LAUSR

Hypersomnia sleep disorders are characterized by overwhelming daytime sleepiness. Treatment options include sodium oxybate the sodium salt of γ-hydroxybutyric acid (GHB). Oxybate, an endogenous metabolite of GABA, acts through GABAB noradrenergic and dopaminergic neurons, as well as at thalamocortical neurons. < 1% may experience suicidal ideations or psychosis. A 17-year-old female with obesity, spina bifida occulta follows with sleep for idiopathic hypersomnia with long sleep (TST 12.6 hours on polysomnography) and a delayed circadian rhythm. Her typical sleep zone is 11:00PM to 10:00AM, but she can easily sleep until 2:00PM. She started sodium oxybate to minimize her sleep burden and improve daytime wakefulness. She initially developed insomnia with concern for mania and migraines with photophobia and phonophobia. After 26 days, oxybate was discontinued. Her migraines persisted daily. Her sleep schedule and mood returned to baseline within 17 days thereafter. A 48-year-old female with anxiety/depression, PTSD has follows with sleep since age 42 for unspecified hypersomnia, either narcolepsy type 1 with long sleep versus idiopathic hypersomnia. Initial polysomnography/MSLT on fluoxetine revealed AHI 1.6, with a mean sleep latency of 6.4 minutes without SOREMPs. Her typical sleep zone was 8:00PM to 9:00AM. She was started on sodium oxybate for her cataplexy and daytime sleepiness. She had remarkable improvement in her symptoms after 4 days. After 35 days on 9 grams nightly she developed anxiety, extracorporeal sensations, and paranoia. The dose was decreased to 7.5 grams nightly. By 7 months of therapy her paranoia progressed to the point where she threatened her landlord and was facing legal consequences. Sodium oxybate was discontinued. At 53-years-old she was trial on mixed-salts oxybate. After three months of therapy, she became hypomanic with severe pressured speech despite a euthymic mood. She reported going without sleep entirely for 3-4 days at a time using this oxybate. Mixed-salts oxybate was discontinued and 36 days later with in addition to quetiapine, her hypomania was nearly resolved and she was able to get 8-9 hours of restful sleep. Hypomania appears to be a rare but serious side effect of oxybate in long-sleepers. Discontinuing oxybate may not be sufficient therapy.