Hypersomnia – Causes, Symptoms, and More

Hypersomnia

Also called: Excessive Sleepiness, Primary Hypersomnia, Somnolence, Breathing Related Hypersomnia

Summary

Hypersomnia is a sleep disorder that causes people to feel extremely sleepy throughout the day. Patients with hypersomnia also sleep for long periods at night and may nap repeatedly during the day. However, the sleep patients receive does not leave them feeling refreshed or more alert.

There are two main categories of hypersomnia. Primary hypersomnia does not have a known cause and is a chronic condition. Secondary hypersomnia may be traced to medical conditions (e.g., narcolepsy), physical injury and use of certain medications (e.g., tranquilizers).

Hypersomnia is considered to be a less common sleep disorder than insomnia, which involves difficulty falling asleep or staying asleep. Hypersomnia is most likely to first occur in people during adolescence and young adulthood.

In diagnosing hypersomnia, a physician may pay particular attention to details such as how much sleep a patient gets each night and whether or not excessive napping occurs. In some cases, a physician may order a sleep study (polysomnography) in which a person’s brain waves and other physiological responses are measured during a typical sleep cycle.

In many cases, hypersomnia is treated with medications. This may include psychostimulants and amphetamines. Certain lifestyle and dietary changes may also be recommended for patients with hypersomnia. However, patients with hypersomnia may continue to require above-average levels of sleep, even with treatment and lifestyle changes.

Other treatment methods may be recommended if a specific medical condition or other cause is found to be responsible for a patient’s hypersomnia.

There is no known way to prevent primary hypersomnia (in which a cause is not identified). Preventing secondary hypersomnia (in which a cause is identified) involves taking steps to prevent its cause. For example, losing weight may help prevent sleep disorders such as hypersomnia in patients who are obese. 

About hypersomnia

Hypersomnia is a sleep disorder that causes people to feel extremely sleepy throughout the day, regardless of how many hours of sleep they had the night before. Patients with hypersomnia also often sleep for long periods at night and have difficulty waking up in the morning. They may have deep urges to nap repeatedly during the day.

Patients with hypersomnia experience excessive sleepiness, despite typically sleeping at least 25 percent longer than normal. No matter how much sleep they get, patients with hypersomnia rarely feel completely rested. The overwhelming urge to nap can become dangerous when patients are involved in activities that require detailed attention, such as driving.

People with hypersomnia also may have difficulty waking in the morning, which can cause occupational problems, such as frequently being late for work. Excessive sleepiness can impair a person’s ability to concentrate and may affect relationships with others. Some patients begin to engage in automatic behavior. For example, patients may find they have driven long distances before realizing it. Patients are often unable to recall the activity that lead up to the circumstances in which they find themselves.

There are two main categories of hypersomnia: primary and secondary. Primary hypersomnia is hypersomnia that does not have a known cause. The two major forms are idiopathic hypersomnia and recurrent insomnia. Most patients with primary hypersomnia experience chronic sleepiness. However, some patients may experience sleepiness that lasts for days or weeks before resolving, a pattern that may recur over a period of years. Recurrent primary hypersomnia, an uncommon condition also known as Kleine-Levin syndrome, is also characterized by hypersexuality and compulsive eating.

Secondary hypersomnia is hypersomnia that occurs as the result of known factors such as medical conditions (e.g., narcolepsy), physical injury or the use of certain medications (e.g., tranquilizers).

Patients with hypersomnia are at risk of developing related disorders. For example, the social and occupational consequences of hypersomnia may trigger bouts of depression. Patients who take stimulants to remain awake may develop substance abuse disorders.

Hypersomnia is considered to be a less common sleep disorder than insomnia, which involves difficulty falling asleep or staying asleep. Hypersomnia is most likely to first occur in people during adolescence and young adulthood. Some patients may find that their symptoms resolve during middle age.

Risk factors and causes of hypersomnia

The cause of hypersomnia often remains unknown. Genetics appears to play a role in some types of hypersomnia, but how the condition is inherited is unknown.

