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class="vector-toc-list"> <li id="toc-Stimulants" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Stimulants"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Stimulants</span> </div> </a> <ul id="toc-Stimulants-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Sleep_promoting_medications" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Sleep_promoting_medications"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2</span> <span>Sleep promoting medications</span> </div> </a> <ul id="toc-Sleep_promoting_medications-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Cognitive_Behavioral_Therapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Cognitive_Behavioral_Therapy"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.3</span> <span>Cognitive Behavioral Therapy</span> </div> </a> <ul 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<button aria-controls="toc-Research-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Research subsection</span> </button> <ul id="toc-Research-sublist" class="vector-toc-list"> <li id="toc-GABA-directed_medications" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#GABA-directed_medications"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.1</span> <span>GABA-directed medications</span> </div> </a> <ul id="toc-GABA-directed_medications-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Transcranial_direct-current_stimulation_(tDCS)" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Transcranial_direct-current_stimulation_(tDCS)"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.2</span> <span>Transcranial direct-current stimulation (tDCS)</span> </div> </a> <ul id="toc-Transcranial_direct-current_stimulation_(tDCS)-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Transcranial_magnetic_stimulation_(TMS)" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Transcranial_magnetic_stimulation_(TMS)"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.3</span> <span>Transcranial magnetic stimulation (TMS)</span> </div> </a> <ul id="toc-Transcranial_magnetic_stimulation_(TMS)-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Mazindol" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Mazindol"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.4</span> <span>Mazindol</span> </div> </a> <ul id="toc-Mazindol-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Selegiline" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Selegiline"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.5</span> <span>Selegiline</span> </div> </a> <ul id="toc-Selegiline-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Atomoxetine" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Atomoxetine"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.6</span> <span>Atomoxetine</span> </div> </a> <ul id="toc-Atomoxetine-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Ritanserin" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Ritanserin"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.7</span> <span>Ritanserin</span> </div> </a> <ul id="toc-Ritanserin-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Antidepressants" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Antidepressants"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.8</span> <span>Antidepressants</span> </div> </a> <ul id="toc-Antidepressants-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Caffeine" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Caffeine"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.9</span> <span>Caffeine</span> </div> </a> <ul id="toc-Caffeine-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Melatonin" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Melatonin"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.10</span> <span>Melatonin</span> </div> </a> <ul id="toc-Melatonin-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Levothyroxine" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Levothyroxine"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.11</span> <span>Levothyroxine</span> </div> </a> <ul id="toc-Levothyroxine-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Orexin_agonists" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Orexin_agonists"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.12</span> <span>Orexin agonists</span> </div> </a> <ul id="toc-Orexin_agonists-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Levodopa" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Levodopa"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.13</span> <span>Levodopa</span> </div> </a> <ul id="toc-Levodopa-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Carnitine" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Carnitine"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.14</span> <span>Carnitine</span> </div> </a> <ul id="toc-Carnitine-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">10</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> 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class="firstHeading mw-first-heading"><span class="mw-page-title-main">Idiopathic hypersomnia</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. 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class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-de mw-list-item"><a href="https://de.wikipedia.org/wiki/Idiopathische_Hypersomnie" title="Idiopathische Hypersomnie – German" lang="de" hreflang="de" data-title="Idiopathische Hypersomnie" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%ED%8A%B9%EB%B0%9C%EC%84%B1_%EA%B3%BC%EB%8B%A4%EC%88%98%EB%A9%B4" title="특발성 과다수면 – Korean" lang="ko" hreflang="ko" data-title="특발성 과다수면" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Ipersonnia_idiopatica" title="Ipersonnia idiopatica – Italian" lang="it" hreflang="it" data-title="Ipersonnia idiopatica" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%94%D7%99%D7%A4%D7%A8%D7%A1%D7%95%D7%9E%D7%A0%D7%99%D7%94_%D7%90%D7%99%D7%93%D7%99%D7%95%D7%A4%D7%AA%D7%99%D7%AA" title="היפרסומניה אידיופתית – Hebrew" lang="he" hreflang="he" data-title="היפרסומניה אידיופתית" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E7%89%B9%E7%99%BA%E6%80%A7%E9%81%8E%E7%9C%A0%E7%97%87" title="特発性過眠症 – Japanese" lang="ja" hreflang="ja" data-title="特発性過眠症" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/Hipersomnia_idiopatyczna" title="Hipersomnia idiopatyczna – Polish" lang="pl" hreflang="pl" data-title="Hipersomnia idiopatyczna" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Hipersonia_idiop%C3%A1tica" title="Hipersonia idiopática – Portuguese" lang="pt" hreflang="pt" data-title="Hipersonia idiopática" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%98%D0%B4%D0%B8%D0%BE%D0%BF%D0%B0%D1%82%D0%B8%D1%87%D0%B5%D1%81%D0%BA%D0%B0%D1%8F_%D0%B3%D0%B8%D0%BF%D0%B5%D1%80%D1%81%D0%BE%D0%BC%D0%BD%D0%B8%D1%8F" title="Идиопатическая гиперсомния – Russian" lang="ru" hreflang="ru" data-title="Идиопатическая гиперсомния" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a href="https://zh.wikipedia.org/wiki/%E7%89%B9%E5%8F%91%E6%80%A7%E5%97%9C%E7%9D%A1%E7%97%87" title="特发性嗜睡症 – Chinese" lang="zh" hreflang="zh" data-title="特发性嗜睡症" data-language-autonym="中文" data-language-local-name="Chinese" class="interlanguage-link-target"><span>中文</span></a></li> </ul> <div class="after-portlet after-portlet-lang"><span class="wb-langlinks-edit wb-langlinks-link"><a href="https://www.wikidata.org/wiki/Special:EntityPage/Q2730080#sitelinks-wikipedia" title="Edit interlanguage links" class="wbc-editpage">Edit links</a></span></div> </div> </div> </div> </header> <div class="vector-page-toolbar"> <div class="vector-page-toolbar-container"> <div id="left-navigation"> <nav aria-label="Namespaces"> <div id="p-associated-pages" class="vector-menu vector-menu-tabs mw-portlet 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data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Idiopathic hypersomnia</th></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Sleep_medicine" title="Sleep medicine">Sleep medicine</a>, <a href="/wiki/Neurology" title="Neurology">Neurology</a>, <a href="/wiki/Psychiatry" title="Psychiatry">Psychiatry</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data"><a href="/wiki/Hypersomnia" title="Hypersomnia">Difficulty staying awake</a>, <a href="/wiki/Mental_fog" class="mw-redirect" title="Mental fog">mental fog</a>, <a href="/wiki/Excessive_daytime_sleepiness" title="Excessive daytime sleepiness">persistent sleepiness</a></td></tr></tbody></table> <p><b>Idiopathic hypersomnia</b> <b>(IH)</b> is a <a href="/wiki/Neurological_disorder" title="Neurological disorder">neurological disorder</a> which is characterized primarily by <a href="/wiki/Hypersomnia" title="Hypersomnia">excessive sleep</a> and <a href="/wiki/Excessive_daytime_sleepiness" title="Excessive daytime sleepiness">excessive daytime sleepiness</a> (EDS).<sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Idiopathic hypersomnia was first described by Bedrich Roth in 1976, and it can be divided into two forms: polysymptomatic and monosymptomatic.<sup id="cite_ref-2" class="reference"><a href="#cite_note-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> The condition typically becomes evident in early adulthood and most patients diagnosed with IH will have had the disorder for many years prior to their diagnosis.<sup id="cite_ref-ref-3_4-0" class="reference"><a href="#cite_note-ref-3-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> As of August 2021<sup class="plainlinks noexcerpt noprint asof-tag update" style="display:none;"><a class="external text" href="https://en.wikipedia.org/w/index.php?title=Idiopathic_hypersomnia&action=edit">[update]</a></sup>, an <a href="/wiki/Food_and_Drug_Administration" title="Food and Drug Administration">FDA</a>-approved medication exists for IH called <a href="/wiki/Xywav" title="Xywav">Xywav</a>, which is an oral solution of <a href="/w/index.php?title=Calcium_oxybate&action=edit&redlink=1" class="new" title="Calcium oxybate (page does not exist)">calcium</a>, <a href="/w/index.php?title=Magnesium_oxybate&action=edit&redlink=1" class="new" title="Magnesium oxybate (page does not exist)">magnesium</a>, <a href="/wiki/%CE%93-Hydroxybutyric_acid" title="Γ-Hydroxybutyric acid">potassium</a>, and <a href="/wiki/Sodium_oxybate" title="Sodium oxybate">sodium oxybates</a>;<sup id="cite_ref-fdaref_5-0" class="reference"><a href="#cite_note-fdaref-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> in addition to several off-label treatments (primarily FDA-approved narcolepsy medications).<sup id="cite_ref-ref-5_6-0" class="reference"><a href="#cite_note-ref-5-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p><p>Idiopathic hypersomnia may also be referred to as IH, IHS, or primary hypersomnia,<sup id="cite_ref-rareref_7-0" class="reference"><a href="#cite_note-rareref-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> and belongs to a group of <a href="/wiki/Sleep_disorder" title="Sleep disorder">sleep disorders</a> known as central hypersomnias, central disorders of hypersomnolence, or <a href="/wiki/Hypersomnia" title="Hypersomnia">hypersomnia</a> of brain origin.