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This paper explores the relationship between insular stroke and the disruption of tobacco use. A functional analysis of the role of the insula in maintaining homeostasis suggests that the insula monitors hypoxia and applies dyspnea to motivate the individual to regulate breathing. From its' early usage, nicotine has been used to treat respiratory disorders. It increases respiratory drive, promoting better breathing. Insular stroke likely interferes with this self-regulation. A new self-medication model is proposed for tobacco use. The effect on public policy is discussed., ((c) 2010 Elsevier Ltd. All rights reserved.)

We present a plausible and powerful explanation for nicotine addiction that is consistent with recent findings. Sleep apnea, the periodic cessation of breathing during sleep, may be responsible for the addictive nature of nicotine. The main symptoms of sleep apnea are somnolence and obesity. Nicotine has been shown to decrease these two symptoms as well as reduce the frequency and duration of apneas. When an apneic youth uses tobacco, the nicotine may begin to treat the apnea and reduce the symptoms. The response of the human system is, naturally, to continue that which improves life, assuring addiction of the apnea to the nicotine. Many of the illnesses attributed to tobacco use and passive parental smoking may actually be confounded by the inherited influence of sleep apnea. Treating the apnea may be a necessary precondition for a successful tobacco cessation program. Understanding the apnea-tobacco relationship may be an important step in the development of a tobacco prevention program for youth.