Menstruation-related periodic hypersomnia: a case study with successful treatment.

ABSTRACT

A 16-year-old girl suffered from 1 to 2-week periods of hypersomnia associated with each menstruation. Serum hormone levels were normal. CSF concentrations of homovanillic acid and 5-hydroxyindolacetic acid were lower in hypersomniac than in symptom-free phases. 3-methoxy-4-hydroxyphenylethylene glycol was not affected. The sleep periods occurred only in connection with ovulatory menstrual cycles. When ovulation was inhibited by a combination of ethinylestradiol and lynestrenol, an oral contraceptive pill, the hypersomnia ceased. Thus, the hypersomnia seemed to be linked to the occurrence of ovulatory menstruations.

ABSTRACT

PIP A 16-year old girl who had undergone normal pubertal development at 13 years 8 months began to menstruate with moderate or severe dysmenorrhea and 1 to 2 weeks of hypersomnia at 16 years 2 months. She was without symptoms between hypersomniac phases. The patient was followed for 3 years, in the hospital for 31 days and as an outpatient thereafter. Examination, including neurologic and gynecologic status, was normal. Serum levels of follicle stimulating hormone, luteinizing hormone, estradiol, and progesterone were normal. CSF concentrations of homovanillic acid and 5-hydroxyindolacetic acid were lower in her hypersomniac than in symptom-free phases. 3-methoxy-4-hydroxyphenylethylene glycol was not affected. The sleep periods occurred only in connection with ovulatory menstrual cycles. Inhibition of ovulation with the oral contraceptive pill Lyndiol, which contains a combination of 50 mcg ethinyl estradiol and 2.5 mg lynestrenol, led to a cessation of the hypersomnia. When treatment was discontinued, the patient had 2 cycles without ovulation and no sleep periods, but ovulation and periodic hypersomnia occurred regularly thereafter. Reinstitution of the contraceptive pill controlled the symptoms. Discontinuation of the treatment was tested 2 more times for 3 months each, and the ovulatory cycles were again accompanied by sleep periods.