side effects and she thought taking more would really only make her feel worse. But at the same time, the medication was the only thing allowing her to make it through the day. So Anna agreed to the higher dose, she hung up, drove to the pharmacy, and picked up more medication.
One year later, on a Friday in April of 2007, Anna was wrapping up her work for the week when the phone on her desk rang. It was her boss. He wanted her to come up to his office before she went home. Anna's hand trembled as she set down the receiver. She wasn't sure if the trembling was from a side effect of the stimulants or from nerves from what her boss just asked her to do. She knew what this conversation was going to be about and she'd been dreading it for months.
Anna had begun missing entire days of work without warning and without explanation. Even though she was constantly taking all of her stimulants, it wasn't uncommon for Anna to still literally sleep days away. Sometimes she'd go to bed and sleep for 20, 25, or even 30 hours straight. It didn't matter how many alarms she set either, Anna slept through all of them, only waking up when her body finally let her. Anna got up from her chair and her legs felt heavy.
Even now, with adrenaline coursing through her body, all Anna wanted to do was sleep. It took all her strength to trudge down the hall to her boss's corner office. She knocked on the door and then, in a somber tone, her boss asked her to come inside. Anna sat down across from his desk and tried to stay composed. She felt angry at her body for betraying her. She'd put in so many years of hard work and she was sure that it was all about to slip away.
But Anna's boss didn't fire her. He reassured Anna that he valued her contributions, but he was really concerned about her health. Though Anna rarely talked about it, her boss was quite aware of her sleep issue, and so he recommended that she take a six-month leave of absence so she could get to the bottom of it.
Anna didn't want to do this. She wanted to keep working, but she knew that taking this leave of absence was probably the right thing to do. If she couldn't be consistently relied on, she wouldn't be helping the firm, her clients, or herself. So she thanked her boss for understanding and promised to do everything she could to get back to work soon.
The next afternoon, Anna was lying on her couch at home, trying to make sense of her struggles. She sipped on a cup of coffee and tried to watch TV, but as usual, she couldn't stop herself from nodding off. This time though, waking up was worse than ever. Her head was pounding and the light coming in through the blinds seemed overwhelmingly bright. She had sharp hunger pangs in her stomach and her joints felt stiff and her muscles were weak and shaky. It took all her effort just to roll onto her side.
She saw the TV had shut off and the cup of coffee she'd just been drinking was now totally cold and the cream inside of the coffee was clearly rotten and curdled at the top of the cup. Anna was confused and grabbed her phone on the coffee table and she checked the time and date. And what she saw literally did not seem possible. According to the time, Anna had just slept for 53 hours straight.
It had been over two days since she'd laid down on the couch, but it felt like a second had passed. Staring at the date and time on her phone, she felt sick. Her symptoms were really starting to frighten her. How long would she sleep the next time? A week? More? How could she live anything like a normal life if this was what happened to her? She called Dr. Rye's office immediately, and he thankfully had an immediate appointment available.
As Anna dragged herself off the couch and walked out to her car, she felt weak and clumsy. Walking was like trying to pull her body through sludge these days. She gingerly lowered herself into the driver's seat and then drove straight to the Emory Clinic Sleep Center. Mr. Ballin' Collection is sponsored by BetterHelp.
When your schedule is packed with kids' activities, big work projects, and more, it can be easy to let your priorities slip, even if you know doing so will make you miserable. But when you feel yourself losing control over your time and your sanity, that's when you need to remind yourself that certain priorities are non-negotiable. Things like taking care of your mental health.
That said, I always make sure to step back and spend time away from work with my family or friends. This is because my therapist always stresses how important it is to recharge whenever I can. That way I don't burn out. This is why I think therapy can be so helpful for people whose lives feel very hectic, which is basically all of us. If you're thinking of starting therapy, give BetterHelp a try.
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Before long, Anna was in that familiar exam room, sitting across from Dr. Rai. He seemed surprised to see her, but when she told him about falling asleep for 53 hours straight, his eyes went wide.
Dr. Rai knew that spending so much time asleep could actually be dangerous. It meant Anna wasn't eating, drinking water, or exercising for days at a time. In the long term, this could lead to malnutrition, dehydration, and muscle atrophy. If she wasn't able to take care of herself, her body would eventually quit working. However, Dr. Rai said he did have an idea for what they could do next. It was a last-ditch effort and something he would not recommend unless it was absolutely an emergency, and clearly this was that.
There was a test that could help them figure out what was causing her to sleep so much, but for it to be accurate, she needed to stop taking all the stimulants he'd been prescribing. Anna leaned back in her seat after hearing this. She knew the stimulants weren't perfect. No matter the dosage, she always needed more, and she was still sleeping way too much,
But at the same time, the idea of not taking them scared her. If she could sleep for 53 hours with stimulants in her system, what would happen to her without stimulants? But in Dr. Rai's opinion, getting rid of the stimulants might be the only way to figure out what was happening inside of her brain. It would take about a month for the drugs to clear her system, so the doctor scheduled an appointment for a month from then in May.
