Dx with idiopathic hypersomnolence (mslt, <1 min).osa diagnosis on cpapx 4wks. drug screen (-). clinically discordant- feel fine at work. is there any danger?

Hypersomnia: Idiopathic hypersomina is a rare disorder that is similar to narcolepsy which also has a low mslt. Aside from the effects of hypersomnia causing traffic accidents, etc., there's no long term complications of these disorders. Osa, if untreated, is associated with increased mortality, cardiovascular disease (chf, mi, arrhythmias), impaired glucose metabolism, cognitive dysfunction, and depression.

IS and OSA no go: If you have osa then DX of is is not really appropriate in my mind. Probably the hypersomnia is related to residual effect of osa then optimize treatment of osa and consider addition of Modafinil if osa treatment is optimal and ahi bellow 5 and compliance is optimal. Make sure there is no sorem if there is one mslt has to be repeated and read by expert lab.

Consult doctor: You need more of test to see if C-PAP fits well , you feel comfortable and there is no desaturation that you oxygen level is well maintained on C-PAP.Discuss with your doctor -ENT specialist and sleep study specialist .