Category Archives: Hypersomnia

Treatment of Hypersomnias

This post focuses on treatment of the hypersomnias of central origin as defined in the second edition of the International Classification of Sleep Disorders (ICSD-2). Rational therapy begins with an understanding of the normal anatomy, physiology, and neurochemistry of central wake / sleep mechanisms. Basic Wake Systems The ascending reticular activating system, defined in part… Read More »

Hypersomnia: Pharmacologic Therapy

Narcolepsy: Pharmacologic Therapy Recurrent Hypersomnias The recurrent hypersomnias described in the ICSD-2 are the Kleine-Levin syndrome and menstrual-related hypersomnia. Kleine-Levin Syndrome The Kleine-Levin syndrome was first described by Antimoff in 1898, detailed by Willi Kleine in 1925, clearly summarized by Max Levin in 1929, and formally named the Kleine-Levin syndrome by Critchley and Hoffmann in… Read More »

Narcolepsy: Pharmacologic Therapy

The Standards of Practice Committee of the American Academy of Sleep Medicine (AASM) provides a periodically updated list of medicines recognized for the treatments of hypersomnolence associated with narcolepsy. The list has included modafinil, amphetamines, and amphetamine-like drugs (methylphenidate), whereas sodium oxybate, non-sedating tricyclic antidepressants (TCAs, protriptyline), selective serotonin reuptake inhibitors (SSRIs, fluoxetine), and monoamine… Read More »

Hypersomnia: Nonpharmacologic Theory

Behavioral Therapy Good sleep hygiene is a mandatory part of treating hypersomnolence. It is a positive set of habitual sleep-related behaviors that involve exercise, appropriate diet (in regard to meal size, frequency, and composition), regular sleep-wake schedules, and a proper sleep environment (with optimal dark-light contrast and temperature and noise level control). Good sleep hygiene… Read More »

Special Considerations for Treatment of Hypersomnias

Side Effects Of Treatment Adverse Effects of Treatment Drugs in Short-Term Use Adverse Effects of Treatment Drugs in Long-Term Use Age And Gender Effects Of Treatment There are no major age effects of treatment, with the exception of some recent reports regarding the possibility of sudden death in children and adolescents with cardiac disease who… Read More »

Adverse Effects of Treatment Drugs in Short-Term Use

Short-Term Use of Psychostimulants Psychostimulants, such as methylphenidate and dextroamphetamine, are effective in controlling the somnolence of narcolepsy. However, they often show side effects due to stimulation of the sympathetic nervous system. Constitutional factors may contribute to the development and severity of side effects. These include dry mouth, headache, palpitations, sweating, tremor, anorexia, gastritis, nausea,… Read More »

Adverse Effects of Treatment Drugs in Long-Term Use

Long-Term Adverse Effects of Psychostimulants Psychostimulants have been used for many years for the treatment of narcolepsy. Adequate control of somnolence in the daytime is usually possible. However, this control is not always possible because of side effects and nonadherence. The awakening effects of psychostimulants should not be extended beyond evening meals to minimize remaining… Read More »

Driving Risk And Medicolegal Aspects

A driver’s license is typically suspended or revoked when the diagnosis of narcolepsy and / or sleep-related breathing disorders is established in some countries. However, the regulations vary from country to country, and are less severe in other countries. In the United States, the regulations differ by state, with California having the strictest regulations. When… Read More »

Types of Hypersomnias

Somnolence is a complex state, impacted by multiple determinants such as quantity and quality of prior sleep, circadian time, drugs, attention, motivation, environmental stimuli, and various medical, neurological, and psychiatric conditions. Clearly, somnolence is welcomed when sleep is desired, but at other times often becomes an unwanted symptom. Pathological or inappropriate somnolence is clinically termed… Read More »