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> <i><a href="/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders" title="Diagnostic and Statistical Manual of Mental Disorders">Diagnostic and Statistical Manual of Mental Disorders</a></i>, Fourth Edition (DSM-IV) defines idiopathic hypersomnia as <a href="/wiki/Excessive_daytime_sleepiness" title="Excessive daytime sleepiness">EDS</a> without <a href="/wiki/Narcolepsy" title="Narcolepsy">narcolepsy</a> or the associated features of other <a href="/wiki/Sleep_disorder" title="Sleep disorder">sleep disorders</a>.<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> It occurs in the absence of medical problems or sleep disruptions, such as <a href="/wiki/Sleep_apnea" title="Sleep apnea">sleep apnea</a>, that can cause secondary <a href="/wiki/Hypersomnia" title="Hypersomnia">hypersomnia</a>. </p> <style data-mw-deduplicate="TemplateStyles:r886046785">.mw-parser-output .toclimit-2 .toclevel-1 ul,.mw-parser-output .toclimit-3 .toclevel-2 ul,.mw-parser-output .toclimit-4 .toclevel-3 ul,.mw-parser-output .toclimit-5 .toclevel-4 ul,.mw-parser-output .toclimit-6 .toclevel-5 ul,.mw-parser-output .toclimit-7 .toclevel-6 ul{display:none}</style><div class="toclimit-3"><meta property="mw:PageProp/toc" /></div> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1251242444">.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}</style><table class="box-More_citations_needed_section plainlinks metadata ambox ambox-content ambox-Refimprove" role="presentation"><tbody><tr><td class="mbox-image"><div class="mbox-image-div"><span typeof="mw:File"><a href="/wiki/File:Question_book-new.svg" class="mw-file-description"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/50px-Question_book-new.svg.png" decoding="async" width="50" height="39" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/75px-Question_book-new.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/9/99/Question_book-new.svg/100px-Question_book-new.svg.png 2x" data-file-width="512" data-file-height="399" /></a></span></div></td><td class="mbox-text"><div class="mbox-text-span">This section <b>needs additional citations for <a href="/wiki/Wikipedia:Verifiability" title="Wikipedia:Verifiability">verification</a></b>.<span class="hide-when-compact"> Please help <a href="/wiki/Special:EditPage/Idiopathic_hypersomnia" title="Special:EditPage/Idiopathic hypersomnia">improve this article</a> by <a href="/wiki/Help:Referencing_for_beginners" title="Help:Referencing for beginners">adding citations to reliable sources</a> in this section. Unsourced material may be challenged and removed.</span> <span class="date-container"><i>(<span class="date">June 2021</span>)</i></span><span class="hide-when-compact"><i> (<small><a href="/wiki/Help:Maintenance_template_removal" title="Help:Maintenance template removal">Learn how and when to remove this message</a></small>)</i></span></div></td></tr></tbody></table> <p>Individuals with IH share common symptoms including <a href="/wiki/Excessive_daytime_sleepiness" title="Excessive daytime sleepiness">excessive daytime sleepiness</a>, <a href="/wiki/Sleep_inertia" title="Sleep inertia">sleep inertia</a>, <a href="/wiki/Clouding_of_consciousness" title="Clouding of consciousness">brain fog</a>, and long sleep periods.<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> </p> <ul><li><a href="/wiki/Excessive_daytime_sleepiness" title="Excessive daytime sleepiness">Excessive daytime sleepiness</a>, characterized by persistent sleepiness throughout the day and often a general lack of energy, even during the day after apparently adequate or even prolonged nighttime sleep. People with EDS nap repeatedly throughout the day and have strong urges to sleep while driving, working, eating, or conversing with others.<sup id="cite_ref-moawad_13-0" class="reference"><a href="#cite_note-moawad-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Sleep_inertia" title="Sleep inertia">Sleep inertia</a> (also known as sleep drunkenness), characterized by having extreme difficulty waking up and feeling an uncontrollable desire to go back to sleep.<sup id="cite_ref-moawad_13-1" class="reference"><a href="#cite_note-moawad-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Clouding_of_consciousness" title="Clouding of consciousness">Clouding of consciousness</a> characterized by inattention, thought process abnormalities, comprehension abnormalities, and language abnormalities. These symptoms may affect performance on perception, memory, learning, executive functions, language, constructive abilities, voluntary motor control, attention, and mental speed. Affected individuals can complain of forgetfulness, confusion, or inability to think clearly.<sup id="cite_ref-JohnNoble_14-0" class="reference"><a href="#cite_note-JohnNoble-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup></li> <li>Excessive sleep (9 hours or more over a full 24-hour period), without feeling refreshed after waking. Daytime naps can be up to several hours and are also unrefreshing.<sup id="cite_ref-moawad_13-2" class="reference"><a href="#cite_note-moawad-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup></li></ul> <p>Some studies have shown increased frequencies of palpitations, digestive problems, difficulty with body temperature regulation, and other symptoms in patients with IH.<sup id="cite_ref-1997_Bassetti_15-0" class="reference"><a href="#cite_note-1997_Bassetti-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-ref-orig-7_16-0" class="reference"><a href="#cite_note-ref-orig-7-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> Anxiety and depression are frequent, and are likely to be a response to chronic illness.<sup id="cite_ref-1997_Bassetti_15-1" class="reference"><a href="#cite_note-1997_Bassetti-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> A case series in 2010 found that peripheral vascular symptoms, such as cold hands and feet (e.g., <a href="/wiki/Raynauds" class="mw-redirect" title="Raynauds">Raynaud syndrome</a>), were more common in people with IH than in controls.<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> </p><p>Other <a href="/wiki/Autonomic_dysfunction" class="mw-redirect" title="Autonomic dysfunction">autonomic dysfunctional</a> symptoms, such as <a href="/wiki/Syncope_(medicine)" title="Syncope (medicine)">fainting episodes</a>, <a href="/wiki/Orthostatic_hypotension" title="Orthostatic hypotension">dizziness upon arising</a>, possibly <a href="/wiki/Migraine" title="Migraine">migrainous</a> headaches, food cravings, and <a href="/wiki/Impotence" class="mw-redirect" title="Impotence">impotence</a> may also be correlated with IH.<sup id="cite_ref-ref-orig-7_16-1" class="reference"><a href="#cite_note-ref-orig-7-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-2001_Billiard_18-0" class="reference"><a href="#cite_note-2001_Billiard-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> Researchers have found that people reporting IH symptoms report high levels of autonomic dysfunction on par with other conditions of autonomic failure (i.e., <a href="/wiki/Multiple_system_atrophy" title="Multiple system atrophy">MSA</a> and <a href="/wiki/Diabetes" title="Diabetes">diabetes</a>). As of 2019<sup class="plainlinks noexcerpt noprint asof-tag update" style="display:none;"><a class="external text" href="https://en.wikipedia.org/w/index.php?title=Idiopathic_hypersomnia&action=edit">[update]</a></sup> there is no evidence that such symptoms are related to IH.<sup id="cite_ref-19" class="reference"><a href="#cite_note-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Causes">Causes</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=2" title="Edit section: Causes"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Unlike <a href="/wiki/Narcolepsy" title="Narcolepsy">narcolepsy</a> with <a href="/wiki/Cataplexy" title="Cataplexy">cataplexy</a>, which has a known cause (<a href="/wiki/Autoimmune" class="mw-redirect" title="Autoimmune">autoimmune</a> destruction of hypocretin-producing neurons), the cause of IH is largely unknown. As of 2012<sup class="plainlinks noexcerpt noprint asof-tag update" style="display:none;"><a class="external text" href="https://en.wikipedia.org/w/index.php?title=Idiopathic_hypersomnia&action=edit">[update]</a></sup>, researchers have identified a few abnormalities associated with IH, which with further study may help to clarify the etiology.<sup id="cite_ref-2012_Mignot_20-0" class="reference"><a href="#cite_note-2012_Mignot-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p><p>Destruction of <a href="/wiki/Noradrenergic" class="mw-redirect" title="Noradrenergic">noradrenergic neurons</a> has produced hypersomnia in experimental animal studies, and injury to <a href="/wiki/Adrenergic" title="Adrenergic">adrenergic</a> neurons has also been shown to lead to hypersomnia. IH has also been associated with a malfunction of the <a href="/wiki/Norepinephrine" title="Norepinephrine">norepinephrine</a> system and decreased <a href="/wiki/Cerebrospinal_fluid" title="Cerebrospinal fluid">cerebrospinal fluid</a> (CSF) <a href="/wiki/Histamine" title="Histamine">histamine</a> levels.<sup id="cite_ref-emed_overview_1_21-0" class="reference"><a href="#cite_note-emed_overview_1-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> </p><p>Researchers have recently found an abnormal hypersensitivity to <a href="/wiki/GABA" title="GABA">GABA</a> (the major brain chemical responsible for <a href="/wiki/Sedation" title="Sedation">sedation</a>) in a subset of patients with central hypersomnia i.e.: IH, narcolepsy without cataplexy and long sleepers. They have identified a small (500 to 3000 <a href="/wiki/Dalton_(unit)" title="Dalton (unit)">daltons</a>) naturally occurring bioactive substance (most likely a <a href="/wiki/Peptide" title="Peptide">peptide</a> as it is <a href="/wiki/Trypsin" title="Trypsin">trypsin</a>-sensitive) in the CSF of affected patients. Although this substance requires further identification of its chemical structure, it is currently referred to as a "somnogen" because it has been shown to cause hyper-reactivity of <a href="/wiki/GABA-A_receptors" class="mw-redirect" title="GABA-A receptors">GABA<sub>A</sub> receptors</a>, which leads to increased sedation or somnolence. In essence, it is as though these patients are chronically sedated with a <a href="/wiki/Benzodiazepine" title="Benzodiazepine">benzodiazepine</a> (medication which acts through the GABA system) such as <a href="/wiki/Midazolam" title="Midazolam">midazolam</a> or <a href="/wiki/Alprazolam" title="Alprazolam">alprazolam</a>, even though they do not take these medications.<sup id="cite_ref-clinicaltrials.gov_Flumazenil_22-0" class="reference"><a href="#cite_note-clinicaltrials.gov_Flumazenil-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Clarithro_Trial_23-0" class="reference"><a href="#cite_note-Clarithro_Trial-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=3" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Idiopathic hypersomnia lacks a clearly defining biological marker (i.e., <a href="/wiki/HLA-DQB1" title="HLA-DQB1">HLA-DQB1</a>*0602 <a href="/wiki/Genotype" title="Genotype">genotype</a> in narcolepsy). Doctors can more carefully exclude these causes of EDS in order to more correctly diagnose IH.