Note: Page numbers of article titles are in boldface type. A Accidents, risk of, with insufficient sleep, 318 Acquired immunodeficiency syndrome (AIDS), comorbid with narcolepsy, 298 299 Actigraphy, in narcolepsy diagnosis, 275 Alcohol, hypersomnias caused by, 200 Amphetamines, in hypersomnia treatment, 337 Animal models, of pathophysiology of narcolepsy, 264 265 Antidepressants, hypersomnias caused by, 199 Antiepileptic drugs, hypersomnias caused by, 200 Antihistamines, hypersomnias caused by, 199 200 Antihypertensive drugs, hypersomnias caused by, 200 Antipsychotics, hypersomnias caused by, 199 Anxiety, in narcolepsy, 272 Anxiolytics, hypersomnias caused by, 199 Apnea. See Obstructive sleep apnea. Appetite, comorbid dysregulation in narcolepsy, 292 294 compulsive eating in Kleine-Levin syndrome, 303 306 Armodafinil, in hypersomnia treatment, 337 Arousal, dopamine neurotransmission and, 184 regulatory mechanisms of sleep and, 180 182 Autoimmune disorders, of nervous system, hypersomnia and, 258 259 Autoimmunity, in pathophysiology of narcolepsy, 266 267 Automatic behavior, in narcolepsy, 271 B Behavioral management, of hypersomnia, 323 331 age considerations in, 326 327 older adults, 326 327 young adults, 326 cognitive-behavioral intervention for, 329 in context of parent disorder, 327 329 circadian rhythm sleep disorders, 327 328 idiopathic hypersomnia, 288, 327 narcolepsy, 327, 346 348 sleep apnea, 327 unipolar and bipolar depression, 328 329 options for, 325 326 distracting technologies, 326 exercise, 325 326 napping, 326 Sleep Med Clin 7 (2012) 391 398 doi:10.1016/s1556-407x(12)00056-2 1556-407X/12/$ see front matter Ó 2012 Elsevier Inc. All rights reserved. sleep diaries, 325 sleep hygiene, 326 Behaviorally induced insufficient sleep syndrome, 251 252, 313 323 consequences of sleep deprivation, 316 319 neurobehavioral effects, 316 317 physiologic effects, 317 319 risk of accidents, 317 sleep architecture and physiologic sleepiness, 316 epidemiology of, 315 316 factors affecting risk of and adaptation to insufficient sleep, 319 320 in differential diagnosis of hypersomnias, 191 193 management, 320 Biomarkers, of narcolepsy and other hypersomnias, 233 248 basic sleep physiology and symptoms of, 235 236 changes in other neurotransmitter systems in, 243 244 discovery of hypocretin deficiency in, 236 238 histamine and, 244 246 hyprocretin involvement in symptomatic, hyprocretin ligand and narcolepsy phenotype, 239 241 neurobiology of wakefulness, 234 235 pathophysiology with normal hyprocretin levels, 238 Bipolar depression, behavioral management of, 328 329 Brain injury, secondary neurogenic hypersomnia after traumatic, 257 Brainstem lesions, hypersomnia as a consequence of, 182 183 Breathing disorders, sleep-related, in differential diagnosis of hypersomnias, 193 194 C Caffeine, in hypersomnia treatment, 337 Cardiovascular disease, as consequence of hypersomnia in older adults, 373 Cataplexy, in narcolepsy, 268 269 in children, 269 Central nervous system (CNS) hypersomnia Kleine-Levin syndrome. See Kleine-Levin syndrome. narcolepsy. See Narcolepsy. sleep.theclinics.com
