Treatment of hypersomnia

Central nervous system (CNS) hypersomnia disorders such as narcolepsy and idiopathic hypersomnia significantly impair quality of life and lead to safety risks in driving and occupational abilities. Effectively and tolerably counteracting hypersomnia symptoms is thus a critical public health mandate. Pharmacological treatment with stimulants remains the mainstay of care for CNS hypersomnia patients. Traditional sympathomimetic stimulants including methylphenidate and amphetamines remain the most effective and commonly used options for most patients, although the advent of the nonsympathomimetic stimulant agents modafinil and armodafinil has provided effective yet safer and more tolerable treatment options for many narcolepsy patients. Anticataplectic treatments for narcolepsy patients include tricyclic and selective serotonin reuptake inhibitor antidepressants and sodium oxybate, the sodium salt of γ-hydroxybutyrate. Important adjunctive treatments for hypersomnia include caffeine and several nonpharmacologic measures such as prescribed napping, sleep hygiene education, relaxation training, cognitive behavioral therapy, and bright light therapy. Effective and tolerable treatment strategies for hypersomnia patients first requires an accurate diagnosis of the underlying cause or causes, expert knowledge of the complex clinical pharmacology of available stimulant and anticataplectic treatments, and familiarity with nonpharmacologic options with tailoring of the most appropriate combination of treatments to the individual patient.