Central Hypersomnias in Adult Women of Childbearing Age

The differential diagnosis of primary hypersomnias in women includes narcolepsy (type 1/with cataplexy and type 2/without cataplexy), idiopathic hypersomnia, recurrent hypersomnia (Klein-Levin Syndrome, menstrual-related hypersomnia), idiopathic hypersomnia, behaviorally induced insufficient sleep syndrome, hypersomnia due to a medical disorder, hypersomnia due to a medication or substance, and hypersomnia associated with a psychiatric disorder. The hallmark symptom of hypersomnia is excessive daytime sleepiness (EDS). There is evidence suggesting higher prevalence of EDS in women, possibly due to work and family responsibilities, increased prevalence of mood disorders, hormonal changes, and/or the underdiagnoses of sleep disorders in women. In the realm of recurrent hypersomnias, menstrual-related hypersomnia is especially of importance in the evaluation of women. Similarly, given the increased prevalence of depression in women, the relationship between hypersomnia and depression is important to be aware of in evaluating these patients as well. There are several different options for treatment of primary hypersomnias. Special consideration should be given when prescribing modafinil or armodafinil to women given the interaction of these medications with exogenous hormones and oral contraceptives, leading to reduced efficacy and increased clearance of these hormonal treatments. Not enough pregnancy safety data exists with any of the pharmacological treatments for hypersomnia.