Although obstructive sleep apnea (OSA) and narcolepsy are the sleep disorders that commonly present with excessive daytime sleepiness, idiopathic hypersomnia should be considered as well.
A patient with idiopathic hypersomnia will complain of unrefreshing sleep and may further be categorized as someone who does or does not have long sleep time (i.e., up to at least 10 hours).
Clinical symptoms of idiopathic hypersomnia include excessive sleepiness for at least three months and prolonged nocturnal sleep time. A polysomnogram will have excluded such other causes of daytime sleepiness as OSA.
Idividuals with idiopathic hypersomnia will fall asleep very quickly during multiple sleep latency testing, with a mean sleep latency of less than eight minutes. These patients will also have fewer than two sleep-onset REM periods (SOREMP’s), in contrast to narcolepsy where a patient will fall asleep in less than eight minutes but will have two or more SOREMP’s.
Extended naps during the day are not uncommon in patients with idiopathic hypersomnia. In most cases, these individuals will still be able to fall asleep easily at bedtime but will often have difficulty waking up in the morning. Symptoms usually begin during early adulthood and continue for years before diagnosis. This condition seems to occur in families, with 50% of patients having a family member with the disorder.
Patients with idiopathic hypersomnia may have such related symptoms as migraine headaches, orthostatic hypotension, and peripheral vascular complaints.
Rule out other disorders of sleep, as well as drug abuse, medication abuse, alcoholism, head trauma, and psychiatric conditions. Hypersomnia can occur in patients with such medical conditions as Parkinson disease or such endocrine disorders as hypothyroidism. Proper screenings and lab work are required.
Idiopathic hypersomnia may or may not respond to stimulant therapy. Modafinil (Provigil) and armodafinil (Nuvigil) are recommended as first-line treatment. Other stimulants, including methylphenidate (Concerta, Metadate, Methlin, Ritalin) and dextroamphetamine can also be used. Of course, use the lowest dose possible to manage symptoms. Encourage good sleep hygiene. I often add stimulating antidepressants in those patients with depression. These medications typically do not work well as standalone treatment but can be good adjuncts to the stimulants.
Idiopathic hypersomnia can be very debilitating. Work and social life are often compromised, so be sure to provide encouragement to the patient. Self-esteem is often low, as family and friends may have classified sufferers as “lazy.” Provide assurance that you want to help improve their daily functioning.