<sup id="cite_ref-2001_Billiard_18-1" class="reference"><a href="#cite_note-2001_Billiard-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> However, "even in the presence of other specific causes of hypersomnia, one should carefully assess the contribution of these etiological factors to the complaint of EDS and when specific treatments of these conditions fail to suppress EDS, the additional diagnosis of IH should be considered."<sup id="cite_ref-2001_Montplaisir_24-0" class="reference"><a href="#cite_note-2001_Montplaisir-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> </p><p>The severity of EDS can be quantified by subjective scales, such as the <a href="/wiki/Epworth_Sleepiness_Scale" title="Epworth Sleepiness Scale">Epworth Sleepiness Scale</a> and the <a href="/wiki/Stanford_Sleepiness_Scale" title="Stanford Sleepiness Scale">Stanford Sleepiness Scale</a>, and also by objective tests, like <a href="/wiki/Actigraphy" title="Actigraphy">actigraphy</a>, <a href="/wiki/Psychomotor_vigilance_task" title="Psychomotor vigilance task">psychomotor vigilance task</a>, maintenance of wakefulness test (MWT),<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Multiple_sleep_latency_test" class="mw-redirect" title="Multiple sleep latency test">multiple sleep latency test</a> (MSLT) although as per latest research studies, the effectiveness of MSLT has been called into question.<sup id="cite_ref-ref-1_26-0" class="reference"><a href="#cite_note-ref-1-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> Several groups of researchers have found normal MSLT results in patients who otherwise seem to have IH. Therefore, when IH is suspected, researchers suggest appending a 24-hour continuous <a href="/wiki/Polysomnography" title="Polysomnography">polysomnography</a> to the standard overnight/MSLT study in order to record total sleep time.<sup id="cite_ref-ref-orig-8_28-0" class="reference"><a href="#cite_note-ref-orig-8-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p><p>The recent studies have also found that reports of sleepiness in IH relate more to mental fatigue rather than physiological sleepiness per se and the subjective scales like ESS, IH symptom diary (IHSD) and PGIC better captures the severity of symptoms consistently.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> </p><p>It is also important to note that whereas narcolepsy is strongly associated with the <a href="/wiki/HLA-DQB1" title="HLA-DQB1">HLA-DQB1</a>*0602 <a href="/wiki/Genotype" title="Genotype">genotype</a>,<sup id="cite_ref-2012_Mignot_20-1" class="reference"><a href="#cite_note-2012_Mignot-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> "HLA typing is of no help in the positive diagnosis of idiopathic hypersomnia."<sup id="cite_ref-2001_Billiard_18-2" class="reference"><a href="#cite_note-2001_Billiard-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> This is "despite some reports that suggest an increase [<i>sic</i>] frequency of HLA Cw2 and DRS in idiopathic hypersomnia subjects."<sup id="cite_ref-2001_Billiard_18-3" class="reference"><a href="#cite_note-2001_Billiard-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p><p>In patients with IH, polysomnography typically shows short sleep latency, increased mean slow wave sleep, and a high mean sleep efficiency. "Latency to REM sleep and percentages of light sleep and REM sleep were normal, compared with normal ranges."<sup id="cite_ref-2007_Anderson_30-0" class="reference"><a href="#cite_note-2007_Anderson-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> Despite this, one study has found increased sleep fragmentation in patients with IH without long sleep time, suggesting multiple possible presentations.<sup id="cite_ref-2012_Pizza_31-0" class="reference"><a href="#cite_note-2012_Pizza-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> </p><p>Per <a href="/wiki/International_Classification_of_Sleep_Disorders#ICSD-3_(2014)" title="International Classification of Sleep Disorders">ICSD-3</a>, five criteria<sup class="noprint Inline-Template" style="margin-left:0.1em; white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Please_clarify" title="Wikipedia:Please clarify"><span title="There are only five reasons listed, but the text indicates there are six criteria necessary for a positive diagnosis. MSLTs are both the 5th and 6th criteria, which makes no sense. (June 2021)">clarification needed</span></a></i>]</sup> must be met for a diagnosis of IH: </p> <ol><li>Daytime lapses into sleep or an irrepressible need to sleep on a daily basis, for at least 3 months</li> <li>Absence of insufficient sleep syndrome</li> <li>Absence of cataplexy</li> <li>Absence of other causes of hypersomnia</li> <li>The presence of positive MSLT tests.<sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup></li></ol> <p>The latest <a href="/wiki/ICD-10" title="ICD-10">ICD-10</a> defines IH with long sleep time as a neurological disorder that is a rare sleep disorder characterized by prolonged sleep at night and extreme sleepiness during the day. There are no apparent causes. This disorder affects the ability to function. It is of <a href="/wiki/Central_nervous_system" title="Central nervous system">central nervous system</a> origin characterized by prolonged nocturnal sleep and periods of daytime drowsiness. Affected individuals experience difficulty with awakening in the morning and may have associated sleep drunkenness, automatic behaviors, and memory disturbances. This condition differs from narcolepsy in that daytime sleep periods are longer, there is no association with cataplexy, and the multiple sleep latency onset test does not record sleep-onset rapid eye movement sleep.<sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Management">Management</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=4" title="Edit section: Management"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Since the underlying mechanism is not yet fully understood, treatment efforts have usually focused on symptom management. In August 2021, low-sodium oxybate (Xywav) became the first U.S. FDA-approved treatment for idiopathic hypersomnia.<sup id="cite_ref-fdaref_5-1" class="reference"><a href="#cite_note-fdaref-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Wake-promoting_medications" class="mw-redirect" title="Wake-promoting medications">Wake-promoting medications</a> used in narcolepsy are also commonly used <a href="/wiki/Off-label" class="mw-redirect" title="Off-label">off-label</a> to help manage the excessive daytime sleepiness of IH. <a href="/wiki/Stimulant" title="Stimulant">Stimulants</a> tend to be less effective for IH than they are for narcolepsy and may be less well tolerated.<sup id="cite_ref-ref-orig-8_28-1" class="reference"><a href="#cite_note-ref-orig-8-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Stimulants">Stimulants</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=5" title="Edit section: Stimulants"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The main treatment of excessive daytime sleepiness is done through central nervous system stimulants. </p><p><a href="/wiki/Methylphenidate" title="Methylphenidate">Methylphenidate</a> and <a href="/wiki/Dextroamphetamine" title="Dextroamphetamine">dextroamphetamine</a> are most used stimulants to controlled EDS. Increased dopamine release is felt to be the main property explaining wake-promotion from these medications.<sup id="cite_ref-2012_Mignot_20-2" class="reference"><a href="#cite_note-2012_Mignot-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Insomnia" title="Insomnia">Insomnia</a> is another common side effect and may require additional treatment.<sup id="cite_ref-epocrates_adderall_36-0" class="reference"><a href="#cite_note-epocrates_adderall-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Solriamfetol" title="Solriamfetol">Solriamfetol</a> is a dopamine and norepinephrine reuptake inhibitor (NDRI) used to treat excessive daytime sleepiness associated with narcolepsy and obstructive sleep apnea.<sup id="cite_ref-37" class="reference"><a href="#cite_note-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Pitolisant" title="Pitolisant">Pitolisant</a>, a selective histamine 3 (H3) receptor antagonist/inverse agonist, was approved by FDA during August 2019. It works by increasing the synthesis and release of histamine, a wake-promoting neurotransmitter in the brain. </p><p><a href="/wiki/Modafinil" title="Modafinil">Modafinil</a> and <a href="/wiki/Armodafinil" title="Armodafinil">Armodafinil</a> elevate <a href="/wiki/Hypothalamic" class="mw-redirect" title="Hypothalamic">hypothalamic</a> <a href="/wiki/Histamine" title="Histamine">histamine</a> levels,<sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> and they are known to bind to the dopamine transporter, thereby inhibiting dopamine reuptake. Modafinil can cause uncomfortable side effects, including <a href="/wiki/Nausea" title="Nausea">nausea</a>, <a href="/wiki/Headache" title="Headache">headache</a>, and a <a href="/wiki/Dry_mouth" class="mw-redirect" title="Dry mouth">dry mouth</a> for some patients, while other patients report no noticeable improvement even on relatively high dosages.<sup id="cite_ref-epocrates_provigil_39-0" class="reference"><a href="#cite_note-epocrates_provigil-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> They may also "interact with low-dose contraceptives, potentially reducing efficacy, although the scientific data supporting this claim is weak and rests on poorly documented anecdotes."<sup id="cite_ref-2012_Mignot_20-3" class="reference"><a href="#cite_note-2012_Mignot-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Sleep_promoting_medications">Sleep promoting medications</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=6" title="Edit section: Sleep promoting medications"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Sodium_oxybate" title="Sodium oxybate">Sodium oxybate</a> (Xyrem) is an <a href="/wiki/Orphan_drug" title="Orphan drug">orphan drug</a> which was designed specifically for the treatment of narcolepsy. Common side effects include <a href="/wiki/Nausea" title="Nausea">nausea</a>, <a href="/wiki/Dizziness" title="Dizziness">dizziness</a>, and <a href="/wiki/Hallucination" title="Hallucination">hallucinations</a>.<sup id="cite_ref-epocrates_xyrem_40-0" class="reference"><a href="#cite_note-epocrates_xyrem-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> A 2016 study by Leu-Semenescu et al. found sodium oxybate reduced daytime sleepiness in IH to the same degree as in patients with narcolepsy type 1, and the drug improved severe sleep inertia in 71% of the hypersomnia patients.<sup id="cite_ref-Benefits_and_risk_of_sodium_oxybate_in_idiopathic_hypersomnia_versus_narcolepsy_type_1:_a_chart_review_41-0" class="reference"><a href="#cite_note-Benefits_and_risk_of_sodium_oxybate_in_idiopathic_hypersomnia_versus_narcolepsy_type_1:_a_chart_review-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> In July 2020, the FDA approved <a href="/wiki/Xywav" title="Xywav">Xywav</a>™ (calcium, magnesium, potassium, and sodium oxybates), an oral solution for the treatment of cataplexy or excessive daytime sleepiness (EDS) in patients 7 years of age and older with narcolepsy.<sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Cognitive_Behavioral_Therapy">Cognitive Behavioral Therapy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=7" title="Edit section: Cognitive Behavioral Therapy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Although behavioral approaches have not been demonstrated to improve clinical markers of IH, <a href="/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">cognitive behavioral therapy</a> has been found to potentially reduce depressive symptoms and improve <a href="/wiki/Self-efficacy" title="Self-efficacy">self-efficacy</a> in people with central disorders of hypersomnolence.<sup id="cite_ref-CBT1_43-0" class="reference"><a href="#cite_note-CBT1-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=8" title="Edit section: Prognosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>IH can profoundly affect work, education, and quality of life due to excessive daytime somnolence. Patients will often need to adapt their lifestyle to avoid situations that might be dangerous while sleepy, such as high risk work, or driving. The risks associated with these activities have been found to be higher for patients with hypersomnias than for those with sleep apnea or severe insomnia.<sup id="cite_ref-ref-5_6-1" class="reference"><a href="#cite_note-ref-5-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=9" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Typically, the symptoms of IH begin in adolescence or young adulthood, although they can begin at a later age.<sup id="cite_ref-ref-orig-5_44-0" class="reference"><a href="#cite_note-ref-orig-5-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-1997_Bassetti_15-2" class="reference"><a href="#cite_note-1997_Bassetti-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> After onset, hypersomnia often worsens over several years,<sup id="cite_ref-1997_Bassetti_15-3" class="reference"><a href="#cite_note-1997_Bassetti-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> but it is often stable by the time of diagnosis and appears to be a lifelong condition.<sup id="cite_ref-ref-3_4-1" class="reference"><a href="#cite_note-ref-3-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Spontaneous remission is only seen in 10–15% of patients.<sup id="cite_ref-2007_Anderson_30-1" class="reference"><a href="#cite_note-2007_Anderson-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-BilliardSonka2016_45-0" class="reference"><a href="#cite_note-BilliardSonka2016-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> </p><p>According to the limited epidemiological data that exists, IH "has more of a female preponderance (1.8/1)."<sup id="cite_ref-MallampalliCarter2014_46-0" class="reference"><a href="#cite_note-MallampalliCarter2014-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> Family cases are frequent, in a range from 25% to 66% without any clear mode of inheritance."<sup id="cite_ref-ref-1_26-1" class="reference"><a href="#cite_note-ref-1-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> </p><p>IH has long been considered a <a href="/wiki/Rare_disease" title="Rare disease">rare disease</a>, believed to be 10 times less frequent than narcolepsy.<sup id="cite_ref-ref-1_26-2" class="reference"><a href="#cite_note-ref-1-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> The prevalence of narcolepsy (with cataplexy) is estimated between 1/3,300 and 1/5,000.<sup id="cite_ref-orphanet_narc_47-0" class="reference"><a href="#cite_note-orphanet_narc-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup> Although the true prevalence of IH is unknown, it is estimated at 1/10,000 to 1/25,000 for the long sleep form and 1/11,000 to 1/100,000 without long sleep.<sup id="cite_ref-orphanet_ih_48-0" class="reference"><a href="#cite_note-orphanet_ih-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup> A more precise estimate "is complicated by a lack of clear biologic markers" and a lack of "unambiguous diagnostic criteria."<sup id="cite_ref-Medscape_IH_Epidemiology_49-0" class="reference"><a href="#cite_note-Medscape_IH_Epidemiology-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> </p><p>Because of the rarity of IH, research into the condition is limited "Patients are rare, researchers and scientists involved in the field are few and research findings are therefore scarce."<sup id="cite_ref-ref-5_6-2" class="reference"><a href="#cite_note-ref-5-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> "In Europe and in North America there is now a public health concern about helping patients and families affected by these rare diseases. Due to the complexity of the disease, they often experience difficulties to be diagnosed and often face social and professional consequences."<sup id="cite_ref-ref-5_6-3" class="reference"><a href="#cite_note-ref-5-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Research">Research</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=10" title="Edit section: Research"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="GABA-directed_medications">GABA-directed medications</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=11" title="Edit section: GABA-directed medications"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There is ongoing research into the efficacy of gamma aminobutyric acid A (GABA<sub>A</sub>) receptor antagonists for the treatment of IH.<sup id="cite_ref-50" class="reference"><a href="#cite_note-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> Research findings suggest that the GABA neurotransmitter system plays a significant role in the etiology of primary hypersomnias, such as IH and Narcolepsy Type 2.<sup id="cite_ref-51" class="reference"><a href="#cite_note-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> Given the possible role of hyperactive GABA<sub>A</sub> receptors in IH, medications that could counteract this activity are being studied to test their potential to improve sleepiness. These currently include <a href="/wiki/Clarithromycin" title="Clarithromycin">clarithromycin</a> and <a href="/wiki/Flumazenil" title="Flumazenil">flumazenil</a>.<sup id="cite_ref-clinicaltrials.gov_Flumazenil_22-1" class="reference"><a href="#cite_note-clinicaltrials.gov_Flumazenil-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Clarithro_Trial_23-1" class="reference"><a href="#cite_note-Clarithro_Trial-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Flumazenil" title="Flumazenil">Flumazenil</a>, a GABA<sub>A</sub> receptor antagonist is approved by the FDA for use in anesthesia reversal and <a href="/wiki/Benzodiazepine_overdose" title="Benzodiazepine overdose">benzodiazepine overdose</a>. Research has shown that flumazenil provides relief for most patients whose CSF contains the unknown "somnogen" that enhances the function of <a href="/wiki/GABA-A_receptors" class="mw-redirect" title="GABA-A receptors">GABA<sub>A</sub> receptors</a>, making them more susceptible to the sleep-inducing effect of GABA. For one patient, daily administration of flumazenil by sublingual lozenge and topical cream has proven effective for several years.<sup id="cite_ref-clinicaltrials.gov_Flumazenil_22-2" class="reference"><a href="#cite_note-clinicaltrials.gov_Flumazenil-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup> A 2014 case report also showed improvement in IH symptoms after treatment with a continuous subcutaneous flumazenil administration. The patient was treated with a short-term subcutaneous administration through 96-hour continuous low dose (4 mg/day) infusion of flumazenil, followed by a slow-release long term subcutaneous administration through flumazenil implant.<sup id="cite_ref-Flumazenil_Infusion_Case_Report_52-0" class="reference"><a href="#cite_note-Flumazenil_Infusion_Case_Report-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Clarithromycin" title="Clarithromycin">Clarithromycin</a>, an antibiotic approved by the FDA for the treatment of infections, was found to return the function of the GABA system to normal in patients with IH. In the pilot study, clarithromycin improved subjective sleepiness in GABA-related hypersomnia.<sup id="cite_ref-2013_Sleep_Abstract_53-0" class="reference"><a href="#cite_note-2013_Sleep_Abstract-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup> In 2013, a retrospective review evaluating longer-term clarithromycin use showed efficacy in a large percentage of patients with GABA-related hypersomnia.<sup id="cite_ref-2013_Clari_Retrospective_54-0" class="reference"><a href="#cite_note-2013_Clari_Retrospective-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> A 2021 <a href="/wiki/Cochrane_(organisation)" title="Cochrane (organisation)">Cochrane</a> study determined that the evidence is inadequate to definitively determine the efficacy of clarithromycin in the management of idiopathic hypersomnia.<sup id="cite_ref-pmid34031871_55-0" class="reference"><a href="#cite_note-pmid34031871-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup> The <a href="/wiki/American_Academy_of_Sleep_Medicine" title="American Academy of Sleep Medicine">American Academy of Sleep Medicine's</a> 2021 clinical practice guidelines conditionally suggested its use, especially for those who don't respond to other therapies.<sup id="cite_ref-pmid34743789_56-0" class="reference"><a href="#cite_note-pmid34743789-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-AASM_GAG_57-0" class="reference"><a href="#cite_note-AASM_GAG-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Transcranial_direct-current_stimulation_(tDCS)"><span id="Transcranial_direct-current_stimulation_.28tDCS.29"></span><a href="/wiki/Transcranial_direct-current_stimulation" title="Transcranial direct-current stimulation">Transcranial direct-current stimulation</a> (tDCS)</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=12" title="Edit section: Transcranial direct-current stimulation (tDCS)"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Dr. Ferini-Strambi and his colleagues in Milan, Italy, performed neurologic examinations by applying anodal tDCS by placing one electrode over the left dorsolateral prefrontal cortex, with the cathode over the contralateral orbit over 3 weeks period and found that seven of the eight participants (87.5%) reported improvement in their daytime sleepiness, including for up to two weeks after the end of the study.<sup id="cite_ref-58" class="reference"><a href="#cite_note-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-59" class="reference"><a href="#cite_note-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Transcranial_magnetic_stimulation_(TMS)"><span id="Transcranial_magnetic_stimulation_.28TMS.29"></span><a href="/wiki/Transcranial_magnetic_stimulation" title="Transcranial magnetic stimulation">Transcranial magnetic stimulation</a> (TMS)</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=13" title="Edit section: Transcranial magnetic stimulation (TMS)"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Neural networks that regulate arousal and sleep comprise a bottom-up (from the brainstem to the cortex) pathway and a top-down (corticothalamic) pathway. The bottom-up pathway emerges from the ascending reticular arousal system (ARAS) and activates the cortex via well-characterized thalamic and nonthalamic pathways through cholinergic and aminergic neurotransmission. The bottom-up pathway represents the leverage point for pharmaceutical interventions. It is complemented by a corticothalamic top-down pathway, which appears to be modifiable through <a href="/wiki/Neurostimulation#Non-invasive_brain_stimulation" title="Neurostimulation">noninvasive brain stimulation (NIBS)</a> techniques.