Until then, the doctor explained to Anna that she really needed to be careful. Once she stopped taking these stimulants, she shouldn't drive just in case she fell asleep behind the wheel, and she should have someone looking after her, making sure she ate, drank, and moved around every day. Anna realized that what the doctor was saying was without these stimulants, she could not live alone anymore. And so, after she made it home from the clinic, she called her parents, who lived in Mississippi, and she told them she needed their help.
Her parents immediately agreed, and her mother said she'd come to stay with Anna in Atlanta for as long as she needed. Anna was relieved to hear this, but at the same time, she was so tired she could barely function. She felt like she was literally sleeping her life away. A month later, in May of 2007, Anna's mom helped her get into the passenger seat of her car. With no stimulants in her system, Anna felt even more lethargic and totally confused.
All she knew on this day was that they were going to the sleep clinic to see Dr. Rye. The whole ride, Anna sat with her head leaned against the window, watching trees and buildings blur together as she slipped in and out of consciousness. When they got to the Emory Clinic Sleep Center, Anna felt so stiff and heavy that her mom had to help her get out of the car. Anna could barely keep her eyes open as she leaned on her mom's arm. And then she shuffled her way into the clinic, feeling like she had cinder blocks stuck to her feet.
Dr. Rai met Anna in the waiting area and walked her back to an exam room. They sat down, Dr. Rai in a chair and Anna on the bed. And as soon as Anna was sitting down, she started to feel herself beginning to fall asleep.
As she struggled to stay awake, Dr. Rai explained the procedure they'd be doing that day. He said sleep was largely controlled by a person's brain. The brain uses nerves and chemicals to send messages through the rest of the body, and if the balance of these chemicals is thrown off, it could make someone sleep far too little or far too much. Dr. Rai thought this could be what was happening to Anna, but he needed to analyze the fluid inside her spinal cord to be sure.
This meant he would need to insert a needle into the base of her spine and withdraw some of the fluid, a procedure known as a spinal tap. Dr. Rai instructed Anna to lay down on the bed in the fetal position with her back facing him. Then, he injected a local anesthetic near her spine and Anna's back went numb. Then, Anna began to feel pressure and a burning sensation as Dr. Rai inserted the needle into her spine and removed a sample of her cerebrospinal fluid.
When the procedure was over, Dr. Rai told Anna it would take a few days for the results to come back. And so Anna stood, her back numb and her whole body exhausted, and she shuffled out to the waiting room where her parents were sitting. Then the parents helped Anna out to the car, they got inside, and they drove back to Anna's house in Atlanta. Anna barely made it inside before she collapsed into bed and fell asleep.
A few days later, Dr. Rai was getting ready to leave work to head home when one of his assistants rushed inside and told him that the results of Anna's test had come in. Dr. Rai adjusted his glasses and then peered down at the data on his computer screen. He reviewed the chemical breakdown of Anna's cerebrospinal fluid and what he saw shocked him so much that he called over other doctors to take a look.
Every sleep specialist at the clinic was totally surprised. The results were so bizarre that one doctor even started laughing at the absurdity of the numbers they were seeing. They had literally never seen anything like this. But while the other doctors stood in disbelief, Dr. Rai felt a mixture of hope and unease. He had seen results like this before, in an Italian sleep study from the 1990s.
In that study, a group of people who had symptoms similar to Anna's were given an experimental drug that cured their sleepiness. It was a drug that Dr. Rai had on hand, which meant he might be able to use it to cure Anna too.
But there were problems that made Dr. Rai hesitant. That Italian study had been discredited after the research was found to have some serious issues. Plus, the drug used in that study to cure their sleepiness was never approved by the Food and Drug Administration to treat sleep disorders and it could cause bad side effects like seizures. So, giving it to Anna would definitely be a risk.
But, faced with Anna's spinal tap results, Dr. Rai thought the risk was worth it, and so he called Anna and told her that he might be able to treat her sleepiness, but they need to do one more test.
The next month, in June of 2007, Anna came back to the Emory Clinic. She'd been off the stimulants now for two months, and it felt like her body was close to shutting down on her, like she'd never be able to do anything except sleep again. Every footstep she took was a total battle. She dragged herself into the exam room and crawled into the bed.
She felt a nurse lift her arm, swab near her wrist, and then jab her with an IV needle. Anna was vaguely aware of other movement in the room. Multiple nurses were standing by just in case Anna had a bad reaction to the drug, like a seizure or worse.
