A woman nods off in a scene from the narcolepsy awareness ad. MoreThanTired.com

"I feel tired all the time."

"It can be tough to concentrate, and I have this need to nap," says a voiceover while images of people falling asleep on public transportation or at the movies flash across the television screen.

The footage in this advertisement is relatable to anyone who's unexpectedly nodded off. But then comes a surprise:

"It could be narcolepsy."

Narcolepsy — most commonly known as the condition that leaves people falling asleep unexpectedly — affects roughly 1 in 2,000 people in the US. In addition to the sleepiness, another symptom is cataplexy, a condition where the body suddenly loses muscle tone after the person expresses strong emotions, like laughing.

So chances are pretty good that if you're sleepy — it is not narcolepsy.

Certainly, narcolepsy is serious for the 0.05% of Americans who suffer from it, but the advertisement described above is running on prime time cable television. And that begs the question that's often asked about widely broadcast consumer ads for such uncommon conditions: Why do drug companies do this?

The answer is simply "because it works." But, that's only true if the drug meets certain conditions — namely that it needs to be expensive.

It needs to be expensive

These types of ads are expected to grow 10% per year, with drug companies spending $8 billion on ads by 2020 up from $5.6 billion in 2016, according to ZS Associates, a sales and marketing firm focused on the healthcare industry.

And the ads the pharma companies are running are targeting incredibly tiny populations. Also on TV these days is an ad for people with a certain kind of advanced small cell lung cancer, and a treatment for a rare sleep disorder that happens to people who are blind. Prescriptions for these can cost upward of $100,000 a year.

ZS principal Pratap Khedkar told Business Insider that running ads for these expensive specialty products makes sense. Sure, you might be spending more per potential patient, but because the drugs cost so much, it pays off.

"It's not very profitable, but it's not making a loss," Khedkar said. The total spending might be $400 or $500 per known case, but the drugmaker can make that back easily with a high-priced specialty medicine.

The narcolepsy ad isn't quite the same as one for, say, Opdivo - a lung cancer immunotherapy. For one thing, it is an "awareness campaign" and doesn't name a specific drug. It does direct people to a website that then encourages them to self-diagnose their condition, and then find a sleep specialist who, presumably, would just prescribe the drug behind all this.

That drug is called Xyrem. It is owned by Jazz Pharmaceuticals — which is running the ads — and it's the only approved drug that treats cataplexy and daytime sleepiness.

And, it costs roughly $20 per dose (taken nightly), after Jazz increased the price at least 841% between 2007 and 2014. There is generic alternative, though, which was just approved in January.

Jazz didn't respond to Business Insider's requests for comment on the ad campaign or its intentions, but a spokeswoman did tell FiercePharma in November 2016, that "we believe that, over time, a targeted narcolepsy awareness initiative may increase the number of patients diagnosed with narcolepsy and may help reduce the time from disorder onset to diagnosis."



So, for the next time you're watching TV and being asked if you might have narcolepsy — now you know why.