By Carolyn Y. Johnson Sleep is mysterious, and it took sleepy animals, serendipity and competition to begin to unravel its precise biology. In the late 1990s, Dr. Masashi Yanagisawa at the University of Texas Southwestern Medical Center discovered two brain chemicals in rodents that seemed to be instrumental in stimulating hunger. He called them “orexins,” a play on “orexis” the Greek word for appetite. At the same time, Dr. Emmanuel Mignot at Stanford University School of Medicine was hunting for the root cause of an inherited form of narcolepsy in Doberman pinschers, Labrador retrievers and Dachshunds. In back-to-back studies published in the summer of 1999, these two lines of research unexpectedly converged, breaking open the neurobiology of sleep and identifying a root cause of the sleep disorder narcolepsy, which affects an estimated one in every 2,000 people in the United States. A new narcolepsy drug based on these insights was approved in August. On Wednesday, Dr. Yanagisawa, now at the University of Tsukuba in Japan, shared the Albert Lasker Basic Medical Research Award with Dr. Mignot, for their work into the nature of sleep. The prestigious prizes are often called “America’s Nobel.” “Their work has cracked open a molecular dissection of sleep regulation, reinforced the immune system’s involvement in human narcolepsy, and pointed toward new treatments for this illness and other sleep disturbances,” the Lasker citation said. The field is now a major target of pharmaceutical companies, but their basic science research was supported largely by philanthropy and federal funding. Thirty years ago, it was far from clear that these scientists were studying the same problem. © 2026 The New York Times Company

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming; Chapter 13: Homeostasis: Active Regulation of the Internal Environment
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep; Chapter 9: Homeostasis: Active Regulation of the Internal Environment
Link ID: 30409 - Posted: 09.12.2026

By Carolyn Y. Johnson Many people have a cartoonish idea of narcolepsy, perhaps picturing someone falling asleep standing up. What people don’t understand is that sleepiness can infiltrate every aspect of daily life, said Julie Flygare, 42, who was diagnosed with the sleep disorder in 2007, during her second year of law school. It interferes with memory, attention and weighs down everyday existence like a “heaviness on the skull,” she said. While taking her current medications, Ms. Flygare has four to six precious hours of wakefulness a day, and still needs a nap. Positive feelings, like, say, the joy of hitting a volley in tennis, trigger episodes of cataplexy; her muscles go slack and her grip on the racket loosens. She, like many other patients, struggled for years to be correctly diagnosed and to find the right combination of stimulants or other drugs to ease her symptoms. Since then, Ms. Flygare has been waiting, and pushing for, a drug aimed not just at alleviating sleepiness, but at replacing a crucial missing brain chemical. Last month, she saw it happen. A first-of-its-kind drug for the sleep disorder narcolepsy was approved by the F.D.A., offering a new treatment for people who live with the debilitating fog of sleepiness. The new drug developed by Takeda Pharmaceutical Co., called Orzeyful, marks a long-sought success in the quest to mimic an essential brain peptide called orexin, which is missing in people with type 1 narcolepsy. About 120,000 people in the United States suffer from this type of narcolepsy, which causes pervasive sleepiness and episodes of cataplexy. Other companies, including Alkermes and Eli Lilly, are chasing close behind. To test narcolepsy treatments, doctors use a “maintenance of wakefulness test” in which a person sits in a dim room for 40 minutes. © 2026 The New York Times Company

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep; Chapter 4: Development of the Brain
Link ID: 30408 - Posted: 09.12.2026

