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sleep:3-hypersomnolence-disorder [on April 21, 2020]
sleep:3-hypersomnolence-disorder [on June 7, 2023] (current)
psychdb
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-====== Hypersomnolence Disorder ======+====== ​Idiopathic Hypersomnia (Hypersomnolence Disorder====== 
 +{{INLINETOC}}
 ===== Primer ===== ===== Primer =====
-**Hypersomnolence Disorder** is a broad diagnosis and includes symptoms of excessive quantity of sleep, deteriorated quality of wakefulness,​ and sleep inertia. Individuals with this disorder fall asleep quickly and have a high sleep efficiency (>90%). They may have difficulty waking up in the morning, sometimes appearing confused, combative, or ataxic. This prolonged impairment of alertness during the sleep-wake transition is often referred to as sleep inertia (or sleep drunkenness).+**Idiopathic Hypersomnia** (ICSD-3) or **Hypersomnolence Disorder** ​(DSM-5), ​is a broad diagnosis and includes symptoms of excessive quantity of sleep, deteriorated quality of wakefulness,​ and sleep inertia. Individuals with this disorder fall asleep quickly and have a high sleep efficiency (>90%). They may have difficulty waking up in the morning, sometimes appearing confused, combative, or ataxic. This prolonged impairment of alertness during the sleep-wake transition is often referred to as sleep inertia (or sleep drunkenness).
  
 == Prevalence == == Prevalence ==
 Approximately 5%-10% of individuals who consult in sleep disorders clinics with complaints of daytime sleepiness are diagnosed as having hypersomnolence disorder. It is estimated that about 1% of the European and U.S. general population has episodes of sleep inertia. Hypersomnolence occurs with relatively equal frequency in males and females. Approximately 5%-10% of individuals who consult in sleep disorders clinics with complaints of daytime sleepiness are diagnosed as having hypersomnolence disorder. It is estimated that about 1% of the European and U.S. general population has episodes of sleep inertia. Hypersomnolence occurs with relatively equal frequency in males and females.
  
-===== Diagnostic Criteria ===== +===== DSM-5 Diagnostic Criteria =====
-<WRAP group> +
-<WRAP half column>+
 == Criterion A == == Criterion A ==
 Self-reported excessive sleepiness (hypersomnolence) despite a main sleep period lasting at least ''​7''​ hours, with at least ''​1''​ of the following symptoms: Self-reported excessive sleepiness (hypersomnolence) despite a main sleep period lasting at least ''​7''​ hours, with at least ''​1''​ of the following symptoms:
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 == Criterion C == == Criterion C ==
 The hypersomnolence is accompanied by significant distress or impairment in cognitive, social, occupational,​ or other important areas of functioning. The hypersomnolence is accompanied by significant distress or impairment in cognitive, social, occupational,​ or other important areas of functioning.
-</​WRAP>​ 
-<WRAP half column> 
  
 == Criterion D == == Criterion D ==
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 </​panel>​ </​panel>​
 </​accordion>​ </​accordion>​
-</​WRAP>​ + 
-</​WRAP>​+==== Sign and Symptoms ==== 
 +  * Individuals often report constant sleepiness and prolonged naps. The naps are not refreshing. There can often be sleep inertia lasting 2-3 hours in the morning, and individuals may be aggressive in the mornings.
  
 ===== Pathophysiology ===== ===== Pathophysiology =====
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   * Viral infections have been reported to have preceded or accompanied hyper somnolence in about 10% of cases. HIV pneumonia, infectious mononucleosis,​ and Guillain-Barré syndrome, can also evolve into hypersomnolence within months after the infection.   * Viral infections have been reported to have preceded or accompanied hyper somnolence in about 10% of cases. HIV pneumonia, infectious mononucleosis,​ and Guillain-Barré syndrome, can also evolve into hypersomnolence within months after the infection.
   * Hypersomnolence can also appear within 6-18 months follow ing a head trauma.   * Hypersomnolence can also appear within 6-18 months follow ing a head trauma.
 +
 +===== Differential Diagnosis =====
 +  * Normative variation in sleep
 +  * Poor sleep quality and fatigue
 +  * Insufficient sleep time
 +  * Breathing-related sleep disorders
 +    * [[sleep:​breathing:​1-osa|Obstructive sleep apnea]]
 +  * Circadian rhythm sleep-wake disorders
 +  * [[sleep:​4-narcolepsy|Narcolepsy]]
 +  * [[sleep:​parasomnias:​home|Parasomnias]]
 +  * [[cl:​kleine-levin-syndrome|Kleine-Levin syndrome]]
 +  * Other mental disorders
 +    * [[mood:​1-depression:​home|Major depressive disorder]]
  
 ===== Investigations ===== ===== Investigations =====
 +
 ==== Polysomnography ==== ==== Polysomnography ====
 Nocturnal polysomnography will show: Nocturnal polysomnography will show:
-  * normal ​to prolonged sleep duration, short sleep latency +  * Normal ​to prolonged sleep duration, short sleep latency 
-  * normal ​to increased sleep continuity +  * Normal ​to increased sleep continuity 
-  * distribution ​of rapid eye movement (REM) sleep is also normal+  * Distribution ​of rapid eye movement (REM) sleep is also normal
  
-Sleep efficiency is mostly greater than 90%. Some individuals with hypersomnolence disorder have increased amounts of slow-wave sleep. The multiple sleep latency test documents sleep tendency, typically indicated by mean sleep latency values of less than 8 minutes. In hypersomnolence disorder, the mean sleep latency is typically less than 10 minutes and frequently 8minutes or less. Sleep-onset REM periods (SOREMPs; i.e., the occurrence of REM sleep within 20 minutes of sleep onset) may be present but occur less than two times in four to five nap opportunities.+  * Sleep efficiency is mostly greater than 90%. Some individuals with hypersomnolence disorder have increased amounts of slow-wave sleep. The multiple sleep latency test documents sleep tendency, typically indicated by mean sleep latency values of less than 8 minutes. ​ 
 +  * In hypersomnolence disorder, the mean sleep latency is typically less than 10 minutes and frequently 8minutes or less. 
 +  * Sleep-onset REM periods (SOREMPs; i.e., the occurrence of REM sleep within 20 minutes of sleep onset) may be present but occur less than two times in four to five nap opportunities.
  
 ===== Treatment ===== ===== Treatment =====
 +  * There are no consistently effective treatments, but [[meds:​stimulants:​modafinil|modafinil]] can be used as a wakefulness promoting agent.
  
-===== Differential Diagnosis ===== 
-  * Normative variation in sleep 
-  * Poor sleep quality and fatigue 
-  * Breathing-related sleep disorders 
-  * Circadian rhythm sleep-wake disorders 
-  * Parasomnias 
-  * Other mental disorders 
  
 ===== Resources ===== ===== Resources =====