Several different medical conditions and disorders also may cause patients to feel extremely drowsy. Typically, these conditions are not considered to be examples of hypersomnia. Instead, they are viewed as causes of hypersomnia symptoms. Several sleep disorders are associated with hypersomnia. They include:

  • Narcolepsy. A neurological condition in which the brain is unable to properly regulate a person’s sleep-wake cycle. Although similar to hypersomnia, it can usually be distinguished by features that include a tendency to suddenly fall asleep and cataplexy (a loss of muscle control when experiencing strong emotions). Adolescents who experience recurrent bouts of hypersomnia are often later properly diagnosed as having narcolepsy (rather than primary hypersomnia).

  • Breathing-related sleep disorders. Conditions in which abnormal breathing interferes with a person’s ability to sleep, leading to hypersomnia. Obstructive sleep apnea is the most common type of breathing-related sleep disorder.

  • Movement disorders that occur during sleep. Patients with conditions that cause movement during sleep (e.g., restless leg syndrome, periodic limb movement disorder) may not sleep well, which can lead to hypersomnia.

Various medical problems also can cause hypersomnia, including head injuries, tumors or damage to the central nervous system. Medical conditions that can cause hypersomnia include depression, bipolar disorder, epilepsy, heart problems, hypercalcemia, hyperthyroidism, liver problems, lung problems, multiple sclerosis, obesity and brain infections (e.g., meningitis, encephalitis).

Other conditions that may trigger hypersomnia include the following:

  • Autonomic nervous system dysfunction. The autonomic nervous system regulates physiologic processes in the body that are not under a person’s control, such as blood pressure. When this system is impaired, it can lead to hypersomnia.

  • Chronic fatigue syndrome. Condition in which a patient experiences prolonged tiredness that is not relieved by rest. Hypersomnia often is associated with this condition.

  • Drug or alcohol abuse. Use of various illegal and legal drugs and medications can cause hypersomnia. For example, patients who abuse sleep-aid drugs may experience chronic drowsiness.

  • Use of certain medications. Use of some medications (e.g., tranquilizers) may cause hypersomnia. Generally, hypersomnia abates once a patient stops using these drugs.  

Young people may be more at risk of hypersomnia than older people. Hypersomnia most often occurs in people between the ages of 15 and 30 years old. Gender may be a risk factor for some types of hypersomnia. For example, the recurrent primary hypersomnia known as Kleine-Levin syndrome affects men more often than women.

Signs and symptoms of hypersomnia

Patients with hypersomnia typically experience an overwhelming sense of sleepiness throughout the day that makes it difficult for them to stay awake. They may lack energy and find it difficult to think clearly.

Feelings of sleepiness tend to progress over a given period of time. Unlike some other sleep disorders (e.g., narcolepsy), patients with hypersomnia typically do not suddenly fall asleep. However, patients with hypersomnia may find themselves napping throughout the day for periods of one hour or longer. This can interfere with social activities and work. Patients are most likely to succumb to the desire to sleep during activities that involve less stimulation, such as while watching television or listening to a speaker. Patients with hypersomnia rarely feel refreshed despite such long napping.

In addition, patients with hypersomnia usually fall asleep quickly, sleep especially deeply and sleep for long periods of time at night (e.g., eight to 12 hours). They may find it difficult to wake in the morning and often feel disoriented when they do wake. This is sometimes known as “sleep drunkenness.”

Other symptoms associated with hypersomnia include:

  • Anxiety
  • Decreased appetite (anorexia)
  • Hallucinations
  • Impaired memory
  • Increased daytime hyperactivity in children
  • Irritability and restlessness
  • Slowed speech and thinking

Patients with the recurrent primary hypersomnia known as Kleine-Levin syndrome often also display hypersexuality. They may masturbate in front of others or make inappropriate sexual advances. This is more common in male patients than female. Patients with Kleine-Levin syndrome may also overeat compulsively and can spend up to 20 hours asleep at one time.

