Abstract Introduction Narcolepsy and idiopathic hypersomnia (IH) are chronic central disorders of hypersomnolence that typically emerge in adolescence but often remain undiagnosed for years. Their primary clinical feature, excessive daytime sleepiness, closely resembles symptom patterns frequently observed in mood and attention-related psychiatric conditions in young adults, increasing the likelihood of diagnostic misclassification. Within college populations, where insufficient sleep is the norm, pathological hypersomnolence may be particularly difficult to recognize. This study evaluated the prevalence, demographic patterns, psychiatric comorbidity, and functional outcomes associated with diagnosed and probable hypersomnolence disorders in a large national sample. Methods The analysis utilized responses from 103,619 students in the Spring 2024 ACHA-NCHA IIIb survey. Students self-reporting a diagnosis of narcolepsy or hypersomnolence (n = 170 after data-quality exclusions) comprised the diagnosed group. A probable hypersomnia group (n = 1,081) was identified using a stringent 10-point rubric incorporating sleep duration, daytime sleepiness, frequency of feeling rested, and academic impairment. All other respondents served as controls. Group differences in psychiatric diagnoses, wellbeing, substance use, and academic outcomes were assessed using chi-square tests and one-way ANOVA. Results Probable hypersomnolence was 6-7 times more prevalent than self-reported medical diagnoses, indicating substantial underdiagnosis. Both diagnosed and probable groups were disproportionately female, White, and queer-identified relative to the broader sample. Students with hypersomnolence exhibited markedly elevated rates of depression, anxiety, ADHD, and bipolar-spectrum diagnoses, alongside higher likelihood of receiving psychotropic medication. Indices of psychological wellbeing were significantly poorer, including higher serious psychological distress, loneliness, and suicide risk. Several forms of substance use risk were elevated. Academic outcomes were adversely impacted: both hypersomnia groups reported lower GPA and were more likely to consider withdrawing from college due to health-related challenges. Conclusion Findings indicate that hypersomnolence disorders in college students are substantially underdiagnosed and frequently overshadowed by psychiatric symptoms. The magnitude of impairment across mental health, substance use, and academic functioning underscores the need for systematic screening of hypersomnolence symptoms in college health settings and greater clinical awareness of sleep-psychiatric diagnostic overlap. Support (if any) Supported by the University of St. Thomas Young Scholars Program.
Loomis et al. (Fri,) studied this question.