Too Tired or Too Drugged?

    
      Re: Too Tired or Too Drugged?
    


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Posted by CCF Neuro MD on August 16, 1997 at 11:47:12:

In Reply to: Too Tired or Too Drugged? posted by Laura on July 23, 1997 at 10:09:46:

: I'm a 42F that has been on lithium for 15 years for BP.  Thyroid is tested yearly and is okay; blood level okay for me.  Daytime sleepiness is debilitating.  I wake up and need a nap to start the day. I have memory lapses, accidents, and can fall asleep anywhere, any time.  I was looking up something else and found narcolepsy.  I've never had cataplexy, but I've have the hypnagogic hallucinations, and some sleep paralysis.  I've taken my ADD son's Ritalin/Dexedrine in emergencies and it helps.  My question: Is it the lithium/lithium levels or could it be narcolepsy or something else?
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Dear Laura:
I agree. Your symptoms are quite concerning for narcolepsy. Although cataplexy is frequent, it is not a universal symptom of narcolepsy. You do seem to have some of the other symptoms of the disorder. Narcolepsy is not an uncommon condition, but is under-recognised.
Although lithium has effects on sleep architecture and the circadian rhythm, I could not find references of lithium inducing narcolepsy, or causing hypersomnolence at therapeutic levels.  
A complete sleep study (MSLT and polysomnography) can help diagnose your problem. Very importantly, it can help exclude other causes of excessive daytime drowsiness, such as obstructive sleep apnea syndrome. Pursuing a diagnostic work-up of your symptom is very appropriate because hypersomnolence can be dangerous (e.g. while driving), and most causes of the problem are eminently treatable.
I certainly do not recommend your taking your son