Hypersomnia
Hypersomia is a condition which is characterized by the tendency to sleep excessively[1]. There are two main types in which the condition has been divided namely, primary Hypersomia which is also known as idiopathic Hypersomnia[2], and recurrent, or primary recurrent insomnia. The division has been made on the basis of the frequency in which sleep occurs, because the symptoms of both the types are similar in nature.
Symptoms
People with Hypersomnia feel the need to sleep at random times throughout the day.
People suffering from Hypersomnia complain of recurring and frequent episodes of heavy sleep during the daytime, which is also called EDS (Excessive Daytime Sleepiness). This is different from the feeling of being tired and fatigued, and is also independent of disturbed sleeping routines. These people are generally forced to take short naps at different times throughout the day which also include inappropriate times during school, work, a conversation, a meeting or even during a meal. Despite the frequency of the naps, they do not prove to be helpful and do not relieve the patient from feeling sleepy again.
Another feature of the patients presenting with Hypersomnia is prolonged sleep during the night and extreme difficulty in waking up the next morning. They often feel confused and even disoriented upon waking up from a long sleep. Some of the other symptoms which are associated with Hypersomnia include irritation, low energy throughout the day, anxiety, delayed thought and comprehension, slow speech, some forms of hallucination, confusion, appetite loss, restlessness and difficult in retrieving memories.
Some of the patients that suffer from Hypersomnia cannot function normally socially, in a relationship, in family, in their occupation as well as various different settings and situations. Hypersomnia initially presents in young adulthood or adolescence. The symptoms that have been mentioned are seen in both forms of the condition:
Primary Hypersomnia
In case of primary Hypersomnia the symptoms continue to manifest in the patient for months and in some cases, years. This is recognized by the DSM-IV and has separate diagnostic criteria[3].
Recurrent Hypersomnia
In case of recurrent Hypersomnia however, the symptoms are recurring rather than permanent. There may be periods during which they are absent entirely, periods in which the symptoms are clearly seen as well as those periods in which both these situations coexist.
The most well known type of this Hypersomnia is known as the Kleine Levin’s syndrome which is rare today. In this condition, the patient has the tendency to sleep for as long as 18 hours in a day and still does not feel fresh and alert upon waking up finally.
Causes of Hypersomnia
There are various factors that can lead to Hypersomnia. It may occur due to some form of brain damage and associated disorders which may include depression, uremia, Celiac Disease and fibromyalgia. Hypersomnia may not present as an independent disease, but can actually be a symptom of various different sleeping disorders and conditions such as sleep apnea, periodic limb movement disorder, narcolepsy and restless leg syndrome. Hypersomnia can also occur due to the adverse effect of some medications such as drugs prescribed for bipolar disorder, depression and anxiety. Drug withdrawal syndrome can also lead to some degree of Hypersomnia. Other causes include excessive intake of alcohol and drugs. Genetic predisposition has significant relevance in the occurrence of the condition.
It has also been noted that obese and overweight patients are more prone to suffer from the condition than the rest. There are also studies that indicate that excessive sleeping can lead to weight gain and hence both the studies correlate. This occurs mainly because of the decreased levels of energy consumption released by metabolic processes during sleep. This in turn makes it difficult to lose weight. Sleeping disorders can therefore initiate weight gain and deposition of adipose tissue (fat tissue) in the body.
Diagnosis
Hypersomnia is not a very common disorder and affects less than 5% of adults. It usually starts between the ages of 15 years and 30 years and has a slow progression. It can take years to develop as well. The diagnosis is based on the lifestyle of a patient, who has had this sleep disorder for at least 1 month. If the Hypersomnia occurs due to medicine or some other disorder, it is not diagnosed as Hypersomnia.
Treatment of Hypersomnia
Hypersomnia can be treated by a variety of medicines that are prescribed by your health care provider. These medications include stimulants and antidepressants along with new medications that have become popular such as Xyrem and Proviqil.
Patients with Hypersomnia need to be evaluated for any underlying condition that may be contributing to the excessive sleeping. If drug use or substance abuse is a causative factor, then that needs to be treated first. If sleep apnea is also diagnosed with Hypersomnia a treatment known as CPAP or Continuous Positive Airway Pressure has to be done.
Medicines that cause sleepiness or drowsiness prescribed for another condition also need to be discontinued or changed. Trying to establish an early bed time routine may also help people who suffer from Hypersomnia get into a normal routine. Stimulants such as coffee and tea are also helpful along with complete elimination of alcohol and smoking.
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Medications
The treatment of Hypersonmia is symptomatic in nature[4]. The stimulants and other medications that are prescribed include:
- Amphetamine
- Modafinil
- Methylphenidate
- Clonidine
- Bromocriptine
- Antidepressants
- Levodopa
- MAO inhibitors
These medicines need to be prescribed by a heath care provider and their dosages are adjusted according to each individual patient.
Lifestyle changes
Usually lifestyle changes are successful in treating people with Hypersomnia. These include avoiding alcohol and smoking, eating healthier food and exercising more. Exercise helps make a person more alert and sleep better as well as increases physical well being.
- http://www.ninds.nih.gov/
- Michel Billiard Sleepiness: Causes, Consequences and Treatment: Idiopathic Hypersomnia (Editor) Michael J. Thorpy
- DSM-IV The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
