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on, I have seen thousands of patients, many blood pressure. Apnoea affects people with terrors, in which people, typically children, of whom have ‘slept their life away’ undiag- a narrow upper airway, often due to obesity; arise screaming while still asleep, come from nosed. Given that half of all people with the when they breathe in, the back of their throat non-REM sleep, when one part of the brain condition develop it before the age of 18, this collapses, disturbing sleep and reducing the attempts to wake the person while the cor- is especially tragic for children, for whom oxygen they take in. The standard treatment tex is still asleep. Sleepwalkers can experi- every year is critical for development. is simple — supporting the airway during ence fatal falls, or even have unconscious Yet narcolepsy’s cause is remarkably sleep with pressurized air — but many find sex, which can have medical and legal con- simple. It was discovered in 1999 by my team it hard to tolerate. Nothing better is available. sequences. In REM sleep behaviour disorder and that of Mashashi Yanagisawa through Some harbour fears linked to sleep. As — in which REM sleep paralysis does not genetic studies in dogs and mice. In humans, Nicholls notes, many people with insomnia work and patients enact their dream — peo- research pinned it down to the loss of around (which affects 10% of people, most often ple might attack their bed partner. Most go 20,000 neurons in the brain’s hypothalamus women) are terrified by their lack of sleep, on to develop Parkinson’s disease. Research containing hypocretin, a wakefulness-pro- and try to force themselves into it. They has only recently started to outline the neural moting protein. The next question is how they might spend too underpinnings of these pathologies. are lost. With data suggesting an autoimmune long in bed, making “We are in denial For all its strengths, Nicholls’s fascinating process following an influenza infection (in their sleep worse by about our need book leaves us wanting more. As Sleepyhead which the immune system confuses parts of reducing their sleep for sleep, and shows, sleep sciences are still in their infancy, the flu virus with hypocretin neurons), a full debt too much. This the prevalence and current research is mostly descriptive. understanding of the condition might teach causes a vicious cir- of disorders Luckily — although Nicholls doesn’t cover us much about autoimmunity in the brain. cle. Their anxiety preventing it.” this — the field is now poised to benefit from A more effective treatment will be available might be exacer- two scientific transformations. The first is once hypocretin-stimulating compounds bated by the barrage of media stories on the genomics, which has cracked open the molec- are developed that can penetrate the brain, need to sleep for eight uninterrupted hours ular basis of some objectively measurable which could happen in the next decade. These a night, or even by accounts of fatal familial traits or behaviours. The second is tools such compounds help narcoleptics and many other insomnia. In that extremely rare condition, as activity trackers, electroencephalography people with unexplained sleepiness. slumber is impossible because of lesions in the electrodes, devices to track movement caused Nicholls drives home, too, how in denial thalamus, the brain region that filters out sen- by the heartbeat, and snoring recorders, we are about our need for sleep, and the sory perceptions as we fall asleep. The most which are making the objective tracking of prevalence of disorders preventing it. Sleep effective treatment for insomnia is a better our waking and sleeping lives vastly easier. ■ apnoea, which involves snoring and pauses understanding of sleep physiology, notably in breathing, affects 10–20% of the popula- restricting sleep to increase sleep pressure Emmanuel Mignot is the Craig Reynolds tion, most often men. Until the 1980s, it was and break the vicious circle. Professor of Sleep Medicine in the largely unknown to physicians, although Parasomnias occupy a chunk of the book Department of Psychiatry and Behavioral attested in fiction: a famous sufferer is Joe in — ‘almost normal’ disorders such as sleep Sciences at Stanford University in California Charles Dickens’ 1837 The Pickwick Papers. walking, night terrors and sleep paralysis. and the Director of the Stanford Center for It took decades for mainstream medicine These mixed states have definitive physio- Sleep Sciences and Medicine. to recognize it as a frequent cause of high logical explanations. Sleepwalking and night e-mail: [email protected]

FILM Bollywood takes on menstrual stigma Subhra Priyadarshini lauds a biopic of an inspired Indian sanitary-pad innovator.

