Excessive Daytime Sleepiness Has a Significant Detrimental Impact on Psychological, Social and Vocational Function and Personal Safety,

EXCESSIVE DAYTIME SLEEPINESS HAS A SIGNIFICANT DETRIMENTAL IMPACT ON PSYCHOLOGICAL, SOCIAL AND VOCATIONAL FUNCTION AND PERSONAL SAFETY, thus adversely affecting quality of life. Sleepiness is an important public health issue among individuals who work in fields where the lack of attention can result in injury to self or others such as transportation and healthcare. Hypersomnia of central origin is a category of disorders in which daytime sleepiness is the primary complaint, but the cause of this symptom is not due to “disturbed nocturnal sleep or misaligned circadian rhythms.”1 Narcolepsy, a disorder characterized by excessive daytime sleepiness and intermittent manifestations of REM sleep during wakefulness, is the best characterized and studied central hypersomnia. The use of stimulants for treatment of narcolepsy was the subject of an American Academy of Sleep Medicine (AASM) review paper in 1994, and formed the basis for practice parameters published by the Standards of Practice Committee (SPC) of the AASM on therapy of narcolepsy with stimulants.2,3 In 2000, the SPC published a combined review and updated practice parameters on treatment of narcolepsy that included therapies other than stimulants.4 Since the publication of the 2000 paper, there have been significant advances concerning the treatment of hypersomnia to justify a practice parameters update. In addition, since the publication of the previous practice parameters, the AASM published a revised coding manual, the International Classification of Sleep Disorders, Second Edition (ICSD-2).1 The ISCD-2 includes 12 disorders under the category of hypersomnia of central origin. This updated parameter paper and the accompanying review expanded the scope of the review and practice parameters to a subset of disorders in which the primary pathophysiology of hypersomnia is not related to sleep restriction, medication use or psychiatric disorder. For these disorders, the use of alerting medications often represent the primary mode of therapy. The specific disorders included in these practice parameters are narcolepsy (with cataplexy, without cataplexy, due to medical condition and unspecified) idiopathic hypersomnia (with long sleep time and without long sleep time), recurrent hypersomnia, and hypersomnia due to a medical condition. For the remainder of this manuscript, use of Practice Parameters for the Treatment of Narcolepsy and other Hypersomnias of Central Origin