Why would someone suddenly have difficulty awakening? Two week duration now. Was on Lexapro and Sonata and both have been dc'd so no meds at all. Guy has 3 alarm clocks placed throughout his room. Last time I saw him he reported he thought he was in a dream that morning and was turning off his alarms in his dream. Sleeps 9.5 hours straight through. No hx of any sleep disturbances in past. What gives?
Does he sleep extra on weekends (behaviorally induced insufficient sleep)? What hours has he traditionally slept (circadian misalignment or time zone change)? Any head trauma or neurological infections? Any sleep paralysis or cataplexy-like stuff? Also, are all three alarm clocks going off simultaneously or has he staggered them over a multi-minute period that is simply wrecking he last REM phase? He may be torturing himself with an hour or so of unnecessary wakeups...
Cut out alcohol, get some exercise and keep some regular sleep times. I'd check a thorough neurological exam just to be safe there isn't some anatomical problem starting. I agree he needs a regular sleep study first.
If the PSG is positive for OSA, then I'd get him PAP. If it's negative for SDB or PLMs, then I'd let him sleep as much as he wants for two weeks (keeping a sleep log), check a TSH and free T4, and do a PSG with MSLT (and UDS) to check for narcolepsy and idiopathic hypersomnolence, etc.
Other causes could be vitamin deficiency, low testosterone, anemia, bradycardia, drug abuse, stress, etc.
Keep us posted on the outcome!