rugal innovation is a new norm ‘Period poverty’ is a health issue affect- open up this taboo topic for much-needed in India, emerging sporadically in ing women in countries across the globe. In discussion through narrative sparked by pockets of brilliance — from rural Britain, 1 in 10 girls and women aged 14–21 melodrama and music. Like Shree Narayan Fhamlets to technology labs. It has even cannot afford sanitary products, according Singh’s 2017 film Toilet: Ek Prem Katha, cen- spawned a word in Hindi: jugaad. to London-based charity Plan International tred around the problem of open defecation, Thanks to jugaad, bioengineer Manu UK. In India, according to a 2015–16 govern- it has captured the imagination of a nation Prakash is flooding rural schools in ment health survey, just 58% of women aged grappling with a massive burden of women’s India with his US$1 ‘foldscope’, an 15–24 can afford to use a hygienic method health issues. origami-inspired microscope teaching of menstrual protection: 78% in urban areas Directed by R. Balki, Pad Man has a science to tens of thousands of children. and 48% in rural ones. And the average varies starry cast. Muruganantham (renamed It is also in this spirit that, in 2000, school wildly between states — from 91% in Tamil Lakshmikant) is played by renowned Bol- dropout Arunachalam Muruganantham Nadu to just 31% in Bihar. The rest resort to lywood action-hero-turned-character-actor created a do-it-yourself unit in Coimbatore, rags, leaves and even ash. This can result in Akshay Kumar; the powerful theatre actor Tamil Nadu, to manufacture the world’s serious health risks, such as Radhika Apte plays his wife, Shanthi (called cheapest sanitary pads. Now, Muruganan- Pad Man toxic shock syndrome, and Gayatri). There is even a jingoistic cameo DIRECTOR: tham’s story hits the big screen in Pad Man, R. BALKI lead to absence from school from superstar Amitabh Bachchan, who, billed as the first feature-length film on Columbia/Hope: or work. playing himself, declaims: “India should not menstrual hygiene. 2018. Pad Man attempts to be seen as a country of one billion people.

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Akshay Kumar plays the lead in Pad Man, a fictionalized biopic of sanitary-pad innovator Arunachalam Muruganantham.

India should be seen as a country of one national innovation prize, a spot on TIME collaboration with women’s self-help groups billion minds.” magazine’s ‘100 most influential people’ list and cooperatives. He has spawned close to Muruganantham’s is the inspiring story of in 2014, and one of India’s highest civilian 2,500 such centres, in India and a dozen an unconventional and tenderhearted man. awards, the Padma Shri, in 2016. other developing countries. His pads retail In the early 1990s, he was an assistant in a Pad Man makes Muruganantham’s at a fraction of the cost of those from multi- hardware workshop. His wife’s use of rags unusual journey relatable, although it often national brands. during menstruation concerned him, so he descends a little Although Pad Man captures the essence experimented with materials — first cotton, into preachiness. “Period poverty of grass-roots innovation and benefits from then cellulose fibre — to make a pad that It falters, too, with is a health issue true-to-life portrayals by a brilliant set of wouldn’t leak, in a process of reverse engi- a laboured first affecting women actors, the instructive overtone mars the neering. At first, when it came to testing his half, in which the in countries narrative. If it wants to reach other countries prototypes, “the only available victim was risk to women’s across the affected by period poverty, the song-and- my wife”, Muruganantham said in a 2012 health is not clearly globe.” dance might be a dampener. The film is also TED talk. In Pad Man, we see Lakshmikant delineated, and the currently an urban sensation. Reaching its perfecting the scientific steps of pulverizing stigma associated target audience in India’s rural hinterland cellulose fibres, compressing them, sealing with the subject of menstruation is signalled might be difficult, given the taboo — unless the pad with non-woven fabric and sanitiz- by bursts of “Sharam!” (shame) from the Balki and team have a plan for that. ing the whole with ultraviolet light. And it female actors. Endorsing Bollywood’s Meanwhile, a social movement is now was all accomplished using four ingenious, un­apologetic love affair with song and associated with the film. Muruganantham makeshift machines that cost peanuts, com- dance, the demure Gayatri suddenly breaks has mentored a biologist, Maya pared to the giant assembly lines used by into an exaggerated, hip-swaying number to Vishwakarma, who came home to rural multinational companies. celebrate the puberty of a girl next door. Madhya Pradesh from California four years At the cost of being ostracized for openly The rest of the film brings in the usual ago to spread menstrual-hygiene awareness. tackling a hidden issue, he worked doggedly elements of a potboiler — a love angle, the Vishwakarma has now received backing to on the pad’s design. The biggest challenge rise and rise of the protagonist and Gayatri’s distribute free pads to tribal women. Her was finding volunteers to test it. “Every­ forgive-and-feel-proud reconciliation. mission has earned her the sobriquet Pad one thought I had gone mad,” he says. He Bachchan delivers the applause-inducing Woman. The buzz created by Pad Man might finally realized that he could turn guinea pig line: “America has Superman, Spiderman help her small non-profit organization to get himself. He wore a pad, and used a deflated and Batman. India has Pad Man!” international donors and become a national football filled with goat’s blood and fitted Over the past decade, Muruganantham movement. ■ with a tube. It took him six years to isolate has travelled across villages in India — first cellulose as the core adsorbing medium. selling his sanitary pads, and then setting Subhra Priyadarshini is chief editor of That roller-coaster journey won him a up self-sustaining pad-making units in Nature India.

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