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Sleep Apnea, Snoring, Narcolepsy,
Insomnia and Other Sleep Disorders.

THE SLEEP SITE

BRINGING SECRETS OF THE NIGHT TO THE LIGHT OF DAY...

Understanding the symptoms of sleep disorders.

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IDIOPATHIC HYPERSOMNIA.

 Many e-mail letters received have involved questions about this diagnosis.

What is it? How is it diagnosed? What should patients know about it?

 

--This diagnosis can be explained as follows:

-One could be chronically sleepy for one or both of the following reasons:

1. There is something wrong with sleep that makes it non-refreshing.

2. There is a problem with the brain mechanisms which normally should keep one alert (whether caused by primary problems within the brain or its chemistry, or by other factors (such as sedating medications or thyroid problems).

The most common causes of severe sleepiness beginning or progressively worsening in adults are SLEEP APNEA and RELATED BREATHING DISORDERS DURING SLEEP.

If the problem instead is a primary disorder of brain chemistry, NARCOLEPSY is the leading diagnosis. As outlined elsewhere on this web site, people with narcolepsy are diagnosed either by a clear-cut history of their having had cataplexy, or via their demonstrating REM sleep in two or more daytime naps on a Multiple Sleep Latency Test.

(The latter test is not 100% reliable, since some patients with classic narcolepsy may not demonstrate REM sleep during any of the naps on a given day, simply by chance).



-Idiopathic hypersomnia (or hypersomnolence. as it has been called) is a diagnosis applied to people who are excessively sleepy--but not because there is anything apparently wrong with their sleep, and not because of narcolepsy or any other identifiable cause.

It is basically a diagnosis of exclusion: one that is made by excluding all other possible diagnoses.


-Idiopathic is a more dignified way of saying that we don't know exactly what causes the problem.


-Hypersomnia is not the commonest diagnosis...but it is not rarely made, either.


-Hypersomnia does not appear to be one single entity. Various abnormalities of brain chemistry have been suggested in studies of such patients or suspected as being potential causes.

The brain is complex to the point that there would be many different possible ways to impair alertness.

 

--What are three common features of patients diagnosed with idiopathic hypersomnia?

1. People given this diagnosis are likely to sleep for long periods of time without feeling refreshed. They often do not feel any better after taking naps.

It has been said that a history of not feeling refreshed after sleep will reliably differentiate sleep apnea and hypersomnia from narcolepsy, but I personally don't believe it. I have a number of patients with definite narcolepsy who find naps unrefreshing, and who also wake up feeling groggy and exhausted in the morning.

2. People with idiopathic CNS hypersomnia often have family histories of this same sort of problem, of true narcolepsy or of both entities.

Not infrequently, hypersomnia seems hereditary.

3. For the most part, patients diagnosed as having idiopathic hypersomnia report that their sleepiness began late in childhood, during their teen years, or in their early twenties.

Idiopathic hypersomnia resembles narcolepsy in its typical age of onset.

For this reason, I am hesitant to make this diagnosis in people who develop sleepiness later in life. There is a greater possibility that people with late onset of sleepiness instead suffer from a specific underlying cause: one that should be identified and managed with specific treatment. They deserve a thorough evaluation. 

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Columbus, Ohio, Central Ohio, hospitalssleep, wake, insomnia, sleepiness 

COLUMBUS COMMUNITY HEALTH
REGIONAL SLEEP DISORDERS CENTER
Accredited by the American Academy of Sleep Medicine.

Robert W. Clark, M.D., Medical Director
1430 South High Street, Columbus OH 43207

Tel: [614] 443-7800
Fax: [614] 443-6960

e-mail: flamenco@netexp.net 

 © Copyright 2006 Robert W. Clark M.D. Inc.