Anna watched as Dr. Rai rolled a screen into the room. Everything looked slightly blurry to her. She heard Dr. Rai say they were doing a test to measure her brain's reaction time, and then he put a remote in her hand and told her to press the button as soon as she saw numbers appear on this screen.
Anna tried to follow his instructions, but at the same time, she felt herself drifting in and out of consciousness, and so when a number popped up, she would press the button like she was told to, but she could tell by the look on Dr. Rye's face that she was not doing a good job.
After the test was over, Dr. Rai told Anna that her reaction times were similar to someone who had just been up all night or who had been drinking very heavily. And so now that they had these control results, they could try the medication that Dr. Rai hoped would help her. Anna watched as Dr. Rai put something into her IV bag. The liquid dripped through the tube into her arm and into her bloodstream.
But Anna didn't feel any better. Her head felt like a lead weight, her eyes were so dry that they burned, and the whole room seemed foggy. It took everything in her not to slump over and let her eyes close. For a moment, she had a horrible feeling that this new treatment was not going to work. She would never be able to hold a job or even live by herself again. Then she heard Dr. Rai's voice at her side saying he was going to try a higher dose of this drug. Anna struggled to take a deep breath. She waited for something to happen.
Then, her eyelids snapped open, the room came into focus, and Anna felt like she could hear and see again, and she didn't feel a desperate urge to sleep. Dr. Rai ran the reaction time test again, and Anna didn't have to work to focus on the screen. The reflex test that had seemed impossible before felt very simple now.
When they were finished, Anna looked up at Dr. Rye, close to tears, and she told him she felt alive. For the first time in her adult life, Anna felt truly awake. Dr. Rye watched Anna for a moment. In all the time he'd known her, he'd never seen her look this alert. She sat up straight, her eyes were clear and focused, and she was smiling at him. He couldn't help but smile back. It was incredible to see how much of a difference this drug was making.
Dr. Rai sat down next to Anna and told her that he had never seen a patient like her before. Her brain was basically full of naturally occurring anesthesia. He explained that there's a chemical messenger in everyone's brains known as GABA, G-A-B-A, that helps regulate sleep. Many sleep aids and drugs used for surgical anesthesia make the brain respond more strongly to GABA. The stronger the response, the sleepier a person gets, Dr. Rai said.
And the reason Anna's doctors were so shocked by her test results was because her naturally occurring GABA activity levels were as high as a person who was about to go into surgery. Every day of her life, 24 hours a day, Anna was walking around with the same level of sedation as a person about to have all their wisdom teeth removed.
Dr. Rai watched Anna's jaw drop as she realized that she hadn't just been tired for most of her life. Her own brain had been literally knocking her out. This drug that Dr. Rai had given her was called Flumazenil. Usually, Flumazenil is used in hospitals to help people who are overdosing on sedatives or having trouble waking up from anesthesia. It's an emergency antidote for people whose GABA activity is too high.
So, for Anna, whose GABA activity was always too high, Flamazanil made her brain function like a healthy person's brain. But the FDA never approved Flamazanil for excessive sleepiness. The drug only came as an intravenous medication for use in hospitals, and the effects wore off really quickly. Anna would need to have intravenous injections every few hours to stay awake, and that just wasn't possible from a practical standpoint.
So, Dr. Rai worked with Anna and the drug maker over the next eight months to get an exemption from the FDA that would allow her to take a daily flumazenil pill to prevent her sleepiness. The medication completely changed Anna's life. She's since gone back to work, been promoted to partner at the big prestigious law firm in Atlanta, and is enjoying what she calls "the luxury of life."
From Ballin Studios and Wondery, this is Mr. Ballin's Medical Mysteries, hosted by me, Mr. Ballin. A quick note about our stories. We use aliases sometimes because we don't know the names of the real people in the story. And also, in most cases, we can't know exactly what was said, but everything is based on a lot of research. And a reminder, the content in this episode is not intended to be a substitute for professional medical advice, diagnosis, or treatment.
Thank you.
Script editing is by Scott Allen and Evan Allen. Our coordinating producer is Matub Zare. Executive producers are myself, Mr. Ballin, and Nick Witters. For Wondery, our head of sound is Marcelino Villapondo. Senior producers are Laura Donna Palavoda and Dave Schilling. Senior managing producer is Ryan Lohr. Our executive producers are Aaron O'Flaherty and Marshall Louis for Wondery. Was there a crime committed?
As far as I'm concerned, there wasn't. Guilty by Design dives into the wild story of Alexander and Frank, interior designers who in the 80s landed the jackpot of all clients. We went to bed one night and the next morning we woke up as one of the most wanted people in the United States. What are they guilty of? You can listen to Guilty by Design exclusively and ad-free on Wondery+. Join Wondery Plus in the Wondery app, Apple Podcasts, or Spotify.