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Key Features

  • Classification

    • Breathing-related sleep disorders; see Sleep Apnea, Obstructive

    • Narcolepsy; see Narcolepsy

    • Kleine-Levin syndrome

      • Occurs mostly in young men

      • Associated with antecedent neurologic insults

    • Periodic limb movement disorder

Clinical Findings

  • Kleine-Levin syndrome

    • Hypersomnic attacks lasting up to 2 days and occurring 3–4 times/year

    • Awakening is accompanied by hyperphagia, hypersexuality, irritability, confusion

    • Usually remits after age 40

  • Periodic limb movement disorder

    • Periodic lower leg movements occur only during sleep

    • Subsequent daytime sleepiness, anxiety, depression, cognitive impairment

    • Restless leg syndrome includes movements while awake as well

  • Shift work sleep disorder

    • Occurs when there is excessive fatigue as a consequence of work occurring during the normal sleep period

Diagnosis

  • Clinical or during a sleep study

Treatment

  • Modafinil and its enantiomer armodafinil

    • FDA-approved for treating the excessive daytime fatigue of narcolepsy, sleepiness associated with obstructive sleep apnea, and shift work sleep disorder

    • Usual dosing is 200–400 mg orally each morning for modafinil and 150–250 mg orally in the morning for armodafinil

  • Kleine-Levin syndrome: No treatment is known, although lithium can prevent recurrences in some patients

  • Periodic limb movement disorder: Clonazepam can be used with variable results

  • Shift work sleep disorder

    • Modafinil, 200 mg orally each morning

      • Common side effects include headache and anxiety

      • However, appears to be generally well tolerated

      • May reduce the efficacy of cyclosporine, oral contraceptives, and other medications by inducing their hepatic metabolism

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