By Amanda Heidt Earlier this month, the US Food and Drug Administration approved the first drug designed to treat the root cause of narcolepsy, a condition that affects millions of people by causing extreme sleepiness during the day and wakefulness at night. The success of the drug, called oveporexton and marketed as Orzeyful, is being celebrated by those who struggle with narcolepsy. “It’s the best thing that has ever happened to me,” says Tyler Chapman, who volunteered for one of the clinical trials that contributed to the drug’s approval. But it’s also being watched with anticipation by researchers, who see it as the first in a line of therapies for sleep disorders that are likely to be approved in the coming years. These emerging treatments, known as orexin agonists, are exciting because they promise not just to alleviate symptoms of narcolepsy but also to target the disease’s biological cause — and might even have implications for other neuropsychiatric disorders. With this new strategy against narcolepsy, pharmaceutical companies have jumped at the chance to tap into a market that is projected to top US$6.4 billion annually by the early 2030s. “This is a tremendously exciting time for patients and for clinicians and scientists who have been working towards this for many years,” says Barry Lubarsky, the vice-president of medical affairs at the pharmaceutical company Alkermes, which is based in Dublin and is developing its own narcolepsy treatment. A chance to feel normal For Chapman, a 19-year-old student at the University of Tennessee, Knoxville, the milestone is life changing. Chapman had long struggled with his condition, at times sleeping for 16 hours a day, struggling in school and relying heavily on coffee. When he laughed, it would sometimes trigger his body to collapse, even though he remained fully conscious — a symptom known as cataplexy. Instead of experiencing all that university life has to offer, Chapman says that he rarely went out. © 2026 Springer Nature Limited

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep; Chapter 4: Development of the Brain
Link ID: 30379 - Posted: 08.19.2026

Since his early twenties, science writer Henry Nicholls has struggled against nearly irresistible waves of sleepiness, thanks to narcolepsy — a severe sleep disorder that science has only recently come to understand. "It's this insane weight that your fight with for a little bit and that fighting is completely worthless. There is only one outcome ever: You lose to sleep," he told CBC Radio's Quirks & Quarks. Nicholls explores the science of narcolepsy, and a whole range of other sleep disorders, in his new book Sleepyhead: The Neuroscience of a Good Night's Rest. Along the way he makes the case that the strategies used to cope with serious sleep disorders can help the rest of us sleep better, as well. Over the two decades Nicholls has lived with narcolepsy, science has learned much about it. Though it may still often go undiagnosed, it's thought to affect up to one in 2,000 people. Narcolepsy is the result of the destruction of a tiny population of neurons deep in the brain that are critical for regulating sleep. This means "it's brain damage — a tiny amount," according to Nicholls. The brain has billions of cells, but "just a few tens of thousands of cells, [are] absolutely crucial to the regulation of sleep and wakefulness," Nicholls explained. These cells produce a critical neurotransmitter called hypocretin or orexin. Hypocretin plays a role in waking up or maintaining wakefulness in many areas of the brain by releasing stimulant hormones like norepinephrine. People with narcolepsy never get this hormonal wake-up call. ©2018 CBC/Radio-Canada.

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 25506 - Posted: 09.29.2018

Roland S. Liblau The events that lead to the sleep disorder narcolepsy are a long-standing mystery. Writing in Nature, Latorre et al.1 reveal that people with narcolepsy have unusually high levels of a type of immune cell called a T cell, which targets proteins normally present in neurons in the brain. This finding raises the question of whether narcolepsy arises because T cells unleash an autoimmune response against neurons that are important for sleep regulation. Narcolepsy affects around 1 in 2,000 people2. The symptoms usually begin in adolescence or early adulthood, and include daytime sleepiness and, in some cases, cataplexy — sudden muscle weakness during wakefulness that causes falls. A small population of neurons in the brain produces a protein called hypocretin, which controls sleep–wake cycles3, and narcolepsy-like symptoms occur in animals that have defects in genes required for the production of or response to hypocretin4. Narcolepsy type 2 is associated with daytime sleepiness, and this can progress to narcolepsy type 1, which is characterized by sleepiness and cataplexy. People with narcolepsy type 1 have abnormally low numbers of hypocretin-producing neurons5. Hypocretin levels in the cerebrospinal fluid that bathes the brain and spinal cord can be measured to help diagnose6 narcolepsy type 1, and such tests provide a way of indirectly monitoring the loss of hypocretin-producing neurons over time. The trajectory of this neuronal loss remains to be fully understood, but can take months or years. © 2018 Springer Nature Limited.