392 Cerebral spinal fluid (CSF), hypocretin measurement in, 236 238, 274 275 Children. See Pediatrics. Circadian rhythm sleep disorders, behavioral management of, 327 328 physical examination in patients with hypersomnia and, 215 216 Civil liability, for inappropriate situational sleepiness, 359 360 Cluster headaches, in narcolepsy, 297 Cognitive dysfunction, comorbid, in narcolepsy, 297 298 Cognitive-behavioral intervention, for hypersomnia, 329 Comorbidities, associated with hypersomnia in older adults, 369 372 medical factors and medications, 369 371 sleep disorders, 371 372 of CNS hypersomnia, 291 302 in Kleine-Levin syndrome, 299 in narcolepsy, 291 299 Compulsive eating, in Kleine-Levin syndrome, 303 306 Continuous positive airway pressure (CPAP), in management of hypersomnia in sleep apnea, 327 Criminal liability, for inappropriate situational sleepiness, 357 359 Cytokines, hypersomnia associated with immune system activation, 184 186 D Daytime sleepiness. See Hypersomnia. Delayed sleep phase disorder, in children, 386 387 Dementia, as consequence of hypersomnia in older adults, 373 374 Depression, as consequence of hypersomnia in older adults, 373 behavioral management of unipolar and bipolar, 328 329 Diabetes mellitus, comorbid, in narcolepsy, 294 295 Diagnosis, differential. See Differential diagnosis. Diaries, sleep, in behavioral management of hypersomnia, 325 Differential diagnosis, of hypersomnias, 191 204 behaviorally induced insufficient sleep syndrome, 191 193 caused by medical conditions, 200 202 infectious disorders, 201 metabolic or endocrine disorders, 200 201 neurologic causes, 201 202 caused by medications and drugs, 199 200 alcohol, 200 antidepressants, 199 antiepileptics, 200 antihistamines, 199 200 antihypertensive drugs, 200 antipsychotics, 199 anxiolytics, 199 dopamine agonists, 200 hypnotics, 199 pain medications, 200 idiopathic, 196 197 long sleeper, 193 narcolepsy, 194 196 recurrent, 197 199 Kleine-Levin syndrome, 197 198 menstrual-related, 198 199 sleep-related breathing disorders, 193 194 Distracting techniques, in behavioral management of hypersomnia, 326 Dopamine, neurotransmission and arousal, 184 Dopamine agonists, hypersomnias caused by, 200 Driving, impaired due to inappropriate situational sleepiness, 358 361 civil liability for, 359 360 criminal liability for, 357 359 in commercial motor vehicle drivers, 360 361 legal context, 360 361 in Europe, 361 in US, 360 361 Drugs. See also Pharmacotherapy. inappropriate situational sleepiness due to, legal consequences of, 356 357 E Eating, compulsive, in Kleine-Levin syndrome, 303 306 Elderly patients. See Older adults. Endocrine disorders, comorbid, in narcolepsy, 292 294 hypersomnia secondary to, 200 201 Epilepsy, secondary neurogenic hypersomnia after, 257 258 Epworth sleepiness scale, 225 227 Examination, physical. See Physical examination. Excessive daytime sleepiness (EDS). See Hypersomnias. Exercise, in behavioral management of hypersomnia, 325 326 F Falls, in elderly patients with hypersomnia, 372 373 Fibromyalgia, comorbid with narcolepsy, 297 G Geriatrics. See Older adults. H Hallucinations, in narcolepsy, 269 Headache syndromes, in narcolepsy, 296 297
393 Health-related quality of life. See Quality of life. Histamine, hypersomnia and insufficiency of, 183 184 interaction with hypocretin in narcolepsy, 244 narcolepsy associated with decreased histaminergic neurotransmission, 244 246 HLA typing, in narcolepsy diagnosis, 275 Human immunodeficiency virus (HIV), comorbid with narcolepsy, 298 299 Hypersomnia, 179 389 behavioral management of, age considerations in, 326 327 cognitive-behavioral intervention for, 329 in context of parent disorder, 327 329 options for, 325 326 behaviorally induced insufficient sleep, 313 323 comorbidities of central nervous system, 291 302 in Kleine-Levin syndrome, 299 in narcolepsy, 291 299 cognitive dysfunction, 297 