Hypersomnia

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

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

Clinical or during a sleep study

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