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming; Chapter 15: Emotions, Aggression, and Stress
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep; Chapter 11: Emotions, Aggression, and Stress
Link ID: 25485 - Posted: 09.24.2018

Laurel Hamers Using opioids gives some brain cells a call to action. Opioid addicts’ brains, examined after death, contain about 50 percent more nerve cells that release a molecule called hypocretin, compared with people who didn’t use the drugs, a new study finds. Giving the opiate morphine to mice also induced similar changes in their brains. But the increase didn’t come from new nerve cells, or neurons, being born. Instead, once-dormant neurons appear to rev up their hypocretin machinery in response to the addictive drugs, researchers report June 27 in Science Translational Medicine. The findings fit with a growing body of research that suggests that hypocretin, a brain chemical that regulates wakefulness and arousal, may also be involved in addiction. “I think there is extensive evidence now that shows that the hypocretin neurons are supporting motivated behavior in general,” and addiction falls under that umbrella, says Rodrigo España, a neurobiologist at Drexel University in Philadelphia who wasn’t involved in the new study. For example, his lab recently showed that rats with a less sensitive hypocretin receptor (and therefore a weaker response to the brain chemical) showed less motivation to seek out cocaine rewards. The new study comes from the opposite angle, showing changes in hypocretin neurons in response to drug use, rather than the other way around. “It does suggest the possibility that part of the reason it’s so hard to get off drugs is there’s this massive change in the brain,” says study coauthor and neuroscientist Jerome Siegel of UCLA. |© Society for Science & the Public 2000 - 2018.

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming; Chapter 4: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep; Chapter 3: The Chemistry of Behavior: Neurotransmitters and Neuropharmacology
Link ID: 25153 - Posted: 06.28.2018

By KAREN BARROW Narcolepsy is a sleep disorder that causes excessive sleepiness and frequent daytime sleep attacks. What is it like to never feel fully rested? Three women discuss the realities of living with a sleep disorder. Kailey Profeta learned she had narcolepsy at age 9 after her mother noticed she was unusually tired and had inexplicably gained a lot of weight. Kailey was home-schooled for several years while she and her family learned what combinations of medicines and behavioral adjustments worked to keep her on a normal sleep schedule. She now takes a medicine every night that helps her sleep, but leaves her nauseated in the morning. To cope, she eats breakfast in bed and takes other medications to help her stay awake during the day. Kailey goes home from school every day during third period to take a nap, and she rests again after school. Kailey, who wants to be a fashion designer, works at a bridal boutique during the summer and on weekends. She said that most of her friends understand when she has to rest, but that being a teenager with narcolepsy is not always easy. Patricia A. Higgins suffers from narcolepsy with cataplexy – sudden muscle weakness that causes her to fall and feel temporarily paralyzed. She first began falling from cataplexy as a teenager, and the condition reached its worst point when she was 32; she remembers falling 17 times in one weekend. Getting the correct diagnosis was a struggle. Ms. Higgins went from doctor to doctor and was told at various times that she had a seizure disorder and a psychiatric condition. Eventually, a sleep study confirmed that she had narcolepsy. Narcolepsy has disrupted Ms. Higgins’s work and family life. She is married and the mother of three children, but she left her job as a nurse and cannot drive. She volunteers regularly with the Narcolepsy Network, a support and information group for narcoleptics. © 2018 The New York Times Company

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 24774 - Posted: 03.21.2018

Amelia Hill For a serious examination of the devastating and incurable disability that is narcolepsy, Henry Nicholls’s book, Sleepy Head, is a surprisingly funny account. There is the obvious, if somewhat cruel, humour to be found in stories of people falling asleep in surprising places: in a small boat sailing around the Farne Islands, with the freezing North Sea cascading over the gunwale; while scuba diving; on a rollercoaster; at the dentist’s; on the back of a horse; on a surfboard. But there are other extremely funny insights that Nicholls gives into the crepuscular world that narcoleptics inhabit: his laconic fretting over the etiquette of attending a CBT group for insomniacs, which he discovers he also suffers from while researching the book. “A narcoleptic attending an insomnia clinic could be seen as the height of insensitivity,” he deadpans. Then there’s the attempt to solve sleep apnoea by learning the didgeridoo. (Didgetherapy, since you ask. It involves acrylic didgeridoos and is, apparently, quite effective.) Misjudging his tone entirely, I arrive at our interview expecting a garrulous chat. I’m particularly excited that I opened Nicholls’s book thinking I was pretty special to be able to share with him the fact that my father also had narcolepsy – and close his book having realised that five of my closest family members (including myself) have had diagnosable sleep disorders ranging from sleep apnoea to night terrors to – my own thrilling self-realisation – an episode of hypnagogic hallucination and sleep paralysis. © 2018 Guardian News and Media Limited

