Hypersomnia


Introduction

Hypersomnia is a sleep disorder that causes excessive daytime sleepiness, extended periods of night-time sleep, and/or lack of alertness during wakeful episodes of the day. It induces a state of low attention, disorientation, high irritability, low energy levels, thinking and memory difficulties, and drowsiness. The condition can thus disrupt one’s performance and productivity in daily functions. While studies are still being carried out about the disorder, it can be controlled through medication since natural treatment options might not be viable.

Symptoms

1. The main symptoms of hypersomnia

  1. Excessive sleepiness during the day – The main symptom of hypersomnia is excessive daytime sleepiness. Even when one has had uninterrupted sleep at night, they still get excessively drowsy during the day. The patient falls asleep during inappropriate times such as when conversing, eating, or working.
  2. Sleeping for prolonged periods at night – People with the disorder also tend to sleep longer than usual during the night, and still require to nap repeatedly during the day.

 

2. Additional symptoms of hypersomnia:

  1. Lack of energy and poor performance when performing tasks
  2. Lack of alertness
  3. High irritability and anxiety
  4. Heightened aggravation
  5. Reduced mental ability in learning, thinking, and remembering
  6. Tenseness
  7. Slurry speech
  8. Brain fog
  9. Sleep hallucinations

Causes of hypersomnia

1. Insufficient sleep

Hypersomnia is mainly caused by insufficient sleep during the night. This leads to napping during the day to deal with the lack of sleep. The lack of sufficient night-time sleep may be caused by constant interruptions in bed, drug abuse, underlying health conditions, or a poor sleeping environment.

2. Poor sleep hygiene

Sleep hygiene involves the different habits that enable a person to have a good night’s sleep. They include avoiding taking stimulants before going to sleep, avoiding alcohol, keeping the bedroom dark and quiet at night, avoiding naps during the day, and not performing other tasks while in bed. These habits prepare the body for sleep; therefore, doing the contrary often leads to poor sleep quality and graduates to hypersomnia after a while.

3. Irregular sleep routine

Having an irregular sleep routine affects the body’s rhythm, thus causing a disturbance in the sleep patterns. It is important to have specific sleep and wake times that are followed every day. This creates a body routine whereby one goes to sleep at a specific time of the night and stays alert throughout the day. Factors such as lack of a fixed work schedule, frequent changes in work shifts, and frequent travel can result in people having irregular sleep routines which can cause hypersomnia.

4. Other health conditions

Studies show that hypersomnia can be an indicator of many other diseases and psychiatric conditions. It is commonly associated with other sleep disorders, such as insomnia, sleep apnea, circadian rhythm sleep disorders, and restless legs syndrome. These disorders affect an individual’s sleep quality as they reduce the number of hours of undisturbed sleep that one can get at night. Over time, they cause hypersomnia.

Other medical conditions that cause hypersomnia

1. Major depressive disorder/Clinical depression

Clinical depression is a mental health condition that causes feelings of despondency and dejection with a sudden loss of interest in all activities. This condition affects many aspects of a person’s life including work and sleep. One will have restless sleep that will be frequently interrupted. The lack of sufficient sleep, consequently, leads to excessive sleepiness during the day. Hypersomnia is commonly used to diagnose depression because it is a preceding symptom in many cases.

2. Anxiety disorder

This is a mental condition that causes constant feelings of worry and fear, which tend to be excessive to a point of significantly interfering with one’s normal life. People with the condition have trouble falling or remaining asleep. Thus, they have low sleep efficiency that leads to sleepiness during the day, which accumulates and causes hypersomnia in the long term.

3. Bipolar disorder

This is a mental health condition that causes extreme mood swings characterized by manic and depressive episodes. During manic episodes, one will be in elevated moods and show high energy levels, inflated self-esteem, alertness, and become heavily indulgent in pleasure-related activities. During depressive episodes, the person will have low energy levels, reduced motivation and lack of interest in all activities. The depressive episodes can cause hypersomnia whereby, one may become excessively sleepy after the sudden withdrawal from all other activities.

Diagnosis of hypersomnia

The clinical diagnosis of hypersomnia is mainly based on the information provided by the patient regarding sleeping patterns. Normally, hypersomnia-related symptoms must be present for up to three months and not related to drug and substance use for physicians to confirm the disorder. Thus, doctors will use their experience to analyze these symptoms and determine their cause to rule out other sleep-related disorders. The main symptom that indicates hypersomnia is excessive daytime sleepiness, which causes disorientation or sleep-drunkenness once the patient is awake. The patient has brain fog and does not become refreshed even after sleeping for about 8 hours. The other health conditions that a patient might have are also reviewed by the physician and used in the diagnosis. Doctors will also perform some of the following tests to confirm a case of hypersomnia.

1. Epworth sleepiness scale

Excessive sleepiness is rated using the Epworth Sleepiness Scale, which is a subjective diagnostic method. It is a questionnaire used to assess daytime sleepiness in a victim of the disorder. Individuals answer scored questions that inquire about their likelihood to fall asleep in different situations during the day. A score of 10 and higher on the Epworth Sleepiness Scale indicates a possible case of hypersomnia.

2. Nocturnal polysomnography

This is a test used to diagnose sleep disorders by recording one’s brain waves, blood oxygen levels, heart rate, eye movements, and respiratory rate when asleep. In this test, an individual with hypersomnia shows short sleep latency, lack of interruptions, both REM and NREM sleep, and normal to prolonged sleep duration.

