The interconnectedness of sleep


By John DiTraglia



I don’t understand why we have to spend a third of our lives in bed with our eyes closed and with visions of sugar plums dancing in our heads. When we discover higher forms of life on another planet will they have that hassle? Anyway, on earth we’re stuck with that sad state of affairs and not getting enough sleep is a big problem with multiple repercussions.

To treat insomnia there is a new drug called lemborexant that is the second drug of a class that blocks the action of a hormone called orexin. The first drug in this class of orexin blockers is called suvorexant that came to market in 2014 with the brand name Belsomra. Orexin, the hormone made in the hypothalamus of the brain that is the target of this new kind of sleeping pill, was discovered in 1998. Twenty-two years ago, that doesn’t seem that long ago to someone my age.

Orexin is called that from “orexis” meaning appetite in Greek, because it was first found to stimulate appetite in mice and men. Later it was found to stimulate wakefulness and energy expenditure and other things. Loss of orexin signaling is associated with narcolepsy, a sleep disorder that causes excess day time sleepiness and spells of loss of muscle power called cataplexy and sleep paralysis. So orexin has been studied in these two separate areas of it’s effects, eating and sleeping, but less studied in the connections between them.

We’ve talked about the connections between sleep and obesity multiple times in this column. It is not clear to me whether sleep problems lead to obesity or obesity leads to sleep problems. This orexin story might help explain some of this connection. But it is not clear yet. The orexin system may be more important in the regulation of energy expenditure than food intake. Orexin-deficient narcoleptic patients have increased obesity rather than decreased, as would be expected if orexin were primarily an appetite stimulating hormone. There is no mention of appetite or weight change effects by these new orexin blocking sleep aids.

To sleep, perchance to dream of why we have to sleep so much.

1. Lemborexant for insomnia. The Medical Letter June 29, 2020; 62:97.

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By John DiTraglia

This writer’s opinion is their own and not the opinion of this newspaper

John DiTraglia M.D. is a Pediatrician in Portsmouth. He can be reached by e-mail- jditrag@zoomnet.net or phone-354-6605.

This writer’s opinion is their own and not the opinion of this newspaper

John DiTraglia M.D. is a Pediatrician in Portsmouth. He can be reached by e-mail- jditrag@zoomnet.net or phone-354-6605.