<sup id="cite_ref-60" class="reference"><a href="#cite_note-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup> A single case report study indicates that high-frequency repetitive transcranial magnetic stimulation (HF rTMS) over the left dorsolateral prefrontal cortex (DLPFC) might represent an alternative choice for symptom control in narcoleptic patients with cataplexy. rTMS may also exert intrinsic effects on hypersomnia in depressed adolescents.<sup id="cite_ref-61" class="reference"><a href="#cite_note-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Mazindol">Mazindol</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=14" title="Edit section: Mazindol"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Mazindol" title="Mazindol">Mazindol</a> is a stimulant similar to <a href="/wiki/Amphetamine" title="Amphetamine">amphetamine</a> that "has been shown to be effective in treating hypersomnia in narcoleptics." However, it is not currently approved in the US.<sup id="cite_ref-AdenugaAttarian2014_62-0" class="reference"><a href="#cite_note-AdenugaAttarian2014-62"><span class="cite-bracket">[</span>62<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Selegiline">Selegiline</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=15" title="Edit section: Selegiline"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Selegiline" title="Selegiline">Selegiline</a>, a <a href="/wiki/Monoamine_oxidase_B" title="Monoamine oxidase B">monoamine oxidase B</a> (MAO-B) inhibitor, works by slowing the breakdown of certain substances in the brain (mostly dopamine, but also serotonin and norepinephrine). It may also be useful, as it is also a metabolic precursor of amphetamine and exerts most of its therapeutic effects through amphetamine metabolism. It is not commonly prescribed for people with narcolepsy because of the high dosage required and potential for severe side effects.<sup id="cite_ref-2012_Mignot_20-4" class="reference"><a href="#cite_note-2012_Mignot-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Atomoxetine">Atomoxetine</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=16" title="Edit section: Atomoxetine"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Atomoxetine" title="Atomoxetine">Atomoxetine</a> (or <a href="/wiki/Reboxetine" title="Reboxetine">reboxetine</a> in Europe) is an <a href="/wiki/Adrenergic_reuptake_inhibitor" class="mw-redirect" title="Adrenergic reuptake inhibitor">adrenergic reuptake inhibitor</a> which increases wakefulness (generally less strongly than the medications which act on dopamine) and which has been argued to have a "clear use in the therapeutic arsenal against narcolepsy and hypersomnia although undocumented by clinical trials."<sup id="cite_ref-2012_Mignot_20-5" class="reference"><a href="#cite_note-2012_Mignot-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Ritanserin">Ritanserin</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=17" title="Edit section: Ritanserin"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Ritanserin" title="Ritanserin">Ritanserin</a> is a <a href="/wiki/Serotonin_antagonist" class="mw-redirect" title="Serotonin antagonist">serotonin antagonist</a> that has "been shown to improve daytime alertness and subjective sleep quality in patients on their usual narcolepsy medications." It is intended as an adjunct (supplement to another main therapeutic agent), and although it is not available in the US, it is available in Europe.<sup id="cite_ref-AdenugaAttarian2014_62-1" class="reference"><a href="#cite_note-AdenugaAttarian2014-62"><span class="cite-bracket">[</span>62<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Antidepressants">Antidepressants</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=18" title="Edit section: Antidepressants"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Antidepressant" title="Antidepressant">Antidepressants</a> seems to have some therapeutic effects as they enhance synaptic levels of norepinephrine and serotonin. Further, different medicines are known to augment the activity of one another like as seen in the case of <a href="/wiki/Fluoxetine" title="Fluoxetine">fluoxetine</a> which augmented the activity of methylphenidate when taken together. </p><p><a href="/wiki/Bupropion" title="Bupropion">Bupropion</a>, a norepinephrine-dopamine reuptake inhibitor (NDRI), which works by inhibiting the reabsorption of two important brain chemicals – norepinephrine and dopamine, is known to have wake-promoting effects. <sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2021)">citation needed</span></a></i>]</sup> </p><p><a href="/wiki/Fluoxetine" title="Fluoxetine">Fluoxetine</a>, an antidepressant of the <a href="/wiki/Selective_serotonin_reuptake_inhibitor" title="Selective serotonin reuptake inhibitor">selective serotonin reuptake inhibitor</a> (SSRI) class is also known to have mild stimulating effects. It is also known to augment the activity of methylphenidate.<sup id="cite_ref-63" class="reference"><a href="#cite_note-63"><span class="cite-bracket">[</span>63<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Caffeine">Caffeine</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=19" title="Edit section: Caffeine"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Caffeine" title="Caffeine">Caffeine</a> is one of the safer nondopaminergic wake-promoting compounds. It is widely used but "has intolerable side effects at high doses (including cardiovascular), and it is generally not efficient enough for patients with hypersomnia or narcolepsy."<sup id="cite_ref-2012_Mignot_20-6" class="reference"><a href="#cite_note-2012_Mignot-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Although it is commonly used by people with IH or narcolepsy, many people with these disorders report that it has only limited benefit on their sleepiness. </p> <div class="mw-heading mw-heading3"><h3 id="Melatonin">Melatonin</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=20" title="Edit section: Melatonin"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Melatonin_(medication)" class="mw-redirect" title="Melatonin (medication)">Melatonin</a> is a hormone that the body produces to help regulate sleep. One small study, which used a dose of 2 mg slow-release melatonin at bedtime, found that 50% of participants had “shortened nocturnal sleep duration, decreased <a href="/wiki/Sleep_inertia" title="Sleep inertia">sleep inertia</a>, and relieved daytime sleepiness.” Other studies have shown that melatonin synchronizes the circadian rhythms, and improves the “onset, duration and quality of sleep.” </p> <div class="mw-heading mw-heading3"><h3 id="Levothyroxine">Levothyroxine</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=21" title="Edit section: Levothyroxine"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There have been some studies suggesting <a href="/wiki/Levothyroxine" title="Levothyroxine">levothyroxine</a> as a possible treatment for IH, especially for patients with <a href="/wiki/Subclinical_hypothyroidism" class="mw-redirect" title="Subclinical hypothyroidism">subclinical hypothyroidism</a>.<sup id="cite_ref-ref-orig-11_64-0" class="reference"><a href="#cite_note-ref-orig-11-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-ref-4_65-0" class="reference"><a href="#cite_note-ref-4-65"><span class="cite-bracket">[</span>65<span class="cite-bracket">]</span></a></sup> This treatment does carry potential risks (especially for patients without <a href="/wiki/Hypothyroidism" title="Hypothyroidism">hypothyroidism</a> or subclinical hypothroidism), which include cardiac arrhythmia.<sup id="cite_ref-epocrates_levothyroxine_66-0" class="reference"><a href="#cite_note-epocrates_levothyroxine-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Orexin_agonists">Orexin agonists</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=22" title="Edit section: Orexin agonists"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Orexin-A has been shown to be strongly wake-promoting in animal models, but it does not cross the <a href="/wiki/Blood%E2%80%93brain_barrier" title="Blood–brain barrier">blood–brain barrier</a>. <a href="/wiki/Suvorexant" title="Suvorexant">Suvorexant</a>, a <a href="/wiki/Orexin_antagonist" title="Orexin antagonist">orexin receptor antagonist</a>, has been developed to limit the natural effects of orexin in patients with insomnia. It is therefore possible that a orexin <a href="/wiki/Agonist" title="Agonist">agonist</a> may be similarly developed for the treatment of hypersomnia.<sup id="cite_ref-2012_Mignot_20-7" class="reference"><a href="#cite_note-2012_Mignot-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Levodopa">Levodopa</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=23" title="Edit section: Levodopa"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Levodopa" title="Levodopa">Levodopa</a> (<small>L</small>-DOPA) is an amino acid and is the precursor to the neurotransmitters dopamine, norepinephrine (noradrenaline), and epinephrine (adrenaline). As per a study of six narcoleptic patients it was found that <small>L</small>-DOPA improved <a href="/wiki/Vigilance_(psychology)" title="Vigilance (psychology)">vigilance</a> and performance as evaluated by the AVS and the FCRTT, while the capacity to fall asleep rapidly remained unchanged as evaluated by the MSLT. It raises the hypothesis that dopamine may play a role in the physiopathology of excessive daytime sleepiness of this condition.<sup id="cite_ref-67" class="reference"><a href="#cite_note-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Carnitine">Carnitine</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=24" title="Edit section: Carnitine"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Carnitine" title="Carnitine">Carnitine</a> has also been shown to improve narcolepsy symptoms (including daytime sleepiness) by increasing fatty-acid oxidation.<sup id="cite_ref-68" class="reference"><a href="#cite_note-68"><span class="cite-bracket">[</span>68<span class="cite-bracket">]</span></a></sup> Abnormally low levels of acylcarnitine have been observed in patients with narcolepsy.<sup id="cite_ref-2011_Miyagawa_69-0" class="reference"><a href="#cite_note-2011_Miyagawa-69"><span class="cite-bracket">[</span>69<span class="cite-bracket">]</span></a></sup> These same low levels have been associated with primary hypersomnia in general in mouse studies. "Mice with systemic carnitine deficiency exhibit a higher frequency of fragmented wakefulness and rapid eye movement (REM) sleep, and reduced locomotor activity." Administration of <a href="/wiki/Acetylcarnitine" title="Acetylcarnitine">acetyl-<small>L</small>-carnitine</a> was shown to improve these symptoms in mice.