There are days when we get so caught up with daily life activities that we may lose out on sleep for a few nights only to feel groggy and fatigued the rest of the day. This differs from hypersomnia, a sleep disorder in which an individual constantly feels sleepy during the daytime even with a good night rest. The hallmark of this disorder is that the patient sleeps so much and never feel rested after waking up.
Hypersomnia, or hypersomnolence, is a sleep disorder characterized by excessive daytime sleepiness, even after a good night’s sleep. In these persons, the need to sleep could come at any time, hence, it may put the patient at risk of accidents and injuries.
Somnolence is a state of strong desire to sleep. It may also refer to an unusual pattern of sleeping for long periods. Somnolence is often accompanied by weakness, lethargy, and fatigue. It is considered a symptom, rather than a disorder.
How much sleep is then considered normal? According to the National Sleep Foundation, the normal duration of sleep is 7 to 9 hours daily. Sleeping for longer than this average duration is considered too much. Patients with hypersomnia may sleep up to 14 hours a day.
Hypersomnia may be divided into primary and secondary hypersomnia. Primary hypersomnia occurs independently of any medical condition and is often related to changes in the brain while secondary hypersomnia is caused by medical or mental conditions such as epilepsy, depression, trauma, and medications. Idiopathic hypersomnia is a subtype of primary hypersomnia which has no known causes.
Hypersomnia differs from the occasional daytime sleepiness which almost everybody experiences when they’ve been stressed out or have been sleep-deprived in the nights before. In these situations, one night of good sleep could make the individual feel refreshed and alert again.
Hypersomnia is not a mental disorder but a neurologic disorder. However, it may coexist with other mental disorders such as major depressive disorder and psychosis.
Generally, hypersomnia is diagnosed in about 10% of patients who complain about excessive daytime sleepiness. The onset of hypersomnia is during adolescence and the disorder is rare in children and adults older than 30 years. Primary or idiopathic hypersomnia is a lifelong disorder which does not resolve spontaneously.
The exact causes of primary hypersomnia are not known, however, there are a number of factors which may contribute to its onset. These include genetic predisposition and environmental factors. Alterations in the chemistry of the brain may also contribute to hypersomnia. Scientists found that a high level of a depressant molecule in the brain may cause hypersomnia. Other findings also show that a reduced level of histamine in the brain causes hypersomnia. In addition, low levels of substances, such as hypocretin-1 and hypocretin-2 – which help to keep an individual awake and active – in the brain may result in excessive daytime sleepiness.
Secondary hypersomnia may be caused by several medical conditions including neurodegenerative diseases such as Alzheimer’s disease and Parkinson’s disease, muscle disorders, kidney failure, and sleep apnea.
Typical symptoms of hypersomnia include:
The criteria for a diagnosis of hypersomnia, according to the Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition, is as follows:
Furthermore, hypersomnia may be specified by the duration of symptoms. It is described as “acute” if symptom duration is less than 4 weeks, “subacute” if the patient has been experiencing the symptoms for 1 to 3 months, and “persistent” if symptoms have been present for longer than 3 months.
Hypersomnia may also be specified based on the degree of daytime sleepiness and the frequency of symptoms: It is described as “mild” if symptoms occur for 1-2 days in a week, “moderate” if they occur for 3 to 4 days in a week, and “severe” if the symptoms occur for 5 to 7 days a week.
According to the American Sleep Disorders Association’s International Classification of Sleep Disorders, Second Edition (ICSD-2), hypersomnia may be categorized as monosymptomatic or polysymptomatic based on the nature of nocturnal sleep and pattern of nocturnal awakenings. Excessive daytime sleepiness which is not associated or due to frequent nocturnal awakenings is described as monosymptomatic, while excessive daytime sleepiness associated with long night sleep and sleep inertia or sleep drunkenness upon awakening is described as polysymptomatic.
There are several conditions which may present with hypersomnolence and which must be clinically distinguished from hypersomnolence disorder.
