hypersomnia (hypersomnolence, excessive sleepiness)
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Introduction
Excessive sleepiness.
Etiology
- insufficient sleep (most common)
- sleep fragmentation
- CNS disorders
- disturbances in circadian rhythm
- other medical disorders
- nocturnal pain[3]
- pharmaceutical agents[2]
- analgesics (narcotics)
- antidepressants
- antihypertensives (clonidine)
- antihistamines
- others, especially psychoactive agents
- environmental sleep disorder
- ambient noise
- pets, pests
- 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
Diagnostic procedures
- 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
- 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
More general terms
More specific terms
Additional terms
References
- ↑ Jump up to: 1.0 1.1 1.2 1.3 1.4 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2012, 2015, 2018, 2022.
- ↑ Jump up to: 2.0 2.1 Alessi C In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004
- ↑ Jump up to: 3.0 3.1 Pack AI et al, Risk factors for excessive sleepiness in older adults. Ann Neuorol 2006; 59:893 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16718691
- ↑ Morgenthaler TI et al, Practice parameters for the treatment of narcolepsy and other hypersomnias of central origin. Sleep 2007, 30:1705 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18246980
- ↑ Jump up to: 5.0 5.1 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: https://www.ncbi.nlm.nih.gov/pubmed/14592388
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
- ↑ Jump up to: 7.0 7.1 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: https://www.ncbi.nlm.nih.gov/pubmed/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: https://www.ncbi.nlm.nih.gov/pubmed/29532083 - ↑ Jump up to: 8.0 8.1 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
- ↑ NINDS Hypersomnia Information Page https://www.ninds.nih.gov/Disorders/All-Disorders/Hypersomnia-Information-Page