Which diagnosis best fits duration, episodicity, and exclusions?
A
Narcolepsy
Recurrent periods of irrepressible need to sleep, lapsing into sleep, or napping within same day, for ≥3 months; ≥1 of: cataplexy (brief episodes of bilateral muscle tone loss) ≥few times/month; hypocretin deficiency (CSF hypocretin-1 ≤110 pg/mL); REM sleep latency ≤15 min on MSLT (or mean sleep latency ≤8 min with ≥2 sleep-onset REM periods)
Self-reported excessive sleepiness (hypersomnolence) despite main sleep period of ≥7 hrs; ≥1 of: recurrent lapses into sleep during same day; prolonged main sleep episode (>9 hrs) that is non-restorative; difficulty being fully awake after abrupt awakening
ARecurrent periods of irrepressible need to sleep, lapsing into sleep, or napping within same day, for ≥3 months; ≥1 of: cataplexy (brief episodes of bilateral muscle tone loss) ≥few times/month; hypocretin deficiency (CSF hypocretin-1 ≤110 pg/mL); REM sleep latency ≤15 min on MSLT (or mean sleep latency ≤8 min with ≥2 sleep-onset REM periods)
BSelf-reported excessive sleepiness (hypersomnolence) despite main sleep period of ≥7 hrs; ≥1 of: recurrent lapses into sleep during same day; prolonged main sleep episode (>9 hrs) that is non-restorative; difficulty being fully awake after abrupt awakening
Additional criteria
ANo additional structured criteria supplied
BB. Hypersomnolence occurs ≥3×/week for ≥3 months C. Accompanied by significant distress or impairment D. Not better explained by and does not occur exclusively during another sleep disorder; not occurring exclusively during another sleep-wake disorder
Key features
AA. Recurrent periods of irrepressible need to sleep, lapsing into sleep, or napping within same day, for ≥3 months; ≥1 of: cataplexy (brief episodes of bilateral muscle tone loss) ≥few times/month; hypocretin deficiency (CSF hypocretin-1 ≤110 pg/mL); REM sleep latency ≤15 min on MSLT (or mean sleep latency ≤8 min with ≥2 sleep-onset REM periods)
BA. Self-reported excessive sleepiness (hypersomnolence) despite main sleep period of ≥7 hrs; ≥1 of: recurrent lapses into sleep during same day; prolonged main sleep episode (>9 hrs) that is non-restorative; difficulty being fully awake after abrupt awakening B. Hypersomnolence occurs ≥3×/week for ≥3 months C. Accompanied by significant distress or impairment
Common specifiers
ANarcolepsy Type 1; Narcolepsy Type 2; Narcolepsy due to another medical condition; Mild
BAcute; Subacute; Persistent; Mild
Differential flags
AHypersomnolence disorder (no cataplexy; normal hypocretin; no MSLT SOREMP pattern); Seizure disorder (cataplexy-like episodes - EEG; no emotional trigger); REM sleep behaviour disorder (acting out dreams, not cataplexy)