![]() ![]() Question: What does the hypnogram suggest as the underlying cause of the patient’s hypersomnia? What would you do to confirm the diagnosis?Īnswer: The hypnogram shows early onset of rapid eye movement (REM) sleep with multiple spontaneous awakenings suggestive of narcolepsy. The hypnogram from her nocturnal sleep study is shown below. On physical examination, she is a thin woman with a body mass index of 22.5 kg/m2. At sleep onset, she has had repeated episodes where she sees someone sitting on the edge of her bed and has infrequent episodes of sleep paralysis. When she awakens, she typically is able to return to sleep quickly. She falls asleep within minutes, but reports repeated nocturnal awakenings of unclear cause. She typically is in bed from 11 PM until 7 AM. She also has difficulty with her nocturnal sleep. She falls asleep unintentionally whenever she is sedentary and has fallen asleep driving. She reports an Epworth Sleepiness Scale score of 21/24. More recently, her sleepiness has worsened. Throughout high school, she struggled with remaining awake during class. At that time, she experienced a brief loss of consciousness. She reported that her difficulties with sleep began in adolescence when she suffered a closed head injury in an automobile-pedestrian accident. A 27 year old woman was evaluated for complaints of poor nocturnal sleep quality and excessive daytime somnolence. ![]()
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