Evaluating the Burden, Pathophysiology, and Comorbidities Associated With Idiopathic Hypersomnia to Inform Diagnosis and Treatment
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Which of the following is best described as a temporary disorientation and decline in performance and/or mood after awakening from sleep, often with slower reaction time, poorer short-term memory, and slower speed of thinking, reasoning, remembering, and learning?

Brain fog

Sleep inertia

Cataplexy

Sleep latency

IH is caused by which of the following?

Viral or bacterial infection

Neurochemical imbalance

Neuronal degeneration

The exact cause is currently unknown

A 21-year-old college student presents with excessive daytime sleepiness for the past 3 years. He is obese, with hyperlipidemia and early-stage hypertension. He doesn’t smoke and rarely drinks alcohol. He sometimes falls asleep at work despite efforts to remain awake, and his academic performance in college is impaired due to daytime sleepiness. Naps are briefly refreshing. After arriving at a destination, he often does not recall getting there. Episodes of sleep paralysis occur ~once monthly. He reports no sleep-related hallucinations or cataplexy. What is your next step for this patient?

Exclude sleepiness secondary to medical condition and/or medication

Exclude insufficient or interrupted sleep

Objective measure of severity of Ehlers-Danlos syndrome (EDS) by polysomnogram (PSG) and multiple sleep latency test (MSLT)

Do a PSG for obstructive sleep apnea

Which of the following is most consistent with a diagnosis of idiopathic hypersomnia (IH)?

1 refreshing nap per day and sleep paralysis

Sleep inertia and unrefreshing naps

Cataplexy and sleep-related hallucinations

Disrupted sleep and MSLT >8 minutes

A 22-year-old woman complains of constant daily tiredness, which began at age 19 years. She takes 1 to 2 naps each day, has difficulty waking, and is often confused in the morning. She does not have cataplexy but has difficulty concentrating and is often inattentive during the day; she reports her job is currently in jeopardy. MSLT is consistent with IH, sleep diaries showed prolonged nocturnal sleep, a 24-hour polysomnogram confirmed 12.5 hours of sleep, and the IH severity scale score was 32 (control cutoff of 22). You confirm a diagnosis of IH. Which of the following medications would you start?

Pitolisant

Solriamfetol

Lower-sodium oxybate

Lisdexamphetamine