298 endocrine and metabolic dysregulation, 292 295 headache syndromes, 296 297 HIV/AIDS and other infections, 298 299 psychiatric disorders, 295 296 psychosocial, 291 292 differential diagnosis, 191 204 behaviorally induced insufficient sleep syndrome, 191 193 caused by medical conditions, 200 202 infectious disorders, 201 metabolic or endocrine disorders, 200 201 neurologic causes, 201 202 caused by medications and drugs, 199 200 idiopathic, 196 197 long sleeper, 193 narcolepsy, 194 196 recurrent, 197 199 Kleine-Levin syndrome, 197 198 menstrual-related, 198 199 sleep-related breathing disorders, 193 194 idiopathic, 196 197, 283 289 clinical features and diagnosis, 285 286 epidemiology, 284 285 treatment, 286 288 in children, 379 389 challenges and opportunities, 387 388 clinical assessment, 381 382 consequences of daytime sleepiness in, 380 381 delayed sleep phase disorder, 386 387 factors predisposing to, 379 380 idiopathic, 385 inadequate sleep hygiene, 382 narcolepsy, 382 385 periodic hypersomnia, 382 prevalence, 379 in older patients, 365 378 assessment, 366 367 consequences of, 372 374 demographic factors, 367 369 etiology, 367 medical factors, 369 371 prevalence, 366 sleep disorders and, 371 372 treatment, 374 inappropriate situational sleepiness and the law, 353 363 broad concepts, 353 355 legal frameworks, 357 361 medical conditions associated with, 355 357 Kleine-Levin syndrome, 197 198, 215, 254, 299, 303 312 clinical features, 304 306 clinical variants, 307 308 course of, 306 307 demographics, 304 differential diagnosis, 308 historical note, 303 304 laboratory tests, 306 pathophysiology, 308 309 predisposing and precipitating factors, 304 treatment, 309 310 measurement of excessive sleepiness, 219 232 Epworth sleepiness scale, 225 227 Karolinska sleepiness scale, 228 maintenance of wakefulness test, 223 225 multiple sleep latency test, 219 223 Osler test, 225 psychomotor vigilance testing, 225 Stanford sleepiness scale, 228 narcolepsy, 263 281 clinical features, 267 273 diagnostic classification, 275 276 diagnostic tools, 273 275 epidemiology, 264 neurochemistry and biomarkers of, 233 248 basic sleep physiology and symptoms of, 235 236 changes in other neurotransmitter systems in, 243 244 discovery of hypocretin deficiency in, 236 238 histamine and, 244 246 hyprocretin involvement in symptomatic, hyprocretin ligand and narcolepsy phenotype, 239 241 neurobiology of wakefulness, 234 235 pathophysiology with normal hyprocretin levels, 238 pathophysiology, 264 267 quality of life in, 341 351
394 Hypersomnia (continued ) neurophysiology and neurochemistry, 179 190 as a consequence of brainstem lesions, 182 183 associated with immune system activation, 184 186 dopamine neurotransmission and arousal, 184 due to hypocretin (orexin) insufficiency, 183 histamine insufficiency and, 183 184 regulatory mechanisms of arousal and sleep, 180 182 pharmacotherapy of, 333 340 amphetamines, 337 armodafinil, 337 338 caffeine, 338 indications, 333 335 measuring efficacy of stimulants, 335 337 methylphenidate, 337 modafinil, 337 338 physical examination of patient with, 205 218 general, 206 in circadian rhythm disorders, 215 216 in Kleine-Levin syndrome, 215 in narcolepsy and other central hypersomnias, 214 215 in obstructive sleep apnea, 206 214 in parasomnias, 215 in recurrent hypersomnias, 215 in secondary hypersomnia, 216 in sleep-related movement disorders, 215 primary and secondary neurogenic, 249 261 clinical spectrum, 249 epidemiology and classification, 