1366 Optimal Management of Nightmare Disorder due to Multifactorial Etiologies in a Patient with Hypersomnia

Abstract Introduction Nightmares are usually associated with insomnia but rarely can arise from distinct and overlapping etiologies that can result in hypersomnia. The etiologies that need to be considered would be PTSD, acute stress disorder, nightmare disorder, depression, anxiety, medication/substance effect, narcolepsy, Idiopathic Hypersomnia. Rare causes are intracranial mass lesion, CNS infections, and epilepsy. Report of case(s) A 21-year-old Caucasian female with a history of morbid obesity, major depression, PTSD, and hypertension who presented with complaints of hypersomnia and constant drowsiness during the day. She reported that her daytime drowsiness started when she was around the age of 11 or 12 years old and needed 16 to 17 hours of sleep per day to function but continued to feel unrefreshed on waking up, raising concerns for narcolepsy without cataplexy versus idiopathic insomnia. She also suffers from frequent and recurring nightmares that started around the same age as her hypersomnia complaints with her nightmares occurring almost daily to every other day. This was worsened 2 to 3 years ago when she was a victim of sexual assault, and she is now experiencing more frequent and vivid nightmares related to this event. She is currently being treated by psychiatry for PTSD and depression with Lexapro 20 mg daily and prazosin to help manage her nightRmares. Increasing prazosin 1 mg at bedtime to 2 mg has reduced the intensity of the dreams. Unfortunately, nightmares continue to be a regular occurrence due to her hypersomnia and extended sleep times. A polysomnogram was performed followed by a multiple sleep latency test demonstrating a reduced sleep consistently less than 5 minutes but was negative for sleep onset REM confirming a diagnosis of idiopathic hypersomnia. Treatment of idiopathic hypersomnia using stimulants during the day leads to improvement in her quality of life. Conclusion The patient with multifactorial etiology for nightmare disorder benefited with treatment of the etiologies Support (if any)