<sup id="cite_ref-2009_Miyagawa_70-0" class="reference"><a href="#cite_note-2009_Miyagawa-70"><span class="cite-bracket">[</span>70<span class="cite-bracket">]</span></a></sup> A subsequent human trial found that narcolepsy patients given <a href="/wiki/Carnitine" title="Carnitine">L-carnitine</a> spent less total time in daytime sleep than patients who were given placebo.<sup id="cite_ref-2013_Miyagawa_71-0" class="reference"><a href="#cite_note-2013_Miyagawa-71"><span class="cite-bracket">[</span>71<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=25" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239009302">.mw-parser-output .portalbox{padding:0;margin:0.5em 0;display:table;box-sizing:border-box;max-width:175px;list-style:none}.mw-parser-output .portalborder{border:1px solid var(--border-color-base,#a2a9b1);padding:0.1em;background:var(--background-color-neutral-subtle,#f8f9fa)}.mw-parser-output .portalbox-entry{display:table-row;font-size:85%;line-height:110%;height:1.9em;font-style:italic;font-weight:bold}.mw-parser-output .portalbox-image{display:table-cell;padding:0.2em;vertical-align:middle;text-align:center}.mw-parser-output .portalbox-link{display:table-cell;padding:0.2em 0.2em 0.2em 0.3em;vertical-align:middle}@media(min-width:720px){.mw-parser-output .portalleft{clear:left;float:left;margin:0.5em 1em 0.5em 0}.mw-parser-output .portalright{clear:right;float:right;margin:0.5em 0 0.5em 1em}}</style><ul role="navigation" aria-label="Portals" class="noprint portalbox portalborder portalright"> <li class="portalbox-entry"><span class="portalbox-image"><span class="noviewer" typeof="mw:File"><span><img alt="icon" src="//upload.wikimedia.org/wikipedia/commons/thumb/d/d6/WHO_Rod.svg/12px-WHO_Rod.svg.png" decoding="async" width="12" height="28" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/d6/WHO_Rod.svg/18px-WHO_Rod.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/d6/WHO_Rod.svg/24px-WHO_Rod.svg.png 2x" data-file-width="107" data-file-height="250" /></span></span></span><span class="portalbox-link"><a href="/wiki/Portal:Medicine" title="Portal:Medicine">Medicine portal</a></span></li></ul> <style data-mw-deduplicate="TemplateStyles:r1184024115">.mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column}</style><div class="div-col div-col-small" style="column-width: 25em;"> <ul><li><a href="/wiki/Altered_level_of_consciousness" title="Altered level of consciousness">Altered level of consciousness</a> – Measure of arousal other than normal</li> <li><a href="/wiki/Ascending_reticular_activating_system" class="mw-redirect" title="Ascending reticular activating system">Ascending reticular activating system</a> – Spinal trigeminal nucleus<span style="display:none" class="category-annotation-with-redirected-description">Pages displaying short descriptions of redirect targets</span></li> <li><a href="/wiki/Circadian_rhythm" title="Circadian rhythm">Circadian rhythm</a> – Natural internal process that regulates the sleep-wake cycle</li> <li><a href="/wiki/Doping_in_sport" title="Doping in sport">Doping in sport</a> – Use of banned drugs by athletes</li> <li><a href="/wiki/List_of_drugs_banned_by_WADA" class="mw-redirect" title="List of drugs banned by WADA">List of drugs banned by WADA</a></li> <li><a href="/wiki/List_of_investigational_sleep_drugs" title="List of investigational sleep drugs">List of investigational sleep drugs</a>></li> <li><a href="/wiki/Neuroscience_of_sleep" title="Neuroscience of sleep">Neuroscience of sleep</a> – Study of the neuroscientific and physiological basis of the nature of sleep</li> <li><a href="/wiki/Nootropic" title="Nootropic">Nootropic</a> – Compound intended to improve cognitive function</li> <li><a href="/wiki/Sleep" title="Sleep">Sleep</a> – Naturally recurring resting state of mind and body</li> <li><a href="/wiki/Sleep_medicine" title="Sleep medicine">Sleep medicine</a> – Medical specialty devoted to the diagnosis and therapy of sleep disturbances and disorders</li> <li><a href="/wiki/Sleep_hygiene" title="Sleep hygiene">Sleep hygiene</a> – Set of practices around healthy sleeping</li> <li><a href="/wiki/Sleep_study" title="Sleep study">Sleep study</a> – Sleep Medicine</li> <li><a href="/wiki/Somnology" title="Somnology">Somnology</a> – Scientific study of sleep</li> <li><a href="/wiki/Stimulant" title="Stimulant">Stimulant</a> – Drug that increases activity of central nervous system</li> <li><a href="/wiki/Wakefulness" title="Wakefulness">Wakefulness</a> – Brain state and state of consciousness</li></ul> </div> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=26" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-1">^</a></b></span> <span class="reference-text">Narcolepsy and hypersomnia: review and classification of 642 personally observed cases. Roth B. 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class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Idiopathic_hypersomnia&action=edit&section=27" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a rel="nofollow" class="external text" href="https://www.hypersomniafoundation.org/">Hypersomnia Foundation</a></li></ul> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1236075235">.mw-parser-output .navbox{box-sizing:border-box;border:1px solid #a2a9b1;width:100%;clear:both;font-size:88%;text-align:center;padding:1px;margin:1em auto 0}.mw-parser-output .navbox .navbox{margin-top:0}.mw-parser-output .navbox+.navbox,.mw-parser-output .navbox+.navbox-styles+.navbox{margin-top:-1px}.mw-parser-output .navbox-inner,.mw-parser-output .navbox-subgroup{width:100%}.mw-parser-output .navbox-group,.mw-parser-output .navbox-title,.mw-parser-output .navbox-abovebelow{padding:0.25em 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("counter(listitem)"\a0 "}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-label="Navbox" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q2730080" class="extiw" title="d:Q2730080">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/G47.1">G47.1</a>, <a rel="nofollow" class="external text" href="http://www.icd10data.com/ICD10CM/Codes/G00-G99/G40-G47/G47-/G47.11">ICD-10-CM G47.11</a>, <a rel="nofollow" class="external text" href="http://www.icd10data.com/ICD10CM/Codes/G00-G99/G40-G47/G47-/G47.12">ICD-10-CM G47.12</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=327.11">327.11</a>, <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=327.12">327.12</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D020177">D020177</a></li><li><b><a href="/wiki/SNOMED_CT" title="SNOMED CT">SNOMED CT</a></b>: <a rel="nofollow" class="external text" href="http://snomed.info/id/3731000119107">3731000119107</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000803.htm">000803</a></li><li><b><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></b>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/med/3129-overview">med/3129</a></li><li><b><a href="/wiki/Orphanet" title="Orphanet">Orphanet</a></b>: <a rel="nofollow" class="external text" href="https://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=en&Expert=33208">33208</a></li></ul></div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Diseases_of_the_nervous_system,_primarily_CNS" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Central_nervous_system_disease" title="Template:Central nervous system disease"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Central_nervous_system_disease" title="Template talk:Central nervous system disease"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Central_nervous_system_disease" title="Special:EditPage/Template:Central nervous system disease"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Diseases_of_the_nervous_system,_primarily_CNS" style="font-size:114%;margin:0 4em">Diseases of the <a href="/wiki/Nervous_system" title="Nervous system">nervous system</a>, primarily <a href="/wiki/Central_nervous_system_disease" title="Central nervous system disease">CNS</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Inflammation" title="Inflammation">Inflammation</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Brain" scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_brain" title="Human brain">Brain</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Encephalitis" title="Encephalitis">Encephalitis</a> <ul><li><a href="/wiki/Viral_encephalitis" title="Viral encephalitis">Viral encephalitis</a></li> <li><a href="/wiki/Herpesviral_encephalitis" class="mw-redirect" title="Herpesviral encephalitis">Herpesviral encephalitis</a></li> <li><a href="/wiki/Limbic_encephalitis" title="Limbic encephalitis">Limbic encephalitis</a></li> <li><a href="/wiki/Encephalitis_lethargica" title="Encephalitis lethargica">Encephalitis lethargica</a></li></ul></li> <li><a href="/wiki/Cavernous_sinus_thrombosis" title="Cavernous sinus thrombosis">Cavernous sinus thrombosis</a></li> <li><a href="/wiki/Brain_abscess" title="Brain abscess">Brain abscess</a> <ul><li><a href="/wiki/Amoebic_brain_abscess" title="Amoebic brain abscess">Amoebic</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Brain and <a href="/wiki/Spinal_cord" title="Spinal cord">spinal cord</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Encephalomyelitis" title="Encephalomyelitis">Encephalomyelitis</a> <ul><li><a href="/wiki/Acute_disseminated_encephalomyelitis" title="Acute disseminated encephalomyelitis">Acute disseminated</a></li></ul></li> <li><a href="/wiki/Meningitis" title="Meningitis">Meningitis</a></li> <li><a href="/wiki/Meningoencephalitis" title="Meningoencephalitis">Meningoencephalitis</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_brain" title="Human brain">Brain</a>/<br /><a href="/wiki/Encephalopathy" title="Encephalopathy">encephalopathy</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Neurodegenerative_disease" title="Neurodegenerative disease">Degenerative</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Extrapyramidal_system" title="Extrapyramidal system">Extrapyramidal</a> and<br /><a href="/wiki/Movement_disorders" class="mw-redirect" title="Movement disorders">movement disorders</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Basal_ganglia_disease" title="Basal ganglia disease">Basal ganglia disease</a> <ul><li><a href="/wiki/Parkinsonism" title="Parkinsonism">Parkinsonism</a> <ul><li><a href="/wiki/Parkinson%27s_disease" title="Parkinson's disease">PD</a></li> <li><a href="/wiki/Postencephalitic_parkinsonism" class="mw-redirect" title="Postencephalitic parkinsonism">Postencephalitic</a></li> <li><a href="/wiki/Neuroleptic_malignant_syndrome" title="Neuroleptic malignant syndrome">NMS</a></li></ul></li> <li><a href="/wiki/Neurodegeneration_with_brain_iron_accumulation" title="Neurodegeneration with brain iron accumulation">NBIA</a> <ul><li><a href="/wiki/Pantothenate_kinase-associated_neurodegeneration" title="Pantothenate kinase-associated neurodegeneration">PKAN</a></li></ul></li> <li><a href="/wiki/Tauopathy" title="Tauopathy">Tauopathy</a> <ul><li><a href="/wiki/Progressive_supranuclear_palsy" title="Progressive supranuclear palsy">PSP</a></li></ul></li> <li><a href="/wiki/Multiple_system_atrophy" title="Multiple system atrophy">Striatonigral