Do you have trouble staying awake during the day and find yourself falling asleep when watching television or performing mundane tasks? If so, you are likely experiencing poor nighttime sleep.
Typical causes include stress, snoring, and sleep apnea (where breathing stops and starts during sleep).
However, you may be suffering from narcolepsy, which affects at least 30,000 people in the United Kingdom. According to Narcolepsy UK, eighty percent of those affected are undiagnosed.
I first encountered a narcolepsy patient as a medical student. The young woman kept falling asleep unexpectedly and suddenly. She explained that it may occur when she was eating or in a business meeting, which she considered humiliating.
She frequently got in trouble at school for being unable to keep her eyes open throughout the class. She disclosed that she occasionally lost control of her muscles or her legs and fell to the ground.
Unfortunately, we did not understand much about this ailment back then, so no one could say what was causing these bizarre attacks, and there was little we could do to help her.
Now, thanks to the work of leading doctors and sleep scientists Professor Emmanuel Mignot at Stanford University in the United States and Professor Masashi Yanagisawa at the University of Tsukuba in Japan, we understand what is going on and have new treatments for narcolepsy, as well as a novel class of drugs aimed at those who struggle with chronic insomnia.
A few weeks ago, these two scientists shared the coveted $3 million (£2.75 million) Breakthrough Prize in Life Sciences for their discoveries. In the 1980s, Emmanuel Mignot, a young psychiatrist at the time, began seeing patients with narcolepsy.
As he previously explained: ‘I became interested in narcolepsy because I believed it was the key to understanding sleep, and because it had this human aspect of trying to cure patients with an illness that nobody cared about.’
Therefore, he moved to work at Stanford, which has an excellent sleep research division and a colony of narcoleptic dogs, primarily Dobermans and Labradors.
As with people, dogs can develop narcolepsy on their own, and I have seen extraordinary footage of a bunch of them rushing enthusiastically across a green lawn before dropping into a deep sleep.
Professor Mignot subsequently demonstrated that a mutation in a gene was responsible for the odd behavior of the dogs and that the majority of people with narcolepsy have a similar mutation.
This gene causes individuals to have extremely low quantities of the protein orexin in their brains. It turns out that this is because their immune system is continually destroying the orexin-producing neurons in their brains.
In other words, narcolepsy is an auto-immune illness, similar to type 1 diabetes and rheumatoid arthritis, in which immune cells — which are ordinarily produced by the body to fight disease-causing viruses and bacteria — turn against the body itself. In the case of narcolepsy, healthy brain cells are attacked.
It is currently unknown what causes narcolepsy, although some hypotheses include a hereditary disorder, hormone fluctuations, or an infection.
Even though narcolepsy is a relatively uncommon ailment, this research has led to improvements in our understanding of other, more common sleep disorders, such as insomnia.
People with narcolepsy, for instance, have too little orexin in their brains, whereas individuals with chronic insomnia frequently have too much, keeping them up when they want to sleep.
Researchers hypothesize that orexin also plays an important role in depression, ADHD, and other mental health and neurological diseases.
By targeting the orexin system, these discoveries have led to the creation of new medications that can either wake you up or make you sleepier.
There is a medicine called TAK-994 that increases orexin levels and is aimed to help people with narcolepsy remain awake and alert. It is currently undergoing testing in the United States.
In addition, the European Commission has recently approved a medicine called daridorexant that has the exact opposite effect. It is one of a new class of medications known as dual orexin receptor antagonists (DORAs), which block the function of orexin to aid in the onset of sleep in persons with chronic insomnia.
Daridorexant, unlike existing sleeping medications, targets orexin receptors directly, which should result in fewer side effects and decreased daytime sleepiness (which is a problem with many sleeping pills).
Before this medication can be provided on the NHS, the National Institute for Health and Care Excellence is evaluating it.
In the interim, while we wait for therapies that inhibit orexin to treat chronic insomnia, there are drug-free alternatives proven to increase orexin levels to make you less tired if you’ve had a poor night’s sleep.
Ever wonder why coffee is so stimulating? Because coffee stimulates the secretion of orexin, this is the case. Intermittent fasting (when you restrict your caloric intake for a couple of days each week or eat less often) also increases orexin levels and makes you more alert.
In a 2018 study published in the journal Annals of Thoracic Medicine, Saudi Arabian researchers examined orexin levels in the blood of Muslim volunteers who abstained from eating or drinking during daylight hours throughout the month of Ramadan.
The researchers discovered that the subjects’ orexin levels spiked during Ramadan, but returned to normal once the holy month concluded.
High blood sugar levels suppress orexin production, which helps explain why we feel drowsy after a carb-heavy meal (so if you’re experiencing a midafternoon slump, try a handful of nuts instead of chocolate cookies).
This does not mean, however, that consuming sugary carbohydrates is a good idea if you have insomnia; research indicates that sugary carbohydrates lead to worse, more fragmented sleep.
Finally, following a poor night’s sleep, take an early morning vigorous stroll. Light and exercise have been demonstrated to increase orexin levels.
To treat influenza, consume chicken soup but no bread.
The notion that you should “feed a cold and starve a fever” may sound like an old wives’ tale, and most doctors nowadays would tell you that while you’re sick, it’s crucial to maintain your strength by eating plenty of nourishing food.
However, recent research published in the journal Nature reveals that reducing your carbohydrate intake may help your body fight off diseases like the flu.
Typically, those who are ill losing their appetite. When we consume less, our bodies switch from burning sugar to burning fat, converting fat storage into energy-rich chemicals called ketone bodies.
These can aid in the battle against viral infections by fueling killer T-cells and other immune system cells.
The majority of influenza patients produced huge quantities of ketone bodies, which aided in their recovery, but this did not occur in patients on Covid who became very ill, leading to what the researchers termed an “exhausted” immune response.
Animal research conducted by the same group at the University of Bonn in Germany demonstrated that a ketogenic diet (which is extremely low in carbohydrates) or the direct administration of ketone bodies can strengthen the immune system and prevent lung damage.
If you have a respiratory illness this winter, drink plenty of fluids and try chicken soup (studies have shown it to be effective), but limit your bread intake.