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 24697 - Posted: 02.26.2018

Henry Nicholls One of my first jobs was to keep a lookout for lions. There are some occupations that are not suitable for someone with untreated narcolepsy and this is probably one of them. I was 22, a recent zoology graduate studying meerkats in the Kalahari desert in South Africa. We worked in pairs, one of us on foot, walking with meerkats, the other in the jeep scanning the horizon for danger. On many occasions, I awoke with the imprint of the steering wheel on my forehead, realising that meerkats and colleague had wandered out of sight. I would look for signs of life and, as the panic grew, signs of death. I can tell this story now only because no one got eaten. I have not always been like this. For the first 20 years of my life, I had a healthy relationship with sleep. Shortly after my 21st birthday, though, I began to experience symptoms of narcolepsy, a rare disorder thought to affect about one in every 2,500 people. If people know one thing about narcolepsy, it’s that it involves frequent bouts of uncontrollable sleepiness. This is true, but the condition is so much more disabling, often accompanied by cataplexy (where a strong emotion causes loss of muscle tone and a ragdoll-like collapse), trippy dreams, sleep paralysis, frightening hallucinations and, paradoxically, fractured night-time sleep. There is no cure. Yet. In the Kalahari, back in 1995, I was new to these symptoms. I had little sense of the incalculable toll that fighting a never-ending battle against sleep would take on mind, body and soul. I was not alone. Few family doctors had heard of the condition, let alone encountered a sufferer. Some neurologists knew what to look for, but many did not. Not even sleep specialists could explain why this disorder would suddenly strike, with peak onset at around 15 years of age. © 2017 Guardian News and Media Limited

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 24235 - Posted: 10.24.2017

Ian Sample Science editor Dozens of British children who developed narcolepsy as a result of a swine flu vaccine could be compensated after the high court rejected a government appeal to withhold payments. Six million people in Britain, and more across Europe, were given the Pandemrix vaccine made by GlaxoSmithKline during the 2009-10 swine flu pandemic, but the jab was withdrawn after doctors noticed a sharp rise in narcolepsy among those who received it. The sleep disorder is permanent and can cause people to fall asleep dozens of times a day. Some narcoleptics have night terrors and a muscular condition called cataplexy that can lead them to collapse on the spot. In 2015, a 12-year-old boy, known as John for the proceedings, was awarded £120,000 by a court that ruled he had been left severely disabled by narcolepsy caused by the vaccine. He was seven when he had the jab and developed symptoms within months. Because of his tiredness, John became disruptive at school and found it almost impossible to make friends. He takes several naps a day, cannot shower or take a bus on his own, and may never be allowed to drive a car. Despite paying out, the Department for Work and Pensions argued John’s disability was not serious enough to warrant compensation and said the court was wrong to take into account how the illness would affect him in the future. But the high court on Thursday rejected the government’s appeal that only the boy’s disability at the time should have been considered. The ruling paves the way for more than 60 other people to claim compensation. © 2017 Guardian News and Media Limited

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming; Chapter 15: Emotions, Aggression, and Stress
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep; Chapter 11: Emotions, Aggression, and Stress
Link ID: 23211 - Posted: 02.10.2017

