1026 Severe Sleep Inertia Managed with Bupropion

Abstract Introduction Severe sleep inertia (SI) can often be managed with behavioral modifications and stimulants. This patient’s was resistant to such therapies but had remarkable improvement Bupropion. Report of case(s) An 11-year-old male a history seizures presented hypersomnolence, SI difficulty arousing in the morning for 3 years. There no reported cataplexy, occasional hypnogogic hallucinations paralysis. Family denied witnessed apneas or snoring. He previously undergone an adenotonsillectomy at 6 years age obstructive apnea. When initially seen, he not taking antiseizure medications, Epworth score 14 BMI 30.5 kg/m2. Polysomnogram showed AHI 1.5 events/hour REM latency 179.5 minutes. Multiple testing mean 4 minutes, 7 seconds SOREM periods: consistent narcolepsy. Melatonin methylphenidate were prescribed, followed by dextroamphetamine-amphetamine, discontinued due worsening hypersomnolence. Armodafinil improved his overall daytime sleepiness, however, severe persisted intermittently naps point EMS being called on multiple occasions. EEG brain-MRI normal. For suspected venlafaxine tried beneficial. Calcium-magnesium-potassium sodium oxybate (XW) lead SI. Therefore, Methylphenidate-20mg (MP) then Armodafinil-50mg added before bedtime, frequently missed school. Bedtime Bupropion 150 mg immediate response. has school activities Conclusion Sleep is typically characteristic idiopathic hypersomnia rather than narcolepsy related abnormal transition wakefulness resulting reduced alertness, impaired performance, desire return sleep. Such pronounced atypical caused significant quality life impairment our patient. Nighttime melatonin, XW, MP, bupropion been described literature1. Our patient failed treatments which immediately successful. Support (if any) 1. Treatment bedtime long-acting and/or series patients. Schenck, MD1 ; Golden, MD2 Millman, MD3