Document Detail

Severe, childhood-onset, idiopathic, life-long insomnia responding selectively to opiate therapy: case report with 19 year follow-up.
MedLine Citation:
PMID:  14592269     Owner:  NLM     Status:  PubMed-not-MEDLINE    
BACKGROUND: Idiopathic (primary) insomnia can be difficult to treat; only two prior cases responsive to opiate therapy have been reported. A case is now presented of severe, idiopathic, childhood-onset, familial insomnia, with increased libido, absence of psychopathology, tardive emergence of restless legs syndrome (RLS), and selective response to opiate therapy. CASE REPORT: A 39-year-old woman was referred in 1981 by her physician who had discovered 3 years earlier that propoxyphene treatment of migraines also controlled her chronic insomnia. She had experienced severe insomnia since childhood, and during early adulthood the insomnia intensified, as she would sleep 0-3 h nightly and never napped. Daily generalized motor restlessness resulted in her frequently walking around the house while feeling exhausted. The quality of her life was considerably compromised by her insomnia, motor restlessness, and by an increased libido that was present since puberty and that was only partially relieved by having sex repeatedly with her husband. RESULTS: Nightly opiate therapy for 19 years has controlled the insomnia, motor restlessness, and excessive libido without affecting her normal libido. The insomnia had not responded to treatment with >25 agents covering >10 pharmacologic categories. During her first (unmedicated) polysomnographic (PSG) study in 1981, she slept 0 min while spending 436 min in bed. In 1984, four consecutive PSG studies were conducted in a design that confirmed the efficacy of propoxyphene therapy of her insomnia. In 1990, an ambulatory PSG revealed two runs of EEG rhythmic paroxysmal activity arising from sleep and wakefulness, without clinical correlate. Neurologic history was negative for seizures, but positive for complete right carotid artery occlusion and three transient ischemic attacks. At age 55 years, typical RLS emerged that was controlled with levodopa therapy, and a concurrent relapse of insomnia was controlled with oxycodone replacing propoxyphene. CONCLUSIONS: Nightly opiate therapy of severe idiopathic (primary) insomnia can remain effective during very long-term clinical follow-up. Guidelines are provided for when to consider such an unusual treatment in other cases of severe, chronic insomnia.
C H Schenck; M W Mahowald
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Sleep medicine     Volume:  2     ISSN:  1389-9457     ISO Abbreviation:  Sleep Med.     Publication Date:  2001 Nov 
Date Detail:
Created Date:  2003-10-31     Completed Date:  2003-12-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100898759     Medline TA:  Sleep Med     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  531-6     Citation Subset:  -    
Department of Psychiatry, Minnesota Regional Sleep Disorders Center, Hennepin County Medical Center, and University of Minnesota Medical School, Minneapolis, MN, USA.
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Comment In:
Sleep Med. 2003 May;4(3):251   [PMID:  14592331 ]

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