Excessive Somnolence

Nadav Traeger, MD, FAAP, FCCP, DABSM

Introduction

•Excessive somnolence is the inability to stay awake or adequately alert during the time of the day when the person should not be asleep.

•Adequate alertness is important for good health, optimal academic and physical performance, and avoidance of accidental injuries and motor vehicle crashes.

Etiology

•The most common etiologic origins for excessive somnolence are

—Inadequate amount of sleep relative to the person’s needs. This may be voluntary (to have more time for homework, sports, reading, socializing, watching TV, etc) or because of an inability to fall asleep and/or stay asleep (insomnia).

—Disruption of sleep. This may be due to extrinsic or environmental factors (eg, light, noise) or intrinsic causes (eg, obstructive sleep apnea syndrome [OSAS] or other sleep disorders).

—Inappropriate timing of sleep (as may occur with jet lag or in teens whose internal clock is out of sync with conventional time).

▪Less common but often underdiagnosed are central disorders of hypersomnolence, which include narcolepsy, idiopathic hypersomnia, Kleine-Levin syndrome, hypersomnia due to a medical disorder, hypersomnia due to a medication or substance, and hypersomnia associated with a psychiatric disorder.

Epidemiology

•The epidemiology of excessive somnolence is unknown.

Clinical Features

•Increased tendency to fall asleep

•Low energy or motivation

•Crankiness, moodiness, irritability, crying

•Hyperactivity

•Inattention

•Memory impairment

•Decreased school performance

•Increased tendency for errors and/or accidents

•Excessively long nights of sleep

•Persistence of naps past the age the child should have been outgrown them or recurrence of previously discontinued daytime napping

Diagnostic Considerations

•