Diagnosis methods for hypersomnia

In diagnosing hypersomnia, a physician will typically perform a physical examination and compile a medical history. The physician will pay particular attention to details such as how much sleep the patient gets each night and whether or not excessive napping occurs. It often is helpful if a patient’s sleeping partner can offer details about the patient’s sleep habits, including any abnormalities such as

  • Kicking
  • Pauses in breathing
  • Sleepwalking
  • Snoring
  • Teeth grinding

The physician may also ask about any emotional issues in the patient’s life, whether or not the patient is taking medications or has a medical condition that may be responsible for the patient’s symptoms.

Other questions that a physician may ask include:

  • Do you snore, or experience periods where you stop breathing during sleep?
  • Are you depressed or bored?
  • Have you taken steps to try to reduce your drowsiness?
  • Are you experiencing other symptoms?

Various tests may also be performed to evaluate the patient’s general health and identify any existing disorders of the heart, liver or lungs that may be causing the patient’s symptoms. Depending on the patient’s history and symptoms, these may include blood tests, urine tests and imaging tests (e.g., magnetic resonance imaging [MRI]). A neurological examination may also be performed. This type of examination can helps a physician diagnose disorders of the brain, nerves, muscles and spinal cord.

In some cases, a physician may order a sleep study (polysomnography) in which a person’s brain waves and other physiological responses are measured during a typical sleep cycle. During this test, patients are required to stay overnight in a facility while measurements are performed to record muscle movement, heartbeat, eye movement, leg movements and respiration.

Primary hypersomnia may be diagnosed if patients experience excessive sleepiness that occurs regularly (for at least one month) and that impairs social, occupational or other types of functioning. Recurrent primary hypersomnia may be diagnosed if patients experience excessive sleepiness for at least three consecutive days several times a year for at least two years. Primary hypersomnia may be diagnosed as long as the patient’s symptoms are not found to be caused by another type of sleep disorder (e.g., insomnia, narcolepsy), mental or medical disorder, or the result of certain medications or substances. If a likely cause for a patient’s hypersomnia is discovered, a patient may be diagnosed with secondary hypersomnia.

Treatment and prevention of hypersomnia

Stimulant medications (e.g., amphetamines) are often used to treat patients with hypersomnia. These drugs help prevent patients from falling asleep during work and social activities.

Patients may also lessen the impact hypersomnia has on their lives by making certain lifestyle and dietary changes. Avoiding consumption of alcohol and caffeine may help reduce symptoms of hypersomnia. Patients are generally advised to avoid night-shift work and to limit daytime naps to 45 minutes or less. However, patients with hypersomnia may continue to require above-average levels of sleep, even with treatment and lifestyle changes.

Other treatments may be recommended if a medical condition or other cause is found to be responsible for a patient’s symptoms. For example, patients diagnosed with sleep apnea may be advised to wear a special mask at night so that air can be continuously delivered to keep the airways open, helping to alleviate a patient’s symptoms. Patients whose hypersomnia is caused by the use of certain medications or drugs may find their symptoms go away after discontinuation of the substance causing the hypersomnia.

There is no known way to prevent primary hypersomnia (in which a cause is not identified). Preventing secondary hypersomnia (in which a cause is identified) involves taking steps to prevent its cause. For example, losing weight may help prevent sleep disorders such as hypersomnia in patients who are obese.  

Questions for your doctor about hypersomnia

Preparing questions in advance can help patients to have more meaningful discussions with healthcare providers regarding their condition. Patients may wish to ask their doctor the following questions related to hypersomnia:

  1. How much sleep should I be getting?
  2. What signs indicate I may have a sleep disorder such as hypersomnia?
  3. Could my symptoms be related to another mental or medical condition, or other cause?
  4. What tests will you need to perform to confirm your diagnosis?
  5. Do you recommend I participate in a sleep study?
  6. How should I prepare for these tests?
  7. Can my condition be treated?
  8. What are my treatment options and what are their side effects?
  9. What lifestyle changes can I make to alleviate my symptoms?
  10. What is my long-term prognosis?
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