What is hypersomnia?
Hypersomnia is a sleep disorder characterized by excessive sleepiness during much of the day, despite having maintained a sleep period of at least seven hours. It is considered a dyssomnia, that is, a sleep disturbance that affects the schedule, quantity and quality of sleep.
In hypersomnia, the person is drowsy during the day and finds it difficult to wake up after a normal sleep, which may even be more than nine hours, but is not restful and does not allow the person to rest.
It is considered that someone suffers from hypersomnia when the disorder occurs at least three times a week for at least one month (it can also occur daily). It is a disorder that significantly affects the person who suffers from it, diminishing his or her performance capacity, whether at work, social or personal level. In fact, the person may suffer “falls” of sleep similar to those that occur with narcolepsy, falling asleep in risky situations, such as while driving.
There are different types of hypersomnia:
- Idiopathic or primary hypersomnia. The causes in this case are not known. There is usually normal rest and the excess sleep cannot be explained by organic causes. Within this type of hypersomnia may include Kleine-Levine syndrome, which is recurrent and persistent, causing periods of days or weeks with a lot of sleep. People suffering from primary or idiopathic hypersomnia can sleep up to 20 hours and still be tired, irritable, unstable and with disinhibition of impulses, which leads to hyperphagia and hypersexuality. In addition, hallucinations and memory and speech problems may appear.
- Secondary hypersomnia. Within this group there may be those that are due to sleep deprivation, either because of not having enough sleep or because sleep is interrupted. The effect of some drugs or medications, or some medical or psychiatric disorder also play a role. In this case hypersomnia is the symptom of the disorder, not the disorder itself.
In hypersomnia the patient feels drowsy during a large part of the day.
Prognosis of the disease
Hypersomnia can be severe in the sense that it affects the patient’s daily life, as well as his or her work and personal relationships. In addition, patients with hypersomnia can fall asleep at very serious and life-threatening times. Sleep disorders greatly impair the patient’s quality of life in general, and other problems are associated with them. Narcolepsy is the most severe case of hypersomnia, causing excessive sleepiness and uncontrollable and frequent sleep attacks throughout the day, usually occurring every 3-4 hours. In addition, the urge to sleep is uncontrollable and renders the patient unable to continue his or her daily routine.
Symptoms of hypersomnia
The person suffering from hypersomnia has great difficulty staying awake, which causes great functional impairment accompanied by fatigue, tiredness, loss of concentration and sensory loss or movement problems, also losing attention in their environment. In addition, these symptoms will have other derived problems that will modify personal aspects, with the person suffering affective disorders and social and occupational deterioration.
Most people with hypersomnia do not have problems falling asleep. However, although it is continuous, it is not restful. Patients often have trouble getting up and present as irritable and confused.
Throughout the day they usually have a feeling of continuous drowsiness, where there may be totally routine and automatic behaviors of which the person does not become aware. This daytime drowsiness does not usually appear spontaneously but grows and prolongs, especially at times of low activity or stimulation. In addition, when the person tries to fight drowsiness, the level of alertness suffers, causing low levels of performance and lack of concentration, loss of attention and memory.
Medical tests for hypersomnia
Nocturnal polysomnography can show normal or prolonged sleep duration, whether there is a short sleep latency, whether there is a continuity of sleep that appears normal or increased, and a normal distribution of NREM and REM phases. Some people with hypersomnia have increased amounts of slow wave sleep.
Also, the multiple latency test (MSLT) shows excessive physiological daytime sleepiness, which is characterized by mean sleep latencies of 5-10 minutes. REM sleep is absent during the day in hypersomnia.
What are the causes of hypersomnia?
The causes of hypersomnia are largely unknown. However, in most cases there are usually underlying disorders or problems. Sleep apnea is one of the main causes. It occurs during sleep, when the back of the throat prevents the normal passage of air into the lungs, causing the patient to make great efforts to breathe. There are three main types of apnea:
- Obstructive sleep apnea. It is the most frequent. When the back of the throat blocks the airway and the person struggles to breathe, but does not wake up. Breathing may stop hundreds of times during the night, for periods of 10 seconds or more.
- Central sleep apnea. It is less common and is caused by the failure of the brain to send signals to the muscles and these produce the movements of breathing. This causes the person to wake up because the contractions of oxygen in the blood suddenly decrease.
- Mixed sleep apnea, or a combination of both.
In narcolepsy, which is the most severe case of hypersomnia, the causes are thought to lie in reduced amounts of hypocretin, a protein produced in the brain. However, it is not clear why the brain reduces the production of this protein.
In addition, narcolepsy has a genetic component and a trigger that causes the immune system to act to destroy the protein.
Can it be prevented?
Hypersomnia can only be prevented in cases of secondary hypersomnia, that is, if the excessive sleepiness is caused by a specific cause that causes sleep deprivation, either by routine or by other disorders that influence it. It will be avoided, therefore, by treating the cause that is affecting the person’s rest.
However, specialists in Clinical Neurophysiology and Sleep Medicine make a series of recommendations and advice:
- Maintain regular schedules and routines, i.e., get up at the same time and carry out the same tasks.
- Learn not to be always available. It is important to dedicate time to yourself and do something you really enjoy.
- Organize your time with priority lists.
- Gentle physical exercise, at midday or in the afternoon, about three days a week.
- Short periods of relaxation, about five minutes, twice a day.
Treatments for hypersomnia
The treatment of hypersomnia is very important, as it is a disorder that is very disabling to the patient’s life and can even be dangerous. It is recommended that the patient has a sleep hygiene as correct as possible, with specific times for waking up and going to bed. They should also avoid operating heavy machinery or vehicles.
On the other hand, as already mentioned, sport can be of great help, keeping active and reducing the feeling of sleepiness.
At the psychological level, cognitive-behavioral techniques can help to cope with the problems arising from hypersomnia, helping the patient to focus attention. It also helps the patient to identify the first signs of sleep and to apply exercises both physically and mentally, when they appear, in order to increase the level of consciousness and physiological activity.
The specialist in Clinical Neurophysiology will recommend the best treatment and, if necessary, will recommend the use of excitatory drugs.
Which specialist treats it?
The specialist who treats hypersomnia and other sleep disorders is the expert in Clinical Neurophysiology. He will be able to analyze the quality and quantity of the patient’s sleep, and be able to make a differential diagnosis of the problem the patient is suffering from.