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Treating idiopathic hypersomnia

The diagnosis of idiopathic hypersomnia (IH) has continually evolved since its initial description as “sleep drunkenness” by Bedrich Roth in 1956.

IH is a neurological sleep disorder that affects an estimated 200,000 Americans. Symptoms typically begin in adolescence/young adulthood and manifest over weeks to months with key symptoms of difficulty staying awake/alert during the day (i.e., excessive daytime sleepiness) and falling asleep at unanticipated and inappropriate times. Patients also have trouble being roused from nighttime sleep or daytime naps and exhibit profound sleep inertia when awake. Excess sleep does not improve daytime sleepiness. Although the etiology is unknown, patients can have a family history of sleep disorders such as IH or narcolepsy. The condition severely impacts quality of life and employability, as well as posing safety risks due to impaired cognition, visual attention, and spatial memory.

What are your greatest concerns when treating IH? How do you treat IH, and what is patient response to treatment?

Jorge Osorio from Doctor Unite, Kristina Sowar Commented on a Post
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Addressing the nighttime and daytime effects of insomnia

A 56-year-old woman presents with difficulty sleeping for the past 9 months, along with complaints of daytime sleepiness and fatigue. She claims to get ~4.5 hours of sleep each night despite spending adequate time in bed and implementing recommended sleep hygiene. She reports having difficulty falling asleep and experiences nighttime/early morning awakenings with difficulty falling back to sleep.

The woman appears agitated and distressed by the sleep disturbance and says it is negatively impacting her work, home, and social life. Other than sleep disturbance, the patient is in good health, with no history of cardiometabolic disease, psychiatric illness, substance misuse, or sleep apnea. Her specialist previously prescribed zolpidem but it became less effective after a few weeks. The patient found trazadone intolerable due to excessive daytime drowsiness and impaired daytime functioning. She doesn’t want to take benzodiazepines for insomnia due to concerns about dependence.

Considering the effects of her insomnia both at nighttime and during the day, as well as previous attempts to treat the condition with other drugs, how would you treat this patient’s condition? What medication would you try next and for how long?

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  • from Doctor Unite September 28, 2022
    Consider depression, if negative psychiatric w/u , would start melatonin, consider belsomra, dayvigo
  • September 14, 2022
    thorough evaluation and review of systems for current physical and mental health symptoms. I wonder about anxiety and any recent changes/grief/loss. Also, any other changes in memory, functioning, Show More
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Interaction of sleep duration and depression on cardiovascular disease: a retrospective cohort study - BMC Public Health

Background To assess the interaction of sleep duration and depression on the risk of cardiovascular disease (CVD). Methods A total of 13,488 eligible participants were enrolled in this retrospective cohort ..... see more

Source : https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-022-14143-3


Conclusion: An interaction between short sleep duration and depression in relation to an increased risk of CVD among Chinese middle-aged and elderly individuals was noticed, which may provide a reference that people with diabetes should focus on their sleep duration and the occurrence of depression, and coexisting short sleep duration and...

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Sleep and risk of hypertension in general American adults: the National Health and Nutrition Examination Surveys (2015-2018) - PubMed

Objective: The purpose of research is to investigate the associations of sleep factors separately and jointly with risk of hypertension. Methods: The National Health and Nutrition Examination Surveys (NHANES) is ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/36129105/


Conclusion: Sleep behaviors were cross-sectionally associated with a considerably higher hypertension risk.

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Ethnic differences exist in sleepiness 3 Months after ischemic stroke

Mexican American compared to non-Hispanic white participants reported greater sleepiness 90 days after stroke. * This ethnic disparity persisted when controlling for confounding variables. * Respiratory event index measured soon ..... see more

Source : https://www.sciencedirect.com/science/article/abs/pii/S1389945722011224?via=ihub


Relevance: To examine the association between ethnicity and 90-day post-stroke subjective sleepiness, an important determinant of quality of life, as measured by the Epworth Sleepiness Scale (ESS), among ischemic stroke survivors.