249 250 pathophysiology and diagnostic pitfalls, 250 primary, 250 254 behaviorally induced insufficient sleep syndrome, 251 252 idiopathic, 252 254 Kleine-Levin syndrome and recurrent, 254 narcolepsy, 250 251 secondary, 254 259 after stroke, 254 256 after traumatic brain injury, 257 epilepsy and, 257 258 infectious/autoimmune disorders of nervous system and, 258 259 neuromuscular disorders and, 259 parkinsonism and, 256 257 restless legs syndrome and, 258 Hypersomnolence. See Hypersomnia. Hypnotics, hypersomnias caused by, 199 Hypocretin, deficiency of, and postnatal cell death of hypocretin neurons, 236 238 hypersomnia due to, 183 in idiopathic hypersomnia, 238 in narcolepsy pathophysiology, 239 241, 266 cause of deficiency, 266 I from deficiency to clinical symptoms, 267 ligand deficiency and narcolepsy phenotype, 239 241 deficiency and narcoleptic phenotype, 240 241 sleep regulation and, 239 240 pathophysiology of narcolepsy with normal levels of, 238 in nondeficient primary hypersomnia, 238 involvement in symptomatic narcolepsy, role in Kleine-Levin syndrome, 308 Idiopathic hypersomnia, 252 254, 283 289 changes in other neurotransmitter systems in, 243 244 clinical features, 252 253, 285 286 decreased histaminergic neurotransmission in, 244 246 diagnosis, 253 differential diagnosis, 253 epidemiology, 252, 284 285 hypocretin and, 238 in children, 385 in differential diagnosis of hypersomnias, 196 197 pathophysiology, 253 predisposing factors, 284 285 treatment, 253 254, 286 288 behavioral, 288, 327 Immune system activation, hypersomnia associated cytokines and, 184 186 Inappropriate situational sleepiness, and the law, 353 363 broad concepts, 353 355 legal frameworks, 357 361 civil liability for, 359 360 criminal liability for, 357 359 legal context in Europe, 361 legal context in the US, 360 361 medical conditions associated with, 355 357 drugs, 357 in healthcare workers, 355 insufficient sleep, 355 narcolepsy, 356 357 obstructive sleep apnea, 355 356 Infectious disorders, hypersomnia secondary to, 201, 258 259 Insufficient sleep. See Behaviorally induced insufficient sleep. Intoxication, inappropriate situational sleepiness due to, legal consequences of, 356 357 K Karolinska sleepiness scale, 228
395 Kleine-Levin syndrome, 197 198, 215, 254, 299, 303 312 clinical features, 304 306 behavioral symptoms, 305 cognitive symptoms, 305 end of episodes, 306 mental symptoms, 305 onset of episodes, 305 physical signs symptoms, 306 clinical variants, 307 308 comorbidities with, 299 course of, 306 307 demographics, 304 differential diagnosis, 308 historical note, 303 304 in children, 383 in differential diagnosis of hypersomnias, 197 198 laboratory tests, 306 pathophysiology, 308 309 contribution of neuroimaging studies, 308 mood disorder and, 308 309 neuropathologic data, 308 recurrence, 308 role of hypocretins, 308 physical examination in patients with, 215 predisposing and precipitating factors, 304 treatment, 309 310 L Legal issues, inappropriate situational sleepiness and the law, 353 363 broad concepts, 353 355 legal frameworks, 357 361 civil liability for, 359 360 criminal liability for, 357 359 legal context in Europe, 361 legal context in the US, 360 361 medical conditions associated with, 355 357 drugs, 357 in healthcare workers, 355 insufficient sleep, 355 narcolepsy, 356 357 obstructive sleep apnea, 355 356 Liability, for inappropriate situational sleepiness, 357 360 civil, 359 360 criminal, 357 359 Long sleep, idiopathic hypersomnia with, 284 in