3. Multiple Sleep Latency Test

This is an objective diagnostic method used to diagnose hypersomnia. It is based on sleep latency, which is the period that an individual takes to fall asleep when in a proper sleeping environment. The doctor uses this test to objectivize the length and quality of an individual’s sleep. A patient with hypersomnia has a short sleep latency, thus falls asleep in a very short time.

4. Physical exam for alertness

The doctor can also carry out a physical exam by observing the patient during the consultation stage. Patients with hypersomnia show signs, such as dozing while waiting for the doctor, yawning frequently, having a hard time keeping the eyes open, and poor concentration. This examination provides signs that can be used by the doctor in the diagnosis.

5. Sleep diary

This is a patient’s record of their sleep and wake times. It is very helpful in diagnosis because the doctor can follow the timings to get a precise conclusion. An individual who exhibits signs of a sleep disorder should keep a diary and present it to the doctor for review.

Treatment of hypersomnia

There is currently no treatment approved specifically for the treatment of hypersomnia. The present medications mainly treat the possible causes of the condition and alleviate the symptoms exhibited by the patient. Some patients respond well to the treatments used for other sleep disorders, such as narcolepsy. There are, however, several medications that are used to control excessive sleepiness including:

1. Conventional central nervous system (CNS) stimulants

These are medications that stimulate the brain, thus enabling the patient to stay alert and energetic. These medications are classified into amphetamine and non-amphetamine CNS stimulants. Amphetamine and its derivatives work by increasing the dopamine levels in the body, thus making the patient energetic. They, however, can be abused leading to addiction(habit-forming). Further, when overdosed, amphetamines have serious effects, including headaches, anxiety, tremors, irritation, high blood pressure, and psychotic symptoms. Methylphenidate is the most commonly used amphetamine derivative because it has mild side effects. Its effects also last for a short time and, thus can be used only when necessary.

Non-amphetamine CNS stimulants, on the other hand, are thought to work by inhibiting the reuptake transporters of norepinephrine and dopamine. Modafinil is the most commonly used non-amphetamine CNS stimulant. It works well in most cases of excessive sleepiness and seldom leads to any undesirable effects. It stimulates the brain and promotes alertness, thus enabling a patient to stay awake when necessary. Many patients tolerate it, and it has a very low risk of addiction. In a few cases, however, there has been a need to increase the dosage for modafinil after long-term use. Its side effects include headaches, loss of appetite, anxiety, and nausea.

2. Sodium oxybate

This drug has shown significant therapeutic value in the treatment of excessive sleep disorder. It has very low risks and its potentially undesirable effects during treatment are few. Sodium oxybate is commonly used together with modafinil. It is, however, not recommended for patients with sleep apnea. There are also many concerns in the use of sodium oxybate for treatment because it is highly addictive and has a high potential for abuse. The non-pharmacological form of sodium oxybate, gamma-hydroxybutyrate, is abused by athletes because it increases the release of growth hormones.

3. Caffeine

Caffeine is a common stimulant that is taken to increase alertness. It is mostly taken in the form of a beverage, but its stimulatory effects are quite mild. In the treatment of hypersomnia, caffeine is administered in the form of a tablet that has high levels of the stimulant. It stimulates the brain, increases alertness, and reduces sleepiness. Caffeine works by antagonizing the adenosine receptors, thus increasing neurotransmission. This provocation enables the patient to stay awake for longer.

4. Natural treatment options

The non-medical approaches that are used in treating other sleep disorders are not effective in treating hypersomnia. Taking naps and having long hours of sleep might not have any refreshing effect on hypersomnia patients as they would on healthy people. Several lifestyle changes, however, can make the patient more comfortable and reduce the symptoms of hypersomnia. These include proper sleep hygiene, scheduled naps, a fixed daily schedule, and avoiding drugs and substances that affect one’s sleep patterns.

The patient should also practice self-care by avoiding activities that may be dangerous, such as driving and operating dangerous machinery. Hypersomnia can lead to accidents if the patient gets sleepy while performing tasks that require high levels of alertness. The patient should only participate in such activities if the condition is well controlled by medication that enables wakefulness.

 

Hypersomnia is still being studied and, therefore, many other forms of medication are currently under research. They include new drugs that can be used by patients who do not respond to conventional prescriptions. These emerging drugs include clarithromycin, selegiline, mazindol, flumazenil, pitolisant, and hypocretin-1. Hence, with time, more effective medicines might be available for hypersomnia.

 

Conclusion

Sleep is important to the human body because it improves memory consolidation and leads to normal bodily function.

Hypersomnia is a sleep disorder that causes a patient to experience excessive sleepiness during the day, even after having sufficient sleep at night. This can have adverse effects on the health, work, and social life of the patient. Identifying hypersomnia can be difficult because most patients only view it as tiredness or fatigue. They end up carrying out self-treatment and taking a long time before seeking medical help.

Self-treatment might not be effective in hypersomnia because, unlike other sleep disorders, sleeping for more hours hardly helps. Medication is required to keep the patient alert throughout the day. In diagnosis, the doctor will thoroughly review the symptoms and medical history of the patient before concluding. It is important to identify any other medical conditions that may be associated with the condition, such as depression, bipolar disorder, and anxiety disorders. With proper medication, excessive sleepiness can be controlled.

It is also important for people with the disorder to take care of themselves by avoiding sensitive tasks that require high levels of alertness, such as driving.  Remember to seek medical attention if you feel excessive daytime sleepiness is affecting your life.

You may want to look into sleep supplements or other over-the-counter products to treat symptoms if the condition is a mild, however, if the symptoms  persist  you should seek professional help from a licensed medical professional.

 

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