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Long-Term Outcome of a Series of Patients With Narcolepsy Type 1 and Comorbidity With Immunopathological and Autoimmune Diseases | Martinez-Orozco | Journal of Clinical Medicine Research

Francisco J. Martinez-Orozco, Miguel Fernandez-Arquero, Jose L. Vicario, Laura Lillo-Triguero, Elena Ameyugo, Rosa Peraita-Adrados Abstract Background: The aim of this study was to evaluate the long-term outcome of our series ..... see more

Source : https://www.jocmr.org/index.php/JOCMR/article/view/4758


Conclusions: The prevalence of AD/ID is high in our series, suggesting that NT1 might arise on a background of generalized susceptibility to immune-mediated processes. The occurrence of an ID can in turn influence the development of others in genetically predisposed individuals, which explains the increased associations observed in this...

Efficacy and Safety of Daridorexant in Older and Younger Adults with Insomnia Disorder: A Secondary Analysis of a Randomised Placebo-Controlled Trial - PubMed

doi: 10.1007/s40266-022-00977-4. Online ahead of print. 1 Center for Sleep Medicine, Charité, University Hospital Berlin, Berlin, Germany. 2 Department of Medicine, The Fourth People's Hospital of Guangyuan City, Guangyuan, China. ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/36098936/


Conclusions: In older patients with insomnia, as in younger patients, the efficacy of daridorexant is maximal on night-time and daytime variables at the higher dose of 50 mg. Older patients particularly require this dose to improve daytime functioning. Older patients are not at an increased risk of adverse events or residual effects the next...

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  • September 20, 2022
    Key Points • Source: Drugs & Aging • Conclusion: “In older patients with insomnia, as in younger patients, the efficacy of daridorexant is maximal on night-time and daytime variables at the higher dose of Show More
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Danavorexton, a selective orexin 2 receptor agonist, provides a symptomatic improvement in a narcolepsy mouse model

Danavorexton shows rapid association and dissociation kinetics to OX2R. * Activation mode of endogenous OX2R by danavorexton is similar to that by orexin peptide. * Danavorexton can induce cortical arousal ..... see more

Source : https://www.sciencedirect.com/science/article/pii/S0091305722001435?via=ihub


Conclusion/Relevance: These preclinical findings, together with upcoming clinical observations of danavorexton, could improve our understanding of the pathophysiology of NT1 and therapeutic potential of OX2R agonists.

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Conclusions: The sleep disorders were prevalent among the dental students due to the great amount of stress caused in the study. They should be educated about the stress management methods and importance of sleep.

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Solriamfetol treatment of excessive daytime sleepiness in participants with narcolepsy or obstructive sleep apnea with a history of depression

Solriamfetol treatment outcomes were analyzed according to depression history. * Depression history was prevalent in people with narcolepsy/obstructive sleep apnea. * Solriamfetol improved excessive daytime sleepiness regardless of depression history. ..... see more

Source : https://www.sciencedirect.com/science/article/abs/pii/S002239562200471X?via=ihub


Conclusions: Civilian sleep specialists were twice as likely to diagnose central disorders of hypersomnolence compared to military specialists. Raising awareness about this discrepancy is critical given the occupational and patient care-related implications of misdiagnoses.

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Central disorders of hypersomnolence: diagnostic discrepancies between military and civilian sleep centers - PubMed

doi: 10.5664/jcsm.10144. Online ahead of print. 1 Sleep Disorders Center, Walter Reed National Military Medical Center, Bethesda, MD. 2 Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35855527/


Conclusions: Civilian sleep specialists were twice as likely to diagnose central disorders of hypersomnolence compared to military specialists. Raising awareness about this discrepancy is critical given the occupational and patient care-related implications of misdiagnoses.

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Idiopathic Hypersomnia-A Dynamic Simulation Model

Aims of the study:Commonly used approach to illness assessment focuses on the patient's actual state supplemented by binary records of past events and conditions. This research project was designed to ..... see more

Source : https://www.frontiersin.org/articles/10.3389/fneur.2022.902637/full


Conclusion: Even the simplified dynamic structure designed by the research team reflects the real-life events in patients with IH at the acceptable level of 76.1% and suggests that a similar structure plays an important role in the course of the disease. Therapeutic focus on the parameters identified by the model should enhance the patients'...

