Idiopathic hypersomnia, the recurrent hypersomnias, and EDS associated with nervous system disorders also must be understood in order to provide appropriate evaluation and management. Narcolepsy is the most well known and extensively studied of the EDS conditions arising from CNS dysfunction, yet it, too, is often misunderstood and misdiagnosed. Indeed, lack of an understanding of these conditions not only leads to their being misdiagnosed or overlooked, but at times results in gross mismanagement (e.g., the use of antipsychotic medications for narcolepsy-related hypnagogic hallucinations). Sleep-related conditions that arise from CNS dysfunction tend to be less familiar to the clinician. Comorbid disorders of somnolence or excessive daytime sleepiness (EDS) add frustration to the diagnostic workup and complexity to the treatment of individuals with psychiatric disorders. However, not infrequently, the patient receives the diagnosis of a psychiatric illness when none is present. Sometimes the CNS condition of excessive sleepiness is comorbid with a primary psychiatric disorder. Occasionally, patients will manifest somnolence or frank sleepiness-unrelated to factors such as those noted above or to the primary psychiatric condition they have-as a result of distinct central nervous system (CNS) dysfunction. The careful characterization of the complaint is of key importance in the evaluation of suboptimal alertness or fatigue for appropriate diagnosis and symptom management-primary treatment, when possible, or secondary amelioration. Potential contributing elements include presumed physiological epiphenomena of primary pathological conditions (e.g., “hypersomnia” in “atypical” depression), medication effects, use or abuse of sedating substances, sleep disruption, advanced or delayed circadian rhythm phase, voluntary or involuntary sleep restriction, and other sleep disorders (e.g., obstructive sleep apnea syndrome). Many factors contribute to the experience of diminished alertness across individuals with such complaints. The complaints of tiredness, fatigue, sedation, and sleepiness are common among patients with psychiatric disorders.
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