We’re Taking the First Steps Toward a Cure for Narcolepsy
A drug that promoted sleepiness was not the application that most people with narcolepsy were looking for. By preventing the orexins from binding to their receptors, Belsomra effectively creates an acute case of narcolepsy, but where the fog, ideally, will have started to lift by the morning.
Sleeping pills commonly used to treat insomnia tend to work by depressing the central nervous system as a whole, says Paul Coleman, a medicinal chemist who works at Merck’s laboratories at West Point, Philadelphia, and who was instrumental in the development of Belsomra. “What’s so exciting about Belsomra is that it is very selective for blocking wakefulness, so it doesn’t affect the systems that control balance, memory and cognition,” he says.
In his career, Coleman has developed drugs to treat a range of different infections, illnesses, and disorders, but the orexin system stands out. “Narcolepsy has given us a thread we can pull on to unravel a lot about what underlies the systems that govern wakefulness and sleep,” he says.
“Wakefulness is a pretty central process for everybody, whether you are a healthy person or have narcolepsy or insomnia. It’s the most exciting thing I’ve had a chance to work on.” The applications of Belsomra may be wider still, with clinical trials proposed to investigate its potential to help shift workers sleep during the hours of daylight, improve the sleep of Alzheimer’s patients, help those suffering from post-traumatic stress disorder, combat drug addiction, and ease human panic disorder.
I am delighted to see these developments, but the millions of us with narcolepsy are still hoping for a drug that could work in the brain to rouse rather than silence the orexin system.