Ian Sample Science editor Government lawyers are seeking to block compensation payments to people who developed the devastating sleep disorder, narcolepsy, as a result of a faulty swine flu vaccine. The Pandemrix vaccine made by GlaxoSmithKline (GSK) was given to 6 million people in Britain and millions more across Europe during the 2009-10 swine flu pandemic, but was withdrawn when doctors noticed a rise in narcolepsy cases among those who received the jab. In June, a 12-year-old boy was awarded £120,000 by a court that ruled he had been left severely disabled by narcolepsy caused by Pandemrix. The win ended a three-year battle with the government that argued his illness was not serious enough to warrant compensation. Narcolepsy is a permanent condition that can cause people to fall asleep dozens of times a day, even when they are in mid-conversation. Some suffer from night terrors and a problem with muscular control called cataplexy that can lead them to collapse on the spot. The boy, who remains anonymous, has become disruptive at school because he is so tired and finds it almost impossible to socialise. He needs to take several naps in the school day and cannot shower unattended or take a bus alone. He may never be able to drive as an adult. © 2015 Guardian News and Media Limited

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming; Chapter 15: Emotions, Aggression, and Stress
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep; Chapter 11: Emotions, Aggression, and Stress
Link ID: 21444 - Posted: 09.26.2015

Ed Yong As the H1N1 swine flu pandemic swept the world in 2009, China saw a spike in cases of narcolepsy — a mysterious disorder that involves sudden, uncontrollable sleepiness. Meanwhile, in Europe, around 1 in 15,000 children who were given Pandemrix — a now-defunct flu vaccine that contained fragments of the pandemic virus — also developed narcolepsy, a chronic disease. Immunologist Elizabeth Mellins and narcolepsy researcher Emmanuel Mignot at Stanford University School of Medicine in California and their collaborators have now partly solved the mystery behind these events, while also confirming a longstanding hypothesis that narcolepsy is an autoimmune disease, in which the immune system attacks healthy cells. Narcolepsy is mostly caused by the gradual loss of neurons that produce hypocretin, a hormone that keeps us awake. Many scientists had suspected that the immune system was responsible, but the Stanford team has found the first direct evidence: a special group of CD4+ T cells (a type of immune cell) that targets hypocretin and is found only in people with narcolepsy. “Up till now, the idea that narcolepsy was an autoimmune disorder was a very compelling hypothesis, but this is the first direct evidence of autoimmunity,” says Mellins. “I think these cells are a smoking gun.” The study is published today in Science Translational Medicine1. Thomas Scammell, a neurologist at Harvard Medical School in Boston, Massachusetts, says that the results are welcome after “years of modest disappointment”, marked by many failures to find antibodies made by a person's body against their own hypocretin. “It’s one of the biggest things to happen in the narcolepsy field for some time.” It is not clear why some people make these T cells and others do not, but genetics may play a part. In earlier work2, Mignot showed that 98% of people with narcolepsy have a variant of the gene HLA that is found in only 25% of the general population. © 2013 Nature Publishing Group

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming; Chapter 15: Emotions, Aggression, and Stress
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep; Chapter 11: Emotions, Aggression, and Stress
Link ID: 19055 - Posted: 12.19.2013

By JANE E. BRODY Clea Howard is hardly a tuned-out, disinterested high school student. She likes to be busy: In addition to maintaining an excellent scholastic record at a demanding high school an hour from her Brooklyn home, she studies art, takes dance classes and plays soccer. Yet during her freshman and sophomore years, she was always tired, no matter how much she slept at night. She often fell asleep in class, on the subway, while doing homework or talking to her boyfriend. Even on vacation, when she logged 10 or 11 hours of sleep at night, Clea said, “I was still very tired during the day. I made excuses for myself — maybe I just need more sleep than other teenagers, or maybe I don’t feel any more tired than other people.” Her pediatrician unearthed no medical reason or aberrant sleep habits to explain her extreme fatigue and tendency to doze off at the drop of a hat. An endocrinologist could not find any hormonal or diet-related abnormality. Perhaps, her pediatrician said, a sleep study might show if Clea was getting the kind of rest at night that restores body and mind. At the Sleep Disorders Institute in New York, Clea met with a sleep specialist. It did not take long for Dr. Maha Ahmad to zero in on a possible diagnosis: narcolepsy. © 2012 The New York Times Company