differential diagnosis of hypersomnias, 193 M Maintenance of wakefulness test (MWT), 223 225 Medical conditions. See also Comorbidities. differential diagnosis of hypersomnias caused by, 200 202 infectious disorders, 201 metabolic or endocrine disorders, 200 201 neurologic causes, 201 202 Medications. See Pharmacotherapy. Medicolegal issues. See Legal issues. Memory complaints, in narcolepsy, 271 Menstrual related hypersomnias, differential diagnosis, 198 199 in Kleine-Levin syndrome, 307 Metabolic disorders, hypersomnia secondary to, 200 201 Metabolic dysregulation, comorbid, in narcolepsy, 292 294 Methylphenidate, in hypersomnia treatment, 337 Migraine headaches, in narcolepsy, 296 297 Modafinil, in treatment of hypersomnia, 337 338 after stroke, 255 after traumatic brain injury, 257 idiopathic, 253 254, 287 narcolepsy, 251 Monoamines, hypersomnia and, 183 184 Mood disorders, in Kleine-Levin syndrome, 308 309 in narcolepsy, 272 Mortality, increased risk related to hypersomnia in older adults, 374 Movement disorders, sleep-related, physical examination in patients with hypersomnia and, 215 Multiple sleep latency test (MSLT), 219 223, 274, 286 N Napping, in behavioral management of hypersomnia, 326 in older adults with hypersomnia, 373 Narcolepsy, 263 281 clinical features, 250 251, 267 273 anxiety, 272 cataplexy, 268 269 in children, 269 decreased vigilance, automatic behavior, and memory complaints, 271 disturbed nocturnal sleep, 270 271 excessive daytime sleepiness, 267 268 general aspects, 267 hallucinations, 269 mood disorders, 272 obesity, 271 272 other psychiatric symptoms, 272 psychosocial consequences, 272 273 sleep paralysis, 270 comorbidities with, 291 299 cognitive dysfunction, 297 298 endocrine and metabolic dysregulation, 292 295 headache syndromes, 296 297 HIV/AIDS and other infections, 298 299 psychiatric disorders, 295 296 psychosocial, 291 292
396 Narcolepsy (continued ) diagnostic classification, 275 276 diagnostic tools, 251, 273 275 clinical approach, 273 274 CSF hypocretin-1 measurements, 274 275 multiple sleep latency test, 274 nocturnal polysomnography, 274 other, 275 epidemiology, 195, 250, 264 in children, 383 385 in differential diagnosis of hypersomnias, 194 196, 251 inappropriate situational sleepiness due to, legal consequences of, 356 357 neurochemistry and biomarkers of, 233 248 basic sleep physiology and symptoms of, 235 236 changes in other neurotransmitter systems in, 243 244 discovery of hypocretin deficiency in, 236 238 histamine and, 244 246 hyprocretin involvement in symptomatic, hyprocretin ligand and narcolepsy phenotype, 239 241 neurobiology of wakefulness, 234 235 pathophysiology with normal hyprocretin levels, 238 pathophysiology, 195 196, 251, 264 267 animal models, 264 265 as a hypocretin deficiency syndrome, 265 autoimmunity and, 265 266 cause of hypocretin deficiency, 265 from hypocretin deficiency to clinical symptoms, 266 physical examination in patients with, 214 215 quality of life in, 341 351 considerations in developing indicators of, 342 measurement of, 342 343 selected instruments for, 343 review of studies on, 343 346 with nonpharmacologic management, 346 348 treatment, 196, 251 behavioral management, 327 use of multiple sleep latency test to assess, 219 223 Nervous system, hypersomnia and infectious/ autoimmune disorders of, 258 259 Neurochemistry, and biomarkers of narcolepsy and other hypersomnias, 233 248 basic sleep physiology and symptoms of, 235 236 changes in other neurotransmitter systems in, 