degeneration</a></li> <li><a href="/wiki/Hemiballismus" title="Hemiballismus">Hemiballismus</a></li> <li><a href="/wiki/Huntington%27s_disease" title="Huntington's disease">HD</a></li> <li><a href="/wiki/Olivopontocerebellar_atrophy" class="mw-redirect" title="Olivopontocerebellar atrophy">OA</a></li></ul></li></ul> <ul><li><a href="/wiki/Dyskinesia" title="Dyskinesia">Dyskinesia</a> <ul><li><a href="/wiki/Dystonia" title="Dystonia">Dystonia</a> <ul><li><a href="/wiki/Status_dystonicus" title="Status dystonicus">Status dystonicus</a></li> <li><a href="/wiki/Spasmodic_torticollis" title="Spasmodic torticollis">Spasmodic torticollis</a></li> <li><a href="/wiki/Meige%27s_syndrome" title="Meige's syndrome">Meige's</a></li> <li><a href="/wiki/Blepharospasm" title="Blepharospasm">Blepharospasm</a></li></ul></li> <li><a href="/wiki/Athetosis" title="Athetosis">Athetosis</a></li> <li><a href="/wiki/Chorea" title="Chorea">Chorea</a> <ul><li><a href="/wiki/Choreoathetosis" title="Choreoathetosis">Choreoathetosis</a></li></ul></li> <li><a href="/wiki/Myoclonus" title="Myoclonus">Myoclonus</a> <ul><li><a href="/wiki/Myoclonic_epilepsy" title="Myoclonic epilepsy">Myoclonic epilepsy</a></li></ul></li> <li><a href="/wiki/Akathisia" title="Akathisia">Akathisia</a></li></ul></li></ul> <ul><li><a href="/wiki/Tremor" title="Tremor">Tremor</a> <ul><li><a href="/wiki/Essential_tremor" title="Essential tremor">Essential tremor</a></li> <li><a href="/wiki/Intention_tremor" title="Intention tremor">Intention tremor</a></li></ul></li> <li><a href="/wiki/Restless_legs_syndrome" title="Restless legs syndrome">Restless legs</a></li> <li><a href="/wiki/Stiff-person_syndrome" title="Stiff-person syndrome">Stiff-person</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Dementia" title="Dementia">Dementia</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Tauopathy" title="Tauopathy">Tauopathy</a> <ul><li><a href="/wiki/Alzheimer%27s_disease" title="Alzheimer's disease">Alzheimer's</a> <ul><li><a href="/wiki/Early-onset_Alzheimer%27s_disease" title="Early-onset Alzheimer's disease">Early-onset</a></li></ul></li> <li><a href="/wiki/Primary_progressive_aphasia" title="Primary progressive aphasia">Primary progressive aphasia</a></li></ul></li> <li><a href="/wiki/Frontotemporal_dementia" title="Frontotemporal dementia">Frontotemporal dementia</a>/<a href="/wiki/Frontotemporal_lobar_degeneration" title="Frontotemporal lobar degeneration">Frontotemporal lobar degeneration</a> <ul><li><a href="/wiki/Pick%27s_disease" class="mw-redirect" title="Pick's disease">Pick's</a></li></ul></li> <li><a href="/wiki/Lewy_bodies_dementia" class="mw-redirect" title="Lewy bodies dementia">Lewy bodies dementia</a></li> <li><a href="/wiki/Posterior_cortical_atrophy" title="Posterior cortical atrophy">Posterior cortical atrophy</a></li></ul> <p><a href="/wiki/Creutzfeldt%E2%80%93Jakob_disease" title="Creutzfeldt–Jakob disease">Creutzfeldt–Jakob disease</a> </p> <ul><li><a href="/wiki/Vascular_dementia" title="Vascular dementia">Vascular dementia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Mitochondrial_disease" title="Mitochondrial disease">Mitochondrial disease</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Leigh_syndrome" title="Leigh syndrome">Leigh syndrome</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Demyelinating_disease" title="Demyelinating disease">Demyelinating</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/CNS_demyelinating_autoimmune_diseases" title="CNS demyelinating autoimmune diseases">Autoimmune</a></li> <li><a href="/wiki/Inflammatory_demyelinating_diseases_of_the_central_nervous_system" title="Inflammatory demyelinating diseases of the central nervous system">Inflammatory</a></li> <li><a href="/wiki/Multiple_sclerosis" title="Multiple sclerosis">Multiple sclerosis</a></li> <li>For more detailed coverage, see <a href="/wiki/Template:Demyelinating_diseases_of_CNS" title="Template:Demyelinating diseases of CNS">Template:Demyelinating diseases of CNS</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Episodic/<br /><a href="/wiki/Paroxysmal_attack" title="Paroxysmal attack">paroxysmal</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Epileptic_seizure" class="mw-redirect" title="Epileptic seizure">Seizures</a> and <a href="/wiki/Epilepsy" title="Epilepsy">epilepsy</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Focal_seizure" title="Focal seizure">Focal</a></li> <li><a href="/wiki/Generalized_epilepsy" title="Generalized epilepsy">Generalised</a></li> <li><a href="/wiki/Status_epilepticus" title="Status epilepticus">Status epilepticus</a></li> <li>For more detailed coverage, see <a href="/wiki/Template:Epilepsy" class="mw-redirect" title="Template:Epilepsy">Template:Epilepsy</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Headache" title="Headache">Headache</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Migraine" title="Migraine">Migraine</a></li> <li><a href="/wiki/Cluster_headache" title="Cluster headache">Cluster</a></li> <li><a href="/wiki/Tension_headache" title="Tension headache">Tension</a></li> <li>For more detailed coverage, see <a href="/wiki/Template:Headache" title="Template:Headache">Template:Headache</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Cerebrovascular_disease" title="Cerebrovascular disease">Cerebrovascular</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Transient_ischemic_attack" title="Transient ischemic attack">TIA</a></li> <li><a href="/wiki/Stroke" title="Stroke">Stroke</a></li> <li>For more detailed coverage, see <a href="/wiki/Template:Cerebrovascular_diseases" title="Template:Cerebrovascular diseases">Template:Cerebrovascular diseases</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Sleep_disorders" class="mw-redirect" title="Sleep disorders">Sleep disorders</a> <ul><li>For more detailed coverage, see <a href="/wiki/Template:Sleep" title="Template:Sleep">Template:Sleep</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Cerebrospinal_fluid" title="Cerebrospinal fluid">CSF</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Intracranial_pressure" title="Intracranial pressure">Intracranial hypertension</a> <ul><li><a href="/wiki/Hydrocephalus" title="Hydrocephalus">Hydrocephalus</a></li> <li><a href="/wiki/Normal_pressure_hydrocephalus" title="Normal pressure hydrocephalus">Normal pressure hydrocephalus</a></li> <li><a href="/wiki/Choroid_plexus_papilloma" title="Choroid plexus papilloma">Choroid plexus papilloma</a></li> <li><a href="/wiki/Idiopathic_intracranial_hypertension" title="Idiopathic intracranial hypertension">Idiopathic intracranial hypertension</a></li></ul></li> <li><a href="/wiki/Cerebral_edema" title="Cerebral edema">Cerebral edema</a></li> <li><a href="/wiki/Spontaneous_cerebrospinal_fluid_leak" class="mw-redirect" title="Spontaneous cerebrospinal fluid leak">Intracranial hypotension</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Brain_herniation" title="Brain herniation">Brain herniation</a></li> <li><a href="/wiki/Reye_syndrome" title="Reye syndrome">Reye syndrome</a></li> <li><a href="/wiki/Hepatic_encephalopathy" title="Hepatic encephalopathy">Hepatic encephalopathy</a></li> <li><a href="/wiki/Toxic_encephalopathy" title="Toxic encephalopathy">Toxic encephalopathy</a></li> <li><a href="/wiki/Hashimoto%27s_encephalopathy" title="Hashimoto's encephalopathy">Hashimoto's encephalopathy</a></li> <li><a href="/wiki/Fetal_alcohol_spectrum_disorder" title="Fetal alcohol spectrum disorder">Static encephalopathy</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Both/either</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Degenerative" scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Neurodegenerative_disease" title="Neurodegenerative disease">Degenerative</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Spinocerebellar_ataxia" title="Spinocerebellar ataxia">SA</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Friedreich%27s_ataxia" title="Friedreich's ataxia">Friedreich's ataxia</a></li> <li><a href="/wiki/Ataxia%E2%80%93telangiectasia" title="Ataxia–telangiectasia">Ataxia–telangiectasia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Motor_neuron_diseases" title="Motor neuron diseases">MND</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Upper_motor_neuron" title="Upper motor neuron">UMN</a> only:</i> <ul><li><a href="/wiki/Primary_lateral_sclerosis" title="Primary lateral sclerosis">Primary lateral sclerosis</a></li> <li><a href="/wiki/Pseudobulbar_palsy" title="Pseudobulbar palsy">Pseudobulbar palsy</a></li> <li><a href="/wiki/Hereditary_spastic_paraplegia" title="Hereditary spastic paraplegia">Hereditary spastic paraplegia</a></li></ul></li></ul> <ul><li><i><a href="/wiki/Lower_motor_neuron" title="Lower motor neuron">LMN</a> only:</i> <ul><li><a href="/wiki/Distal_hereditary_motor_neuronopathies" title="Distal hereditary motor neuronopathies">Distal hereditary motor neuronopathies</a></li> <li><a href="/wiki/Spinal_muscular_atrophies" title="Spinal muscular atrophies">Spinal muscular atrophies</a> <ul><li><a href="/wiki/Spinal_muscular_atrophy" title="Spinal muscular atrophy">SMA</a></li> <li><a href="/wiki/Spinal_and_bulbar_muscular_atrophy" title="Spinal and bulbar muscular atrophy">SMAX1</a></li> <li><a href="/wiki/X-linked_spinal_muscular_atrophy_type_2" title="X-linked spinal muscular atrophy type 2">SMAX2</a></li> <li><a href="/wiki/Distal_spinal_muscular_atrophy_type_1" title="Distal spinal muscular atrophy type 1">DSMA1</a></li> <li><a href="/wiki/Congenital_distal_spinal_muscular_atrophy" title="Congenital distal spinal muscular atrophy">Congenital DSMA</a></li> <li>Spinal muscular atrophy with lower extremity predominance (SMALED) <ul><li><a href="/wiki/Spinal_muscular_atrophy_with_lower_extremity_predominance_1" title="Spinal muscular atrophy with lower extremity predominance 1">SMALED1</a></li> <li><a href="/wiki/Spinal_muscular_atrophy_with_lower_extremity_predominance_2A" title="Spinal muscular atrophy with lower extremity predominance 2A">SMALED2A</a></li> <li><a href="/wiki/Spinal_muscular_atrophy_with_lower_extremity_predominance_2B" title="Spinal muscular atrophy with lower extremity predominance 2B">SMALED2B</a></li></ul></li> <li><a href="/wiki/Pontocerebellar_hypoplasia" title="Pontocerebellar hypoplasia">SMA-PCH</a></li> <li><a href="/wiki/Spinal_muscular_atrophy_with_progressive_myoclonic_epilepsy" title="Spinal muscular atrophy with progressive myoclonic epilepsy">SMA-PME</a></li></ul></li> <li><a href="/wiki/Progressive_muscular_atrophy" title="Progressive muscular atrophy">Progressive muscular atrophy</a></li> <li><a href="/wiki/Progressive_bulbar_palsy" title="Progressive bulbar palsy">Progressive bulbar palsy</a> <ul><li><a href="/wiki/Fazio%E2%80%93Londe_disease" title="Fazio–Londe disease">Fazio–Londe</a></li> <li><a href="/wiki/Infantile_progressive_bulbar_palsy" title="Infantile progressive bulbar palsy">Infantile progressive bulbar palsy</a></li></ul></li></ul></li></ul> <ul><li><i>both:</i> <ul><li><a href="/wiki/Amyotrophic_lateral_sclerosis" class="mw-redirect" title="Amyotrophic lateral sclerosis">Amyotrophic lateral