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 16482 - Posted: 03.08.2012

by Sujata Gupta In spring last year, the number of narcolepsy cases in Beijing, China, multiplied threefold. Now, it looks like the swine flu pandemic of the previous winter was to blame. Previously, similar rises in cases of narcolepsy – a disorder that causes sleepiness at inappropriate times – have been linked to use of a swine flu vaccine. The cause was presumed to lie in the drug's adjuvants – additives that boost the immune response to the vaccine. The claim puzzled researchers who saw a concurrent rise in narcolepsy cases in China, where few people had opted to get vaccinated and those who did received a vaccine without adjuvants. Could the flu itself be to blame? To find out, Fang Han and his colleagues at Beijing University People's Hospital studied the medical profiles of 906 people who had come to the hospital with narcolepsy since 1998. The group found that, even in the years before the vaccine was introduced in October 2009, the number of narcolepsy cases followed a seasonal pattern – cases dropped significantly around November and spiked in April. The peak was higher than normal in the spring after the swine flu pandemic (Annals of Neurology, DOI: 10.1002/ana.22587). The idea that flu causes narcolepsy fits in with the theory that narcolepsy is triggered by the immune system's response to airway infections. © Copyright Reed Business Information Ltd.

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 15711 - Posted: 08.23.2011

A swine flu jab has been linked to rare cases of a sleeping disorder and should be the last line of protection for young people, European regulators say. The European Medicines Agency (EMA) said Pandemrix should only be given to children and teenagers at risk of H1N1 flu if other jabs are unavailable. More than six million doses of the vaccine have been given in the UK. Ten suspected cases of narcolepsy linked to the vaccine have been reported to the UK's drug regulator. Pandemrix, made by GlaxoSmithKline (GSK), was the most widely used in the UK during the 2009/10 flu pandemic. However, the vaccine is no longer in use and the remaining stocks will be destroyed this autumn. The EMA's investigation followed reports, mainly from Finland and Sweden but also from Iceland and the UK, of children and adolescents suffering the sleep disorder narcolepsy, which causes people to fall asleep suddenly and unexpectedly. It said studies had shown a six to 13-fold increased risk of narcolepsy in children and adolescents vaccinated with Pandemrix compared with unvaccinated children. In a statement, the EMA said it had "noted that the vaccine is likely to have interacted with genetic or environmental factors which might raise the risk of narcolepsy, and that other factors may have contributed to the results." BBC © 2011

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 15600 - Posted: 07.26.2011

By INGFEI CHEN Scientists have begun to pull back the veil of mystery that has surrounded narcolepsy since it was first described more than 125 years ago. In 2000, investigators reported that a lack of a neurochemical called hypocretin is a prime culprit in the sleep disorder. Patients with classic narcolepsy — a combination of irresistible sleepiness and sudden collapses from muscle weakness — are missing most of the brain cells that make the wakefulness-promoting protein. But high expectations for a therapeutic payoff have since flagged. While narcoleptic patients have gained two helpful new medications in the last decade, they are still waiting for a cure to correct their hypocretin deficiency. Meanwhile, researchers remain flummoxed by the underlying question: What destroys the hypocretin-producing neurons in the first place? “A few years ago we were all sort of proudly crowing about how now we knew what was happening in narcolepsy,” said Dr. Thomas Scammell, a neurologist at Harvard Medical School. “And yeah, now we know what the cellular abnormality is, but we still don’t know what causes it.” As a result, he said, “we can’t stop or reverse the cell loss.” Copyright 2008 The New York Times Company

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 11337 - Posted: 06.24.2010

By LISA SANDERS, M.D. The middle-aged woman perched on the edge of a plastic chair as the doctor explained his thoughts on why her son was having persistent headaches. Suddenly, she toppled forward, collapsing onto the linoleum floor. Dr. Philip Ledereich hurried over to the woman. “Call 911,” he shouted to his nurse. “The patient’s mother has fainted.” Was the fainting brought on simply by stress? Or could there be an underlying neurological problem? Ledereich, an ear, nose and throat specialist in Clifton, N.J., first met the mother a couple of weeks before, when she herself came in as a patient. She was fainting several times a day, and no one knew why. Ledereich hadn’t been able to figure it out, either. Despite that, she took her son to see him for the treatment of a chronic sinus infection. Ledereich was describing various treatment alternatives when the woman pitched to the floor. She had been having these spells almost daily for the past several months, she told him at their first appointment. She was 49, a nurse, and she considered herself pretty healthy until one Saturday nearly three months earlier. That day she had just put on her shoes to go to a bar mitzvah, and as she straightened up she felt a fluttering sensation in her stomach. The next minute she was on the floor. Her husband rushed to her side. She could hear him calling her name, but she couldn’t answer him; she couldn’t even open her eyes. Copyright 2010 The New York Times Company

