Chronic Hypersomnia and Sleep Disturbances in a Young Mother

Case at a Glance

A 30-year-old mother of two presents with chronic hypersomnia and sleep disturbances that have persisted since adolescence, significantly impacting her daily functioning and family life.

Patient's Story

The patient reports experiencing excessive daytime sleepiness since age 12-13, with episodes of prolonged sleep lasting up to 48 hours. She describes a pattern of difficulty falling asleep at night, followed by sleeping until late afternoon (4:30-5:00 PM). When forced to wake early for work or childcare responsibilities, she experiences severe fatigue, feeling 'heavy' and emotionally distressed. As a mother of two young children, she struggles significantly with morning routines and reports sleeping extensively on weekends when her spouse is available to help with childcare, leading to feelings of guilt about missing family time.

Initial Assessment

The patient presents with a complex sleep disorder characterized by both insomnia and hypersomnia symptoms. Her sleep patterns are severely disrupted, with difficulty initiating sleep followed by prolonged sleep episodes. The condition significantly impairs her ability to function as a parent and maintain normal daily activities. She reports feeling emotionally distressed and guilty about her sleep patterns affecting family life.

The Diagnostic Journey

The patient has sought medical attention multiple times over the years but has received only basic sleep hygiene recommendations (early bedtime, screen avoidance, magnesium supplementation) without comprehensive evaluation. Previous healthcare providers have not conducted thorough sleep disorder assessments or considered underlying sleep pathology. A differential diagnosis consideration includes sleep apnea, as suggested by the clinical presentation.

Final Diagnosis

Pending comprehensive sleep study evaluation. Differential diagnosis includes obstructive sleep apnea, idiopathic hypersomnia, circadian rhythm sleep-wake disorders, or underlying mood disorders with sleep disturbance components.

Treatment Plan

Recommend referral to sleep medicine specialist for comprehensive evaluation including overnight polysomnography and multiple sleep latency testing. Consider screening for underlying medical conditions such as thyroid disorders, depression, or other metabolic causes of hypersomnia. Implement structured sleep hygiene protocols and consider cognitive behavioral therapy for sleep disorders.

Outcome and Follow-up

Patient requires ongoing sleep medicine evaluation and monitoring. Treatment success will be measured by improvement in sleep quality, reduced daytime sleepiness, and enhanced ability to maintain normal daily routines and family responsibilities. Regular follow-up appointments will be necessary to adjust treatment plans and monitor progress.