WHEN a showbiz celebrity dies fairly young, people usually suspect an overdose of narcotic drugs or of sleeping pills, or of both.

Michael Jackson’s case sort of fits into that pattern, but with some strange twists.

He was known to be opposed to “recreational drug use,” which is a euphemism for taking prohibited drugs.

Yet, it turns out that he was so bothered by his insomnia that he might have gotten a doctor or nurse to administer a drug called Diprivan (generic name propofol), used as a pre-anesthetic for patients about to undergo surgery.

The drug is given intravenously and has a narrow therapeutic window, which means there’s only a small difference between the amount needed for a medical indication, and an overdose that can cause adverse reactions, including death.

Jackson’s death should make us reexamine our own use of medicines and drugs.

We presume all “bawal na gamot” (drugs prohibited by law) are dangerous, while anything legal, especially if prescribed by the doctor, must be safe.

To give just one example, I had a close friend, who, because of an addiction to shabu (metamphetamine hydrochloride), had problems going to sleep. So he began to take Valium (generic name: diazepam).

Although the Valium came from an illegal source, he argued that it was completely safe because the drug itself was legal, prescribed by doctors.

Eventually, through a cousin was also going through rehabilitation for shabu, he discovered an even more powerful tranquilizer, Thorazine, again a drug he considered “safe” because, after all, it was the doctors giving the medicine. Thorazine’s generic name is chlorpromazine and it’s actually meant to treat the psychosis that comes from shabu abuse, but my friend thought it helped him to sleep.

One day he overdosed on the drug and had to be rushed to the hospital. Fortunately, he survived, and now understands that legal drugs, especially sleeping pills, can be as problematic as the prohibited ones.

The abuse of sleeping pills, and the dependency and addiction that follows, is linked to a lack of understanding of insomnia. We need to recognize that insomnia is a physiological condition, not necessarily an illness.

Everyone occasionally has a sleepless night -- or even several nights. Stress from work, or the home, or both, is a common cause, but it can also be lack of physical activity, too many cigarettes or too much coffee, tea or even Coke (which has caffeine), or even watching a TV show that got you too stimulated. (Wait, wait, I wasn’t specifically referring to those videos. It can be an action film, a horror flick, even a love story.)

Often it can be a combination of different triggering factors. You’re already stressed out and overworked but you put in more hours to solve the problem, and you do this with cup after cup of coffee.

Totally tired out, you turn on the TV and watch the newscasts with report after report on scams. Then you wonder why you still can’t get to sleep.

The worst thing that can happen is to worry about the insomnia. Get up and do something to unwind, and reduce any potential source of stress or stimulation. The more you worry, the more difficult it will be to get to sleep. I tell my students that if their brain can’t take any more while they are reviewing, they should just go to bed early and set the alarm to wake up early.

Night owls

For a growing number of Filipinos, sleeplessness is an occupational hazard because so many are now working nights (the so-called graveyard shift), including the armies of call center agents. Some writers and artists also choose to work nights, claiming they’re more creative then.

Others, like health professionals, have it worse because they alternate with day and night shifts. Then you have flight crews, who have to work at all kinds of odd hours and have to cross so many time zones.

Tranquilizers and drugs like melatonin (which convinces the brain that it’s night time) are sometimes used, but many people in these professions are able to work out their routines without the drugs.

Young people are also prone to insomnia because, by choice, they may be keeping irregular hours.

In my younger (and not too young) years, I acquired quite a reputation as a night owl.

Looking back now, I know that routine came out of a sense of invincibility. When you’re young, your body can take a lot of pounding, but eventually time catches up with you.

If you don’t “reform” on your own, a heart attack usually does the trick.

I was fortunate, as with many others, to have been forced to abandon the night because I had to raise a family.

Babies can be very disruptive to sleep, but at least you’re in the bedroom and able to still get several hours of sleep, even if in installments.

As the children grow up, you might actually find yourself falling asleep earlier than they do (usually out of fatigue from taking care of them during the day.) And then when they become teenagers, you lose sleep because you wait for them to come home from their night-owl routines!

We mortals and ordinary people are fortunate. Fame and celebrity mean overwhelming pressure, as in the case of Michael Jackson, and unfortunately, the “solutions” often become new problems.

Insomnia re-emerges as a serious threat for the elderly, especially if they move from an active life to sedentary retirement.

Many doctors try to console elderly parents by telling them that with age, you don’t need to sleep as much, but that advice should be tempered, especially now that there are all these studies showing that sleep is important for the health of the heart.

Many older people think they’re not sleeping enough when they’re actually reverting to the patterns of new parents. They sit in front of the TV and doze through most of the shows, then wake up and claim they didn’t get to sleep at all.

I’m very much against the use of sleeping pills with the elderly, having seen too many cases of geriatric patients who have serious accidents because the tranquilizers, however mild, leave them too drowsy and uncoordinated even during the day.

Peace medicine

My own paternal grandmother had a bad fall in the early 1980s which left us bewildered because she was always so active and strong.

I flew down to Davao to see her, and checked out the medicines she was taking. It included a bottle of medicine labeled in Chinese “Peace and Quiet Medicine,” which she said a friend, also an elderly grandmother, had given to her to help her get to sleep.

The elderly love to swap medicines, including some pretty powerful and dangerous drugs.

In the case of my grandmother’s “peace and quiet” medicine, the label listed the active ingredient and I realized that my 92-year-old grandmother had become a Valium junkie!

I had her stop the medicine and we lived happily ever after, until pneumonia took her away. She was 98.

If you can’t sleep, don’t lose sleep over it. Get to the root causes of the sleeplessness and you might find the solutions aren’t with drugs, legal or illegal.

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Email: mtan@inquirer.com.ph