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hypersomnia (hypersomnolence, excessive sleepiness)

Excessive sleepiness. Etiology: 1) insufficient sleep (most common) 2) sleep fragmentation a) sleep-disordered breathing - obstructive sleep apnea - central sleep apnea b) periodic limb movement disorder 3) CNS disorders a) narcolepsy b) Kleine-Levin syndrome c) head injury d) depression e) encephalitis 4) disturbances in circadian rhythm a) shift work b) jet lag c) other circadian rhythm sleep disorder 5) other medical disorders a) congestive heart failure b) severe anemia c) hypothyroidism, myxedema 6) nocturnal pain [3] 7) pharmaceutical agents [2] a) analgesics (narcotics) b) antidepressants c) antihypertensives (clonidine) d) antihistamines e) others, especially psychoactive agents 8) environmental sleep disorder a) ambient noise b) pets, pests 9) idiopathic Pathology: - excessive daytime sleepiness associated with accumulation of beta-amyloid in the cingulate gyrus & precuneus regions [7] History: - time available for & spent sleeping prior to additional workup Laboratory: - complete blood count (CBC) to assess anemia - thyroid function tests Special laboratory: - actigraphy suggested as initial step in evaluation of hypersomnia [1] - polysomnography if obstructive sleep apnea or periodic limb movement disorder suspected - multiple sleep latency testing may be useful if narcolepsy suspected - resource intensive & expensive [1] - echocardiogram may be useful if heart failure suspected Radiology: - chest X-ray to assess heart failure Management: - sleep log to quantify sleep - counsel patients on dangers of drowsy driving [1] - consistent sleep-wake schedule to allow for 8 hours of sleep - minimum of 7-8 hours of sleep/24 hours [1] - use of CPAP for obstructive sleep apnea - discontinue non-essential potentially offending medications - calcium, magnesium, potassium, & sodium oxybate oral solution (Xywav) first FDA-approved treatment of idiopathic hypersomnia [8] Notes: - also see NINDS Hypersomnia Information Page [5]

Related

drowsiness narcolepsy somnolence (sleepiness)

Specific

idiopathic hypersomnolence

General

sleep disorder

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018, 2022.
  2. Alessi C In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004
  3. Pack AI et al, Risk factors for excessive sleepiness in older adults. Ann Neuorol 2006; 59:893 PMID: 16718691
  4. Morgenthaler TI et al, Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. Sleep 2007, 30:1705 PMID: 18246980
  5. Kushida CA, Chang A, Gadkary C et al Comparison of actigraphic, polysomnographic, and subjective assessment of sleep parameters in sleep-disordered patients. Sleep Med. 2001 Sep;2(5):389-96. PMID: 14592388
  6. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  7. Carvalho DZ, St Louis EK, Knopman DS et al Association of Excessive Daytime Sleepiness With Longitudinal beta-Amyloid Accumulation in Elderly Persons Without Dementia. JAMA Neurol. Published online March 12, 2018 PMID: 29532057 https://jamanetwork.com/journals/jamaneurology/fullarticle/2674279 - Winer JR, Mander BA. Waking Up to the Importance of Sleep in the Pathogenesis of Alzheimer Disease. JAMA Neurol. 2018 Mar 12. PMID: 29532083
  8. George J First Drug OK'd for Idiopathic Hypersomnia. Sleep drug Xywav gains a new indication MedPage Today August 12, 2021 https://www.medpagetoday.com/neurology/sleepdisorders/94024
  9. NINDS Hypersomnia Information Page https://www.ninds.nih.gov/Disorders/All-Disorders/Hypersomnia-Information-Page