sclerosis</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Sleep_and_sleep_disorders" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Sleep" title="Template:Sleep"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Sleep" title="Template talk:Sleep"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Sleep" title="Special:EditPage/Template:Sleep"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Sleep_and_sleep_disorders" class="nowrap" style="font-size:114%;margin:0 4em"><a href="/wiki/Sleep" title="Sleep">Sleep</a> and <a href="/wiki/Sleep_disorder" title="Sleep disorder">sleep disorders</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%">Stages of <a href="/wiki/Sleep_cycle" title="Sleep cycle">sleep cycles</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist nowrapitems" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Rapid_eye_movement_sleep" title="Rapid eye movement sleep">Rapid eye movement (REM)</a></li> <li><a href="/wiki/Non-rapid_eye_movement_sleep" title="Non-rapid eye movement sleep">Quiescent sleep</a></li> <li><a href="/wiki/Slow-wave_sleep" title="Slow-wave sleep">Slow-wave</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Electroencephalography" title="Electroencephalography">Brain waves</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist nowrapitems" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Alpha_wave" title="Alpha wave">Alpha wave</a></li> <li><a href="/wiki/Beta_wave" title="Beta wave">Beta wave</a></li> <li><a href="/wiki/Delta_wave" title="Delta wave">Delta wave</a></li> <li><a href="/wiki/Gamma_wave" title="Gamma wave">Gamma wave</a></li> <li><a href="/wiki/K-complex" title="K-complex">K-complex</a></li> <li><a href="/wiki/Mu_wave" title="Mu wave">Mu rhythm</a></li> <li><a href="/wiki/PGO_waves" title="PGO waves">PGO waves</a></li> <li><a href="/wiki/Sensorimotor_rhythm" title="Sensorimotor rhythm">Sensorimotor rhythm</a></li> <li><a href="/wiki/Sleep_spindle" title="Sleep spindle">Sleep spindle</a></li> <li><a href="/wiki/Theta_wave" title="Theta wave">Theta wave</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Sleep_disorder" title="Sleep disorder">Sleep disorders</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist nowrapitems" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Oral_and_maxillofacial_pathology" title="Oral and maxillofacial pathology">Anatomical</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bruxism" title="Bruxism">Bruxism</a></li> <li><a href="/wiki/Mouth_breathing" title="Mouth breathing">Mouth breathing</a></li> <li><a href="/wiki/Sleep_apnea" title="Sleep apnea">Sleep apnea</a> <ul><li><a href="/wiki/Catathrenia" title="Catathrenia">Catathrenia</a></li> <li><a href="/wiki/Central_hypoventilation_syndrome" title="Central hypoventilation syndrome">Central hypoventilation syndrome</a></li> <li><a href="/wiki/Obesity_hypoventilation_syndrome" title="Obesity hypoventilation syndrome">Obesity hypoventilation syndrome</a></li> <li><a href="/wiki/Obstructive_sleep_apnea" title="Obstructive sleep apnea">Obstructive sleep apnea</a></li> <li><a href="/wiki/Periodic_breathing" title="Periodic breathing">Periodic breathing</a></li></ul></li> <li><a href="/wiki/Snoring" title="Snoring">Snoring</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Dyssomnia" title="Dyssomnia">Dyssomnia</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Excessive_daytime_sleepiness" title="Excessive daytime sleepiness">Excessive daytime sleepiness</a></li> <li><a href="/wiki/Hypersomnia" title="Hypersomnia">Hypersomnia</a></li> <li><a href="/wiki/Insomnia" title="Insomnia">Insomnia</a></li> <li><a href="/wiki/Kleine%E2%80%93Levin_syndrome" title="Kleine–Levin syndrome">Kleine–Levin syndrome</a></li> <li><a href="/wiki/Narcolepsy" title="Narcolepsy">Narcolepsy</a></li> <li><a class="mw-selflink selflink">Idiopathic hypersomnia</a></li> <li><a href="/wiki/Night_eating_syndrome" title="Night eating syndrome">Night eating syndrome</a></li> <li><a href="/wiki/Nocturia" title="Nocturia">Nocturia</a></li> <li><a href="/wiki/Sleep_state_misperception" title="Sleep state misperception">Sleep state misperception</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><div style="display: inline-block; line-height: 1.2em; padding: .1em 0; line-height: 1.15em;"><a href="/wiki/Circadian_rhythm_sleep_disorder" title="Circadian rhythm sleep disorder">Circadian rhythm<br />disorders</a></div></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Advanced_sleep_phase_disorder" title="Advanced sleep phase disorder">Advanced sleep phase disorder</a></li> <li><a href="/wiki/Cyclic_alternating_pattern" title="Cyclic alternating pattern">Cyclic alternating pattern</a></li> <li><a href="/wiki/Delayed_sleep_phase_disorder" title="Delayed sleep phase disorder">Delayed sleep phase disorder</a></li> <li><a href="/wiki/Irregular_sleep%E2%80%93wake_rhythm" class="mw-redirect" title="Irregular sleep–wake rhythm">Irregular sleep–wake rhythm</a></li> <li><a href="/wiki/Jet_lag" title="Jet lag">Jet lag</a></li> <li><a href="/wiki/Non-24-hour_sleep%E2%80%93wake_disorder" title="Non-24-hour sleep–wake disorder">Non-24-hour sleep–wake disorder</a></li> <li><a href="/wiki/Shift_work_sleep_disorder" title="Shift work sleep disorder">Shift work sleep disorder</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Parasomnia" title="Parasomnia">Parasomnia</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Nightmare_disorder" title="Nightmare disorder">Nightmare disorder</a></li> <li><a href="/wiki/Night_terror" title="Night terror">Night terror</a></li> <li><a href="/wiki/Periodic_limb_movement_disorder" title="Periodic limb movement disorder">Periodic limb movement disorder</a></li> <li><a href="/wiki/Rapid_eye_movement_sleep_behavior_disorder" title="Rapid eye movement sleep behavior disorder">Rapid eye movement sleep behavior disorder</a></li> <li><a href="/wiki/Sleepwalking" title="Sleepwalking">Sleepwalking</a></li> <li><a href="/wiki/Sleep_driving" title="Sleep driving">Sleep driving</a></li> <li><a href="/wiki/Sleep-talking" title="Sleep-talking">Sleep-talking</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Benign phenomena</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Dream" title="Dream">Dreams</a></li> <li><a href="/wiki/Exploding_head_syndrome" title="Exploding head syndrome">Exploding head syndrome</a></li> <li><a href="/wiki/Hypnic_jerk" title="Hypnic jerk">Hypnic jerk</a></li> <li><a href="/wiki/Hypnagogia" title="Hypnagogia">Hypnagogia</a> / <a href="/wiki/Sleep_onset" title="Sleep onset">Sleep onset</a></li> <li><a href="/wiki/Hypnopompia" title="Hypnopompia">Hypnopompia</a></li> <li><a href="/wiki/Sleep_paralysis" title="Sleep paralysis">Sleep paralysis</a></li> <li><a href="/wiki/Sleep_inertia" title="Sleep inertia">Sleep inertia</a></li> <li><a href="/wiki/Somnolence" title="Somnolence">Somnolence</a></li> <li><a href="/wiki/Nocturnal_clitoral_tumescence" title="Nocturnal clitoral tumescence">Nocturnal clitoral tumescence</a></li> <li><a href="/wiki/Nocturnal_penile_tumescence" title="Nocturnal penile tumescence">Nocturnal penile tumescence</a></li> <li><a href="/wiki/Nocturnal_emission" title="Nocturnal emission">Nocturnal emission</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Sleep_medicine" title="Sleep medicine">Treatment</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Sleep_diary" title="Sleep diary">Sleep diary</a></li> <li><a href="/wiki/Sleep_hygiene" title="Sleep hygiene">Sleep hygiene</a></li> <li><a href="/wiki/Sleep_induction" title="Sleep induction">Sleep induction</a> <ul><li><a href="/wiki/Hypnosis" title="Hypnosis">Hypnosis</a></li> <li><a href="/wiki/Lullaby" title="Lullaby">Lullaby</a></li></ul></li> <li><a href="/wiki/Somnology" title="Somnology">Somnology</a> <ul><li><a href="/wiki/Polysomnography" title="Polysomnography">Polysomnography</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Sleep_medicine" title="Sleep medicine">Sleep medicine</a></li> <li><a href="/wiki/Behavioral_sleep_medicine" title="Behavioral sleep medicine">Behavioral sleep medicine</a></li> <li><a href="/wiki/Sleep_study" title="Sleep study">Sleep study</a></li> <li><a href="/wiki/Melatonin" title="Melatonin">Melatonin</a></li> <li><a href="/wiki/Neuroscience_of_sleep" title="Neuroscience of sleep">Neuroscience of sleep</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Daily life</th><td class="navbox-list-with-group navbox-list navbox-even hlist nowrapitems" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bed" title="Bed">Bed</a> <ul><li><a href="/wiki/Bunk_bed" title="Bunk bed">Bunk bed</a></li> <li><a href="/wiki/Daybed" title="Daybed">Daybed</a></li> <li><a href="/wiki/Four-poster_bed" title="Four-poster bed">Four-poster bed</a></li> <li><a href="/wiki/Futon" title="Futon">Futon</a></li> <li><a href="/wiki/Hammock" title="Hammock">Hammock</a></li> <li><a href="/wiki/Mattress" title="Mattress">Mattress</a></li> <li><a href="/wiki/Sleeping_bag" title="Sleeping bag">Sleeping bag</a></li></ul></li> <li><a href="/wiki/Bed_bug" title="Bed bug">Bed bug</a></li> <li><a href="/wiki/Bedding" title="Bedding">Bedding</a></li> <li><a href="/wiki/Bedroom" title="Bedroom">Bedroom</a></li> <li><a href="/wiki/Bedtime" title="Bedtime">Bedtime</a> <ul><li><a href="/wiki/Bedtime_procrastination" title="Bedtime procrastination">Procrastination</a></li> <li><a href="/wiki/Bedtime_story" title="Bedtime story">Story</a></li></ul></li> <li><a href="/wiki/Biphasic_and_polyphasic_sleep" class="mw-redirect" title="Biphasic and polyphasic sleep">Biphasic and polyphasic sleep</a></li> <li><a href="/wiki/Chronotype" title="Chronotype">Chronotype</a></li> <li><a href="/wiki/Circadian_rhythm" title="Circadian rhythm">Circadian rhythm</a></li> <li><a href="/wiki/Comfort_object" title="Comfort object">Comfort object</a></li> <li><a href="/wiki/Dream_diary" title="Dream diary">Dream diary</a></li> <li><a href="/wiki/Microsleep" title="Microsleep">Microsleep</a></li> <li><a href="/wiki/Nap" title="Nap">Nap</a></li> <li><a href="/wiki/Nightwear" title="Nightwear">Nightwear</a></li> <li><a href="/wiki/Power_nap" title="Power nap">Power nap</a></li> <li><a href="/wiki/Second_wind_(sleep)" title="Second wind (sleep)">Second wind</a></li> <li><a href="/wiki/Siesta" title="Siesta">Siesta</a></li> <li><a href="/wiki/Sleep_and_breathing" title="Sleep and breathing">Sleep and breathing</a></li> <li><a href="/wiki/Sleep_and_creativity" title="Sleep and creativity">Sleep and creativity</a></li> <li><a href="/wiki/Sleep_and_learning" title="Sleep and learning">Sleep and learning</a></li> <li><a href="/wiki/Sleep_and_memory" title="Sleep and memory">Sleep and memory</a></li> <li><a href="/wiki/Sleep_deprivation" title="Sleep deprivation">Sleep deprivation</a> / <a href="/wiki/Sleep_debt" title="Sleep debt">Sleep debt</a></li> <li><a href="/wiki/Sleeping_while_on_duty" title="Sleeping while on duty">Sleeping while on duty</a></li> <li><a href="/wiki/Sleepover" title="Sleepover">Sleepover</a></li></ul> </div></td></tr></tbody></table></div>    </div><noscript><img src="https://login.wikimedia.org/wiki/Special:CentralAutoLogin/start?type=1x1" alt="" width="1" height="1" style="border: none; position: absolute;"></noscript> <div class="printfooter" data-nosnippet="">Retrieved from "<a dir="ltr" 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