Excessive daytime sleepiness in young adults

Karl Doghramji, MD and Paul Doghramji, MD

Karl Doghramji, MD
Professor of Psychiatry and Human Behavior
Jefferson Medical College
Director of the Sleep Disorders Center
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania

Paul P. Doghramji, MD, FAAFP

Family Physician, Collegeville Family Practice

Medical Director, Ursinus College

Collegeville, Pennsylvania

A 21 year old college student was referred by a school counselor to see a psychiatrist for possible depression or attention deficit hyperactivity disorder (ADHD). The student described difficulty concentrating in class and feeling very tired all throughout college. Her past medical history was unremarkable, she was not taking any prescription medication, and she reported no drug or alcohol use. A thorough sleep history revealed an erratic sleep schedule, so her doctor recommended that she adhere to a regular sleep schedule for the next 2 weeks. At her follow-up visit, the student reported no improvement, prompting her physician to refer her to a sleep specialist. The results of a nighttime sleep study were completely normal, but a Multiple Sleep Latency Test (MSLT) was positive for narcolepsy. Here, Dr. Karl Doghramji and Dr. Paul Doghramji discuss the pathophysiology of excessive daytime sleepiness, as well as the key diagnostic criteria for narcolepsy.

References

Carskadon MA, Dement WC, Mitler MM, Roth T, Westbrook PR, Keenan S. Guidelines for the multiple sleep latency test (MSLT): a standard measure of sleepiness. Sleep. 1986;9:519-524.
Sullivan SS. Narcolepsy in adolescents. Adolesc Med State Art Rev. 2010;21:542-555, x-xi.
Bodkin CL, Manchanda S. Office evaluation of the "tired" or "sleepy" patient. Semin Neurol. 2011;31:42-53.
Hauw JJ, Hausser-Hauw C, De Girolami U, Hasboun D, Seilhean D. Neuropathology of Sleep Disorders: A Review. J Neuropathol Exp Neurol. 2011;70:243-252.

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