Hypersomnolence, also known as hypersomnia, is characterized by recurrent episodes of excessive daytime sleepiness or prolonged nighttime sleep.
Rather than feeling tired due to lack of or interrupted sleep at night, persons with hypersomnolence are compelled to nap repeatedly during the day, often at inappropriate times such as during work, during a meal, or in the middle of a conversation. These daytime naps usually provide no relief from symptoms.
Like narcolepsy, idiopathic hypersomnolence is a condition characterised by excessive sleepiness. Patients also experience difficulty in waking (either in the morning or at the end of nap periods during the day).
The term idiopathic means ‘of unknown cause’.
As with narcolepsy, patients with this condition often sleep for long periods but, unlike patients with narcolepsy, in whom sleep attacks can occur anytime without warning, patience with idiopathic hypersomnolence have a greater degree of control over their sleep, and do not suffer from cataplexy or the other features of the full narcolepsy syndrome, such as sleep paralysis, hallucinations and automatisms.
Although about 25% of patients experience spontaneous improvement in their condition, it can be life-long and can require treatment with similar stimulant medications to those which are used for treating narcolepsy.
The protocol for diagnosing idiopathic hypersomnolence is identical to that which is used to diagnose narcolepsy.
Patients often have difficulty waking from a long sleep and may feel disoriented.
Other symptoms include:
- increased irritation
- decreased energy
- slow thinking
- slow speech
- loss of appetite
- memory difficulty
Some patients lose the ability to function in family, social, occupational, or other settings.
Some may have a genetic predisposition to hypersomnolence; in others, there is no known cause.
Hypersomnolence typically affects adolescents and young adults.
Specific Diagnostic Criteria for Hypersomnolence
The predominant feature is excessive sleepiness for at least 1 month (in acute conditions) or at least 3 months (in persistent conditions) as evidenced by either prolonged sleep episodes or daytime sleep episodes that occur at least 3 times per week.
The excessive sleepiness causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The excessive sleepiness is not better accounted for by insomnia and does not occur exclusively during the course of another Sleep Disorder (e.g., Narcolepsy, Breathing-Related Sleep Disorder, Circadian Rhythm Sleep Disorder, or a Parasomnia)
It cannot be accounted for by an inadequate amount of sleep.
The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
Hypersomnolence can co-occur with another mental or medical disorders, though this condition cannot adequately explain the predominant complaint of hypersomnolence. In other words, the hypersomnolence is significant enough to warrant its own clinical attention and treatment.
It can result from a physical problem, such as a tumor, head trauma, or injury to the central nervous system. Medical conditions including multiple sclerosis, depression, encephalitis, epilepsy, or obesity may also contribute to the disorder.
Treatments for Hypersomnolence
Treatment for hypersomnolence is based upon the symptoms experienced. Stimulants, such as amphetamine, methylphenidate, and modafinil, may be prescribed. Other drugs used to treat hypersomnia include clonidine, levodopa, bromocriptine, antidepressants, and monoamine oxidase inhibitors.
Changes in behavior (for example avoiding night work and social activities that delay bed time) and diet may offer some relief. Patients should avoid alcohol and caffeine.
Because idiopathic hypersomnolence refers to excessive sleepiness without an identifiable cause, the treatment involves treating the symptoms, not the underlying cause.
Treatment usually involves the use of medication to counter daytime sleepiness and lifestyle changes.
Medications for idiopathic hypersomnolence
Excessive daytime tiredness is usually treated by medicines that stimulate the central nervous system, including amphetamine, methamphetamine, methylphenidate and modafinil.
There are a variety of lifestyle modifications that usually improve treatment efficacy and quality of life. These changes are individualised, and need to be discussed with your treating doctor, however may include:
- Notify your family, friends and employer about your condition
- Ensure a regular sleep schedule of bed times and rising times
- Avoid periods of sleep-deprivation (such as staying ‘out all night’)
- Schedule several short naps each day (10-15 minute naps, 2-3 times per day) to improve alertness and reduce the likelihood of sleep-attacks during activities
- Have a short nap before driving or performing activities that require concentration; never drive when feeling sleepy or tired
- Avoid occupations that involve excessive driving and operating heavy machinery
- Avoid caffeine and nicotine
- Avoid alcohol consumption
- Keep physically active and eat a balanced diet
- Join a patient support group (click here for information on this issue).