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COVID-19 and Central Nervous System Hypersomnias - Current Sleep Medicine Reports

Purpose of review Central nervous system (CNS) hypersomnias can be triggered by external factors, such as infection or as a response to vaccination. The 2019 coronavirus disease (COVID-19) pandemic, which ..... see more

Source : https://link.springer.com/article/10.1007/s40675-022-00226-5


Summary:The hypothesis that there is a pathophysiological mechanism by which the virus, vaccination, and the effects of quarantine aggravate hypersomnias is discussed in this review.

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Orexin 2 receptor-selective agonist danavorexton improves narcolepsy phenotype in a mouse model and in human patients

Proc Natl Acad Sci U S A. 2022 Aug 30; 119(35): e2207531119. Rebecca Evans, a , 1 , 2 Haruhide Kimura, b , 1 Robert Alexander, a , 2 Ceri ..... see more

Source : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9436334/


Relevance: Narcolepsy type 1 (NT1) is a sleep disorder caused by a loss of orexinergic neurons. Narcolepsy type 2 (NT2) is heterogeneous; affected individuals typically have normal orexin levels. Following evaluation in mice, the effects of the orexin 2 receptor (OX2R)-selective agonist danavorexton were evaluated in single- and...

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  • from Doctor Unite September 12, 2022
    Polypharmacy is often needed to address the various symptoms of NT1, but no current treatments directly address the loss of orexin
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Pediatric Narcolepsy-A Practical Review - PubMed

Pediatric narcolepsy is a chronic sleep-wakefulness disorder. Its symptoms frequently begin in childhood. This review article examined the literature for research reporting on the effects of treatment of pediatric narcolepsy, ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/35883958/


Conclusion/Relevance: Pharmacological treatment including some promising newly-developed medication can decrease cataplexy and daytime sleepiness in children with narcolepsy. Other forms of management such as psychosocial interventions involve close cooperation between children, school, family, medical personnel, and can further assist their...

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Retrospective cohort study of hypersomnias of central origin from two Australian tertiary sleep disorders services - PubMed

doi: 10.1111/imj.15920. Online ahead of print. 1 Woolcock Institute of Medical Research, Sydney, NSW, Australia. 2 Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia. 3 ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/36043439/


Conclusions: Patients with hypersomnias of central origin assessed in 2 specialised Australian clinics demonstrate comparable clinical characteristics to other published cohorts internationally, however available pharmacological agents in Australia do not reflect international standards of care.

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What Works for One May Not Work for Another: A New Warning for Modafinil

Narcolepsy is a clinical syndrome of hypothalamic disorder characterized by several sleep-wake disorders. The most common features include daytime sleepiness associated with hallucinations (hypnagogic and hypnopompic hallucinations) at the transition ..... see more

Source : https://www.cureus.com/articles/106374-what-works-for-one-may-not-work-for-another-a-new-warning-for-modafinil


Relevance: Narcolepsy is a clinical syndrome of hypothalamic disorder characterized by several sleep-wake disorders. The most common features include daytime sleepiness associated with hallucinations (hypnagogic and hypnopompic hallucinations) at the transition time of sleep-wake time, cataplexy or sudden loss of muscle tone, and sleep...

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Comparative efficacy and acceptability of psychotherapies, pharmacotherapies, and their combination for the treatment of adult insomnia: A systematic review and network meta-analysis

This study aims to explore the comparative efficacy and acceptability of psychotherapies, pharmacotherapies, and their combinations for insomnia. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, and ClinicalTrials.gov ..... see more

Source : https://www.sciencedirect.com/science/article/abs/pii/S1087079222001009?via=ihub

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Relevance: This study aims to explore the comparative efficacy and acceptability of psychotherapies, pharmacotherapies, and their combinations for insomnia.

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Quality of life changes and their predictors in young adult narcolepsy patients after treatment: A real-world cohort study

BackgroundWe conducted a five-year prospective follow-up study to track the real-world quality of life of patients with narcolepsy after medication and analyzed predictors.MethodsThe study ultimately included 157 participants who completed ..... see more

Source : https://www.frontiersin.org/articles/10.3389/fpsyt.2022.956037/full


Conclusion: Symptom control greatly associates with the quality of life in narcoleptic patients, and medication can play the most important role. Management targeting narcoleptic symptoms, attention impairment, and drug adherence should be provided.