243 244 discovery of hypocretin deficiency in, 236 238 histamine and, 244 246 hyprocretin involvement in symptomatic, hyprocretin ligand and narcolepsy phenotype, 239 241 neurobiology of wakefulness, 234 235 pathophysiology with normal hyprocretin levels, 238 and neurophysiology of hypersomnia, 179 190 as a consequence of brainstem lesions, 182 183 associated with immune system activation, 184 186 dopamine neurotransmission and arousal, 184 due to hypocretin (orexin) insufficiency, 183 histamine insufficiency and, 183 184 regulatory mechanisms of arousal and sleep, 180 182 Neurogenic hypersomnias. See Hypersominias. Neuroimaging studies, in Kleine-Levin syndrome, 308 Neurologic disorders, hypersomnia secondary to, 201 202 Neuromuscular disorders, hypersomnia and, 259 Neurophysiology, and neurochemistry of hypersomnia, 179 190 as a consequence of brainstem lesions, 182 183 associated with immune system activation, 184 186 dopamine neurotransmission and arousal, 184 due to hypocretin (orexin) insufficiency, 183 histamine insufficiency and, 183 184 regulatory mechanisms of arousal and sleep, 180 182 Neurotransmitter system, change in, in narcolepsy and idiopathic hypersomnia, 243 244 O Obesity, in narcolepsy, 271 272 Obstructive sleep apnea, CPAP for, in behavioral management of hypersomnia in, 327 in differential diagnosis of hypersomnias, 193 194 inappropriate situational sleepiness due to, legal consequences of, 355 physical examination in patients with hypersomnia and, 206 214 cardiopulmonary, 212 demographics, 206 dental, 211 212 imaging, 213 214 in specific syndromes, 214 nasal, 208 209 nasopharyngeal endoscopy, 213 neck, 207 208 neurologic, 212 213 oropharyngeal, 209 211 vital signs, 206 207
397 Older adults, hypersomnia in, 365 378 assessment, 366 367 consequences of, 372 374 cardiovascular disease, 373 dementia, 373 374 depression, 373 falls, 372 373 functional outcomes, 372 mortality, 374 napping, 373 demographic factors, 367 369 etiology, 367 medical factors, 369 371 prevalence, 366 sleep disorders and, 371 372 treatment, 374 Orexin, hypersomnia due to, 183 Osler test, 225 P Pain medications, hypersomnias caused by, 200 Paralysis, sleep, in narcolepsy, 270 Parasomnias, physical examination in patients with hypersomnia and, 215 Parkinsonism, secondary neurogenic hypersomnia after, 256 257 Pediatrics, hypersomnia in children, 379 389 challenges and opportunities, 387 388 clinical assessment, 381 382 consequences of daytime sleepiness in, 380 381 delayed sleep phase disorder, 386 387 factors predisposing to, 379 380 idiopathic, 385 inadequate sleep hygiene, 382 narcolepsy, 382 385 cataplexy in, 269 periodic hypersomnia, 382 prevalence, 379 Periodic hypersomnia, in children. See Kleine-Levin syndrome. Periodic limb movement disorder, physical examination in patients with hypersomnia and, 215 Pharmacotherapy, associated with hypersomnia in older adults, 369 371 differential diagnosis of hypersomnias caused by, 199 200 alcohol, 200 antidepressants, 199 antiepileptics, 200 antihistamines, 199 200 antihypertensive drugs, 200 antipsychotics, 199 anxiolytics, 199 dopamine agonists, 200 hypnotics, 199 pain medications, 200 of hypersomnia, 333 340 amphetamines, 337 armodafinil, 337 338 caffeine, 338 indications, 333 335 measuring efficacy of stimulants, 335 337 methylphenidate, 337 modafinil, 337 338 for hypersomnia after stroke, 255 for hypersomnia after traumatic brain injury, 257 for idiopathic hypersomnia treatment, 253 254, 287 for narcolepsy treatment, 