Throw a broad net out for the evaluation because we don't know how much has a physiological component and how much is mental/emotional.
At intake, I get a moderately comprehensive set of labs. Rating Scales like HAMA, HAM-D, PHQ-9, Epworth Sleepiness Scale, and a ROS (Review of Systems) are done. I...
One of the newer agents for wakefulness-promoting agents is Sunosi, which has a higher affinity for DAT and NET compared to any other agent (Wellbutrin, Provigil, Nuvigil, Adderall).
I have a cohort of probably 5-10 patients now, mostly female in their late teens to early twenties, who report needing 10-14 hours of sleep per day and still not feeling refreshed. Excessive daytime somnolence (falling asleep in class or while driving). I tried modafinil and stimulants with modest s...
I recommend light therapy in the morning, more exercise during the day, and judicious use of caffeine.
Great question, but I doubt many of us have really concrete guidelines we follow.
Here is what I would consider:
- Are they fishing for stimulants? Just need to rule this out first.
- I am assuming routine sleep study, and you coached them on sleep hygiene.
- I am also assuming labs were okay? CBC, CMP, ...
Polysomnography can be very helpful with diagnosis, and narcolepsy, while not that common, is treatable. Obstructive sleep apnea (OSA), also treated after PSG diagnosis, can be corrected. These two diagnoses, which are frequent causes of excessive daytime sleepiness, can be documented by PSG. Stimul...