Abstract Introduction Idiopathic hypersomnia (IH) is a central disorder of hypersomnolence characterized by excessive daytime sleepiness (EDS) not attributable to other causes. Diagnosis typically relies on polysomnography followed by multiple sleep latency testing (MSLT). IH affects approximately 1.5% of adults, and up to 9% of children presenting with EDS. In pediatric and adolescent populations, IH leads to significant impairment from morning sleep inertia and persistent daytime sleepiness, adversely impacting school performance, daily functioning, and quality of life. Modafinil is commonly used to reduce sleepiness in IH, though up to one in eight patients do not respond. Methylphenidate hydrochloride (HCl), a dopamine and norepinephrine reuptake inhibitor, has been effective in some IH cases. The delayed release extended-release (ER) formulation, Methylphenidate HCl ER (Jornay PM), is designed for evening dosing with delayed release allowing optimal activation in the morning to combat sleep inertia. We report the case of an older adolescent with IH who experienced marked improvement in morning alertness and overall functioning with nightly Methylphenidate HCl ER. Case Report A 19-year-old male with attention-deficit/hyperactivity disorder (predominantly inattentive type) and anxiety presented with chronic insomnia, delayed sleep phase, and severe morning sleep inertia resulting in excessive school absences. Polysomnography and MSLT showed a mean sleep latency of two minutes without sleep-onset REM periods (potentially SSRI-related) and moderate obstructive sleep apnea demonstrated by an obstructive Apnea-Hypopnea Index (oAHI) of 5.4. CPAP therapy normalized his oAHI, yet significant EDS persisted. The patient was diagnosed with idiopathic hypersomnia and initially treated with Modafinil 100-200 mg daily, improving daytime alertness but not residual morning sleepiness. Methylphenidate HCl ER was introduced at 20 mg nightly, titrated to 40 mg, and increased to 80 mg following discontinuation of Modafinil due to anxiety. Since initiating Methylphenidate HCl ER, the patient demonstrated dramatic improvement—transitioning from frequent high school absences to perfect attendance as a full-time community college student. Both the patient and parent reported substantial improvements in morning wakefulness, academic engagement, and overall functioning. Discussion This case highlights the potential therapeutic benefit of nightly Methylphenidate HCl delayed release ER (Jornay PM) in managing idiopathic hypersomnia, particularly for addressing morning sleep inertia—a symptom inadequately treated by standard stimulants. While current therapies often fail to restore full daytime functioning, this delayed-release formulation may offer an alternative or adjunctive approach. Further research is warranted to evaluate its efficacy and safety in adolescents and young adults with IH. This abstract is funded by: None
Das et al. (Fri,) studied this question.