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Sleep Care

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Hypersomnia

Have you ever woken up from an eight hour night of sleep and said to yourself, “I don’t feel like I slept at all!?” Imagine feeling that way continuously for months or even years! Those suffering from hypersomnia know what that feels like. Hypersomnia (HS) is a disorder where a person gets too much sleep but never feels refreshed and energized. The National Sleep Foundation reports that approximately 40% of the population has experienced some symptoms of Hypersomnia from time to time. Fortunately, hypersomnia is

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an uncommon disorder that is believed to affect 200,000 people in the U.S., and for most will typically occur between the ages of 15 and 30. Hypersomniacs often tend to sleep longer at night and have a hard time waking up in the morning. They often exhibit sleep deprivation, anxiety, slow speech, loss of appetite and energy, an increased sense of irritation, and slow thinking. They even feel the need to take frequent naps throughout the day, even though they don’t feel a benefit from them. The dangerous part is that those naps can often occur at inconvenient times, such as during work, while eating, and even while driving. There are two forms of hypersomnia, one is Primary Hypersomnia more commonly known as Idiopathic Hypersomnia (IH). For a person with idiopathic hypersomnia who has not been treated, they will experience symptoms of the disorder continuously for months or years. There are also two types of IH. One is IH with long sleep, where the individuals will sleep for 10 or more continuous hours each night; and the other is IH with short sleep, where the person will sleep 6 to 10 hours each night. Patients with hypersomnolence will experience excessive daytime sleepiness (EDS), which differs from just feeling tired because of a poor night’s sleep. With hypersomnia the patient is actually sleeping more than enough, unlike insomnia where the patient isn’t getting enough sleep. For a person to be diagnosed with IH, they must exhibit these symptoms for at least 1 month and have a significant impact on the patient’s daily activities. The second type is Recurrent Hypersomnia. These individuals will experience periods ranging from 1 day to several days of excessive daytime sleepiness while not feeling refreshed. This pattern will reoccur throughout the year, but the person will not experience it constantly like those with Idiopathic Hypersomnia. Kleine-Levin syndrome is a disorder whose symptoms include recurrent hypersomnia. This syndrome occurs in approximately three times more males than females. In this extremely rare disorder, a person may sleep 18 or more hours per day, but wake up not feeling refreshed or energized. These people often eat uncontrollably and therefore experience rapid weight gain. Hypersomnia (HS) can be caused by damage to the brain, clinical disorders such as depression and fibromyalgia, medications such as those used for depression and anxiety, drug and alcohol abuse, and even genetics. HS can also be a symptom exhibited in narcolepsy, obstructive sleep apnea, and

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restless leg syndrome. HS is often misdiagnosed as narcolepsy as narcoleptics feel the need to sleep; however unlike people with HS, narcoleptics find daytime sleep rejuvenating. It is a common belief that people who are overweight have an increased chance of developing HS, as studies have shown a correlation between lack of sleep and weight gain. Others believe that HS may be caused by problems linked to the hypothalamus in the brain. Unfortunately, there have not been enough studies performed to support either of these claims. If HS is suspected, but cannot be

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linked to a particular cause, then the patient is diagnosed with Idiopathic Hypersomnia (IH). By this point, you may be asking, “Can anything be done for this disorder?” Unfortunately, this is a lifelong disorder and cannot be cured; however, there are things that can be done to treat it. Often times, the sleep doctors will order a Polysomnography (PSG), which is an overnight sleep study that can determine night time breathing disturbances such as sleep apnea (OSA). If the doctor does suspect HS, they will likely have the PSG followed by a Multiple Sleep Latency Test (MSLT), which is a daytime study where the person will be asked to take a series of 20 minute naps over the course of 8 hours. If the person has a sleep latency (period in which they fall asleep) of 10 minutes or less, then that supports HS as a possible diagnosis. Narcoleptics also fall asleep very quickly and for shorter periods of time; however they will exhibit the early onset of REM sleep 2 or more times during the MSLT study. Hypersomniacs tend to take longer naps and sometimes don’t even experience REM. If HS is diagnosed, sleep doctors will often prescribe stimulants such as amphetamine, Provigil, Nuvigil, or Ritalin. If the patient is on any medication that causes drowsiness, doctors will often recommend an alternate medication that does not cause drowsiness. There are things that you can do at home to promote better sleep. The doctors recommend that you develop and maintain a regular sleep-wake schedule and avoid beverages that contain alcohol or caffeine. At least 20 minutes of exercise per day, stop smoking, and weight loss are often common recommendation as well. If you are experiencing any or all of the symptoms described in this article, please contact your sleep physician.  

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