Although both conditions are characterized by excessive daytime sleepiness, patients with narcolepsy present with other distinct features such as cataplexy and the presence of sleep-onset REM periods. Cataplexy is described as brief periods of muscle weakness triggered by emotions while the patient is asleep.
A diagnosis of narcolepsy requires the presence of at least 2 sleep-onset REM periods. In contrast, in hypersomnolence disorders, patients record little or no dreaming during their daytime sleep because of the paucity of REM sleep. Additionally, unlike hypersomolence disorder, narcolepsy may have an age of onset during adulthood or in the elderly.
Conditions which may present similarly to hypersomnolence syndrome include circadian rhythm sleep disorders, substance-induced sleep disorders, and kleine-Levin syndrome. Circadian rhythm disorder is characterized by difficulty awakening from sleep and excessive morning sleepiness as a result of an abnormal sleep-wake schedule. Kleine-Levin syndrome is characterized by chronic episodic hypersomnia but with personality and mood changes. These changes may include hypersexuality, unusual cravings, and derealization.
Hypersomnia most commonly affects adolescents and is rare in children and adults older than 30 years. In children, daytime sleepiness may manifest as hyperactivity. Children with hypersomnia may present with a strong need for daytime naps, especially at inconvenient places such as schools, however, excessive daytime sleepiness is rare in children.
Mark, a 19-year-old college student is referred to the sleep clinic by his primary physician on account of his excessive daytime sleepiness which he has been experiencing for about two months. He noted that he sleeps for about 12 hours at night and still wakes up feeling very sleepy and tired. He added that this sleep pattern occurs for most days in a week and has been affecting his studies and personal life. He describes his typical day as finding it difficult to wake up from a night’s sleep and lapsing into sleep many times while he is in class. He eventually goes back to his room to have several naps, each lasting about 40 minutes. He notes that he feels very concerned because he is lagging behind in his school work and wants to have his previous sleep pattern restored.
Coping with hypersomnia may be very challenging because the disorder may negatively affect daily activities and impair an individual’s functionality, however, there are a few strategies patients could employ to improve the symptoms:
Hypersomnia often becomes severe, if not treated early. In severe hypersomnia, patients don’t often respond to treatment. Treatment of idiopathic hypersomnia is largely symptomatic since its exact causes are unknown. Treatment includes the use of drugs, behavioral modifications, and sleep hygiene therapy.
Common medications used to treat hypersomnia include amphetamines, modafinil, dextroamphetamine, selegiline, and methylphenidate which help keep the patient awake. Other medications used in treating hypersomnia include antidepressants, clonidine, levodopa, bromocriptine, amantadine, methysergide, and pemoline, all of which work by keeping the brain stimulated and active. Drug therapy usually involves maintaining the patient on a daily dose of these stimulants such that the patient remains awake and alert during the day.
Home remedies for hypersomnia involve practicing sleep hygiene:
Living with hypersomnia may be embarrassing, as patients tend to be caught in social distress and reduced work or school performance. Therefore, patients need to seek the help of sleep professionals for evaluation and treatment. Sleep hygiene and behavioral modifications, however, are pivotal in the clinical improvement of these patients.
Check your plan benefits for coverage of mental or behavioral health services. You may inquire through your company’s human resources unit for employer-sponsored health coverage for treatment of this condition or you may contact your health insurance company directly. Also, find out about out-of-pocket costs and deductibles you will pay to access these mental health services under your insurance plan.
Your primary care physician, after a thorough psychological evaluation of your symptoms, will refer you to a sleep therapist, neurologist, or psychiatrist, or all three of them, for therapy. You may also check through online resources and directory to find the right therapist for you.
Qualities you should look for in an LMHP include:
You should ask your therapist the following questions to help you gain more insight into your symptoms and the scope and potential effectiveness of available treatment options.
Hypersomnolence disorder is a sleep disorder characterized by multiple episodes of excessive daytime sleepiness despite having a good night’s rest and difficulty waking up. Hypersomnia may lead to serious personal, occupational, and social problems which result in job loss, poor school performances, and impaired daily functioning. Treatment of hypersomnia involves the use of stimulant medications, behavioral therapy, and practicing sleep hygiene.
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