Recurrent hyper- and hyposomnia: a new diagnostic entity? Polysomnographic findings and a 30-year follow-up.

OBJECTIVES: This study reports on the sleep evaluation and follow-up of a professional woman who, in her 30s and 40s, had a decade of severe episodic fluctuations in the length of her sleep (12 vs. 4 h). BACKGROUND: Severe psychogenic fluctuations in the duration of sleep have not previously been described except in bipolar disorders. METHODS: Psychological and medical history and a total of 29 polysomnogram nights are presented, as well as a 30-year follow-up interview. RESULTS: Long sleep episodes (>10 h) were characterized by excessive stage 1 sleep and a stage we called 'very light sleep' (over 50% alpha waves mixed with 5-10% delta waves). Long sleeps were also associated with hyperphagia and hypersexuality. Short sleeps (<4 h) emphasized delta and REM sleep. Sleep normalized spontaneously after about a decade of severe fluctuations. CONCLUSIONS: In this patient, the recurrent hypersomnia/hyposomnia episodes may have been based mainly on psychiatric factors.

Pupillometry in clinically sleepy patients.

OBJECTIVES: Investigators have suggested using pupillometry to assess alertness in hypersomnolent patients. In this study we assessed hypersomnolent patients and normal volunteers by using pupillometry and examined the usefulness of this technique for the diagnosis of pathologic sleepiness in individual patients. METHODS: Forty-nine patients were examined by pupillometry and their sleepiness was assessed by using the multiple sleep latency test (MSLT). Thirty-three normal well-rested volunteers were also examined by pupillometry. The patients were classified as having 'mild', 'moderate', or 'severe' sleepiness, based on their mean MSLT sleep latency. Several dynamic variables of pupil diameter were calculated from the pupillograms and correlated with the mean MSLT sleep latency, and were compared between severity groups of patients and the well-rested normal subjects. RESULTS: All but two pupillometric variables were significantly correlated with sleep latency. All except the same two pupillometric variables of the sleepiest group were significantly different from those of normal subjects. However, only 51% of patients with mean sleep latencies less than 10 min and 35% of patients with mean sleep latencies of less than 5 min could be correctly identified by pupillometry. CONCLUSIONS: Pupillometry is clearly associated with differences in alertness between groups of patients. However, pupillometric assessment cannot substitute for the MSLT in most cases.

The treatment of parasomnias with hypnosis: a 5-year follow-up study.

STUDY OBJECTIVES: This study involves a replication and extension of a previous one reported by Hurwitz et al (1991) on the treatment of certain parasomnias with hypnosis. METHODS: Thirty-six patients (17 females), mean age 32.7 years (range 6-71). Four were children aged 6 to 16. All had chronic, "functionally autonomous" (self-sustaining) parasomnias. All underwent 1 or 2 hypnotherapy sessions and were then followed by questionnaire for 5 years. RESULTS: Of the 36 patients, 45.4% were symptom-free or at least much improved at the 1-month follow-up, 42.2% at the 18-month follow-up, and 40.5% at the 5-year follow-up. CONCLUSIONS: One or 2 sessions of hypnotherapy might be an efficient first-line therapy for patients with certain types of parasomnias.