251 Physical examination, of patients with hypersomnia, 205 218 general, 206 in circadian rhythm disorders, 215 216 in Kleine-Levin syndrome, 215 in narcolepsy and other central hypersomnias, 214 215 in obstructive sleep apnea, 206 214 in parasomnias, 215 in recurrent hypersomnias, 215 in secondary hypersomnia, 216 in sleep-related movement disorders, 215 Polysomnography, nocturnal, in diagnosis of narcolepsy, 274 Primary neurogenic hypersomnias, 250 254 behaviorally induced insufficient sleep syndrome, 251 252 idiopathic. See Idiopathic hypersomnia. Kleine-Levin syndrome and recurrent, 254 narcolepsy. See Narcolepsy. Psychiatric symptoms, in narcolepsy, 272, 295 296 Psychomotor vigilance testing, 225 Psychosocial comorbidities, of narcolepsy, 272 273, 291 292 Psychosocial management, of narcolepsy, quality of life with, 346 348 Q Quality of life, in narcolepsy, 341 351 considerations in developing indicators of, 342 measurement of, 342 343 selected instruments for, 343 review of studies on, 343 346 with nonpharmacologic management, 346 348 R Recurrent hypersomnia, in differential diagnosis of hypersomnias, 197 199
398 Recurrent (continued) Kleine-Levin syndrome, 197 198, 308 menstrual-related, 198 199 physical examination in patients with, 215 REM behavior disorder, physical examination in patients with hypersomnia and, 215 Restless legs syndrome, physical examination in patients with hypersomnia and, 215 secondary neurogenic hypersomnia after, 258 S Secondary hypersomnia, physical examination in patients with, 216 Secondary neurogenic hypersomnias, 254 259 after stroke, 254 256 after traumatic brain injury, 257 epilepsy and, 257 258 infectious/autoimmune disorders of nervous system and, 258 259 neuromuscular disorders and, 259 parkinsonism and, 256 257 restless legs syndrome and, 258 Sexuality, disinhibition of, in Kleine-Levin syndrome, 303, 305 Short sleep, idiopathic hypersomnia with, 284 Sleep, basic neurophysiology of, 235 236 behaviorally induced insufficient, 313 323 disturbed nocturnal, in narcolepsy, 270 271 regulatory mechanisms of arousal and, 180 182 sufficiency and insufficiency of, 313 314 Sleep apnea. See Obstructive sleep apnea. Sleep hygiene, in behavioral management of hypersomnia, 326 in children, hypersomnia due to inadequate, 383 Sleep-related disorders, breathing disorders in differential diagnosis of hypersomnias, 193 194 delayed sleep phase disorder in children, 386 387 in older adults, hypersomnia associated with, 371 372 movement disorders, physical examination in patients with hypersomnia and, 215 sleep paralysis in narcolepsy, 270 Sleepiness scales, objective and subjective measurement with, 219 232 Epworth sleepiness scale, 225 227 Karolinska sleepiness scale, 228 maintenance of wakefulness test, 223 225 multiple sleep latency test, 219 223 Osler test, 225 psychomotor vigilance testing, 225 Stanford sleepiness scale, 228 Stanford sleepiness scale, 228 Stimulants. See Pharmacotherapy. Stroke, secondary neurogenic hypersomnia after, 254 256 T Tension headaches, in narcolepsy, 297 Traumatic brain injury, secondary neurogenic hypersomnia after, 257 Treatment, of hypersomnia. See Pharmacotherapy, Behavioral management, and individual disorders. U Upper airway resistance syndrome, in differential diagnosis of hypersomnias, 193 194 V Vigilance, decreased, in narcolepsy, 271 W Wakefulness, neurobiology of, 234 235 Weight, comorbid endocrine and metabolic dysregulation in narcolepsy, 292 294 Working hours, effect on sleep, 319 320