Sleep Disorders and Medicine

Hypersomnia’s and Neurologic Sleep Disorders

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These practice parameters pertain to the treatment of hypersomnia’s of central origin. It serves as both an update of previous practice parameters for the therapy of narcolepsy and as the first practice parameters to address treatment of other hypersomnia of central origin. Specific disorders addressed by these parameters are narcolepsy (with or without cataplexy, due to medical condition), the idiopathic hypersomnia, recurrent hypersomnia and hyperxsomnia due to medical condition. Central hypersomnias are diseases manifested in excessive daytime sleepiness (EDS) not caused by disturbed nocturnal sleep or misaligned circadian rhythms. The Central hypersomnias includes narcolepsy with or without cataplexy, idiopathic hypersomnia. recurrent hypersomnia, with and without long sleep , behaviorally induced insufficient sleep disorder, Narcolepsy and hypersomnia due to medical conditions, and finally hypersomnia induced by substance intake. Epworth Sleepiness Scale is a subjective tool mostly used for Excessive daytime sleepiness assessment, Whereas the Multiple Sleep Latency Test serves as an objective diagnostic method for narcolepsy and idiopathic hypersomnias. As for symptomatic therapy of EDS, the central nervous system stimulants modafinil and methylphenidate seem to work well in most cases and in narcolepsy and Parkinson’s disease; sodium oxybate also has notable therapeutic value. In 1966, William Dement proposed that patients with excessive daytime sleepiness, but without cataplexy, sleep paralysis, or sleep-onset rapid eye movement (REM), should not be considered narcoleptic. In 1972, Roth described a type of hypersomnia with sleep drunkenness that consists of difficulty coming to complete wakefulness, confusion, disorientation, poor motor coordination, and slowness, accompanied by deep and prolonged sleep. The abrupt sleep attacks seen in classic narcolepsy are not present in this disorder.