Nicotine and Narcolepsy

One of the most common sights at narcolepsy meetings and conferences remains the number of people with narcolepsy who “stand in the street of shame” for a quick smoke. On a purely unscientific and random questioning of people it does seem that more people with narcolepsy smoke as a percentage than from the population as a norm. The only study we can find on this was carried out back in 2008 which showed (from a small sample) that 62.5% of narcolepsy patients were smokers. Perhaps it’s for a reason!

Back in 2005 a paper was published (Lambe et al. Hypocretin and nicotine excite the same thalamocortical synapses in prefrontal cortex: correlation with improved attention in rat. J Neuroscience. 2005; 25: 5225-5229.) that showed that nicotine and orexin excite the same identified synapses of the thalamocortical arousal pathway within the prefrontal cortex. Although it is known that attention can be improved when nicotine is infused directly into the midlayer of the prefrontal cortex in a rat, the effects of hypocretin on attention were not, in 2005, fully understood. As a result of the rat studies reported in this paper paper it was suggested that lack of orexin did reduce attention in people with narcolepsy and that orexin is needed to maintain attention processing relevant to executive functions of the prefrontal cortex.

The paper went further and suggested that as there was an overlap in synapses excited by orexin and nicotine; could nicotine help people to concentrate that had reduced orexin? In fact in rats that had orexin removed they proved that nicotine did help with improving attention. The paper ended by the authors suggesting that “The ability of nicotine and orexin to mimic each other in the prefrontal cortex by exciting thalamocortical terminals and enhancing divided attention may yield insight into potential novel treatments for psychiatric and neurological disorders.” And to our knowledge that is where the story ended.

Over the years several individuals have reported that smoking, using nicotine gum or patches helped their narcolepsy. We have also heard from people whose narcolepsy became worse after they stopped smoking, but no full scale scientific trial has yet to be undertaken on this subject and the medical orthodoxy remains that nicotine should be avoided by people with narcolepsy.  

A report in April 2012’s Journal of Clinical Sleep Medicine outlines the case of a New York man who, he says, helps to control his narcolepsy with cataplexy by smoking and using nicotine patches. This isn’t the first report of nicotine helping with narcolepsy as the same journal reported last year on another teenage patient who controlled her daytime sleepiness by using nicotine patches with good results. We are now starting to see more medical literature that nicotine MAY be useful in managing symptoms associated with narcolepsy.

We are not suggesting that anyone should start smoking to help their narcolepsy! Smoking is not a good idea and smoking with narcolepsy is an even worse idea as the number of people who have burned themselves falling asleep smoking will testify but it is interesting.

John Cherry

(Added to website 24th April 2012)