Subgroup 2 consists of individuals who had a viral illness (Guill

Subgroup 2 consists of individuals who had a viral illness (Guillain-Barre, mononucleosis, hepatitis, atypical viral pneumonia) followed by persistent EDS. Subgroup 3 includes patients with no family history or viral

infection prior to onset of EDS. The PSG demonstrates a combination of normal or long nocturnal sleep, and the MSLT performed the day after the PSG shows short SOL without sleep-onset REM periods.139 Pharmacological treatment involves use of stimulants, starting Inhibitors,research,lifescience,medical with either modafinil or methylphenidate and switching to dexedrine spansules if initial treatment is ineffective. Nonpharmacological treatment includes one scheduled daily Inhibitors,research,lifescience,medical nap (noon or late afternoon) no longer than 45 min; avoidance of alcohol, sleep deprivation, heavy meals and shift work; and observance of regular sleep (at least 8.5 h per night) and wake schedules. Parasomnias Parasomnias are characterized by undesirable physical phenomena or behaviors that occur predominantly during sleep. Skeletal muscle activity and autonomic nervous system changes are prominent. Parasomnias are composed of disorders of arousal, partial arousal, and sleepstage transition (Table I). Disorders of arousal are the most common form of parasomnia.They Inhibitors,research,lifescience,medical usually occur during SWS (NREM stages III and IV),

and symptoms typically present in the first third of the night. Studies of twin cohorts and families with sleep terror and sleepwalking suggest that genetic factors Inhibitors,research,lifescience,medical may be involved, and there may be a family history of the same or other NREM arousal parasomnia.140-142 Factors that increase SWS, such as young age, natural deep sleeper, recoverd Inhibitors,research,lifescience,medical from sleep deprivation, central nervous system (CNS) depressant medications (sedatives, hypnotics, alcohol), fever, and the hypersomniac

period in Klcine-Levin syndrome, may aggravate the arousal disorder. Factors that lead to sleep fragmentation, including stress, environmental LY335979 molecular weight stimuli, endogenous stimuli, pain, pregnancy, stimulants, thyroxine taken in the evening, migraine headaches, or Tourcttc’s syndrome, may trigger the parasomnia. Megestrol Acetate Confusional arousals (nocturnal sleep drunkenness) This disorder is more common in children younger than 5 years of age, becomes less frequent during adolescence, and is rare in adulthood. The patient partially awakens from a deep sleep during the first third of the night, is confused and slow in mentation, disoriented to time and space, poorly/partially responsive to external stimuli, manifests automatic behavior (picking at bedclothes), and moans and mumbles incomprehensibly. Attacks last from 30 s to 10 min, and the patient is amnesic for the behavior and for any dream-like or thought-like mentation.

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