Narcolepsy Differential Diagnoses

Updated: May 04, 2023
  • Author: Sagarika Nallu, MD; Chief Editor: Selim R Benbadis, MD  more...
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Diagnostic Considerations

Idiopathic hypersomnia is similar in presentation to narcolepsy, but patients with this condition have no sleep-onset rapid eye movement (REM) period, and naps are unrefreshing. [47] In addition, idiopathic hypersomnia is not associated with cataplexy. Idiopathic hypersomnia can be difficult to distinguish from narcolepsy, though the advent of the modern sleep laboratory has aided in diagnosing these challenging cases.

Differentiation of these 2 disorders can provide valuable insight for therapy. Although amphetamines are used for treatment of both idiopathic hypersomnia and narcolepsy, the excessive daytime sleepiness (EDS) in patients with idiopathic hypersomnia is often resistant to stimulant treatments. In addition, sodium oxybate, which is very costly, is not approved for use in idiopathic hypersomnia.

In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:

  • Prader-Willi syndrome

  • Kasabach-Merritt syndrome

  • Syndrome of autosomal dominant cerebellar ataxia, deafness, and narcolepsy [48]

  • Delayed sleep-phase syndrome

  • Autism

  • Depression

  • Diencephalic lesions

  • Drug abuse

  • Insufficient sleep syndrome

  • Kleine-Levin syndrome [49]

  • Medication effect

  • Norrie disease [50]

  • Poor sleep hygiene

  • Posttraumatic narcolepsy [51]

  • Increased intracranial pressure

  • Conversion disorder, factitious disorder, and malingering

Differential Diagnoses