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 13827 - Posted: 06.24.2010

By Carolyn Y. Johnson Research into an unusual sleep disorder is unraveling what goes awry in the brains of people who fall prey to daytime sleep attacks - and shedding light on everything from addiction to appetite. Work that began in sleepy dogs and mice has led to a significant advance in understanding narcolepsy, providing new insight into the ways in which sleep and wakefulness, eating, and addictive behaviors are linked. The work is pointing to potential therapies not only for people who are chronically sleepy, but also for the much larger numbers who have trouble sleeping at all. At the root of this work is a fundamental brain chemical called orexin. Research over the past decade has shown that narcolepsy is caused by the loss of a type of brain cell that produces orexin. Scientists have found that the chemical also helps determine when we are asleep and awake and plays a role in regulating appetite and addiction. Orexin “was only discovered in 1998,’’ said Dr. Tom Scammell, a neurologist at Beth Israel Deaconess Medical Center. “A lot of the work is related to sleep, but it’s also opened up these other areas.’’ His lab teases out the nuances of narcolepsy with some unconventional techniques - including tickling sleepy mice to keep them awake and feeding them Froot Loops. The anticipation of the sugary cereal triggers one of the most striking symptoms of the disease: a temporary loss of muscle control called cataplexy, causing mice to drop in their tracks. Using gene therapy, he restored orexin to the brains of mice who lacked it and found that it improves their ability to stay awake and reduces cataplexy. © 2009 NY Times Co.

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 13517 - Posted: 06.24.2010

By INGFEI CHEN On a sun-drenched morning this month, a small, black, bushy-haired dog trotted out from the animal care center at Stanford. The Belgian schipperke, Bear, soon veered off to lift a hind leg over a shrub. He was, clearly, oblivious to the gravitas of the day. Bear had spent nearly seven years in the underground kennels as part of a colony of narcoleptic dogs studied by Dr. Emmanuel Mignot, director of the Stanford Center for Narcolepsy. Dr. Mignot had just signed papers to adopt the dog, the last of the colony. Bear’s freedom ended 30 years of investigations that led to the discovery of the importance of a neurochemical called hypocretin in human and animal narcolepsy, and in normal sleep. Bear will now be a pet. And Dr. Mignot has turned to less huggable research subjects, like wet, cold-blooded and, unexpectedly, less cooperative zebrafish. Investigators now understand that narcolepsy arises from a deficiency of the brain cells that make hypocretin, similar to the way that Parkinson’s is caused by the loss of dopamine-producing neurons. Copyright 2007 The New York Times Company

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 10876 - Posted: 06.24.2010

Health Canada has issued a warning about serious skin and allergic reactions related to Alertec, a drug used to relieve excessive sleepiness due to narcolepsy, obstructive sleep apnea and shift-work sleep disorders. The federal agency said patients taking Alertec (modafinil) should seek immediate medical attention if they have any of the following symptoms: skin rash, hives, sores in the mouth, blisters and skin peeling; swelling of the face, eyes, lips, tongue or throat; trouble swallowing or breathing; or a hoarse voice. Alertec, made by Shire Canada Inc., is not approved in Canada for use in children for any condition. The drug can cause mental problems, such as depression, anxiety, hallucinations, mania and suicidal thoughts, although these events were rare during controlled studies. Health Canada says anyone experiencing such psychiatric conditions should stop taking Alertec and seek medical attention. Those taking the drug should tell their doctor if they have any heart problems, chest pain, have had a heart attack or a history of psychiatric disorders. © The Canadian Press, 2007

Related chapters from BN: Chapter 14: Biological Rhythms, Sleep, and Dreaming
Related chapters from MM:Chapter 10: Biological Rhythms and Sleep
Link ID: 11130 - Posted: 06.24.2010