Excessive Sleepiness (Hypersomnia)

A Sleep Disorder (somnipathy)is defined by a medical disorder of the sleep patterns of a person or animal.Many are aware of the common and highly advertised sleep disorders such as; insomnia, apnea, circadian rhythm disorder, narcolepsy, and restless leg syndrome. If you yourself do not suffer from one or more of the many irregular sleep patterns, you likely know someone who does. Battling a sleep disorder is common among millions of Americans. Fortunately the disorders are treatable through a wide variety of medications, so much so that pharmaceutical companies compete through daily advertising. Some of the medications that treat sleeping disorder, Ambien, Rozerem, Lunesta , Provigil, and Serquel, all of which are prescribed to induce or help persons fall and stay a asleep.

While difficulties initiating or maintaining sleep, for any reason, is the most common complaint, there are sleep disorders that encounter the exact opposite (to much sleep). Narcolepsy is acknowledged more so than other sleeping disorders, which main symptoms involves sudden and excess onset bouts of REM. The popularity of Narcolepsy comes more from the comic and exaggerated twist “Hollywood” has introduced, rather than the serious and disappointing symptoms surrounding the disease.

Another sleeping disorder, and the topic of this hub, is Hpersominia. Hypersomnia is characterized by episodes of excessive daytime sleepiness despite long nighttime sleep, consisting of an excess of ten hours or more. The recurring episodes of excessive daytime sleepiness (EDS), is different from feelings of being tired due to lack of or interrupted nighttime sleep. Those who suffer with this disorder receive twelve to fourteen hours of sleep nightly with few or no interruptions. Although long, comfortable, night time sleep takes place, it is very hard to rise when it’s time to wake.

Once awaken, suffers appear to be partially asleep, confused or intoxicated like. Hypersomniacs are compelled to nap repeatedly or sleep for long periods during the day. These almost necessary naps often happen at inappropriate times of the day; while at work, during events, or in conversation. These daytime naps, consisting of deep sleep, almost always provide no relief from symptoms. Naps conclude several hours of sleep, but they are not refreshing. No matter the extent of napping, sufferers are still severely tiered. Those diagnosed, show symptoms of being sleepier than those diagnosed with Narcolepsy. Daytime sleepiness can be more sudden with Narcolepsy, but narcoleptic naps can be refreshing. Although some with Hypersomnia experience symptoms that resemble Narcolepsy such as, sleep paralysis and Hallucinations, they do not have the symptom of cataplexy - the sudden attack of muscle weakness, nor do they have as many episodes of quickly entering REM sleep as someone with narcolepsy.

The disoriented or intoxicated feeling suffers have is called sleep drunkenness. Confusion and sleep drunkenness are common after morning awakening and also after naps. Other symptoms may include anxiety, increased irritation, decreased energy, restlessness, slow thinking, slow speech, loss of appetite, and memory difficulty. About 30 percent of people with this disorder experience headaches. Fifteen to 25 percent may have depression symptoms. Some suffers lose the ability to function in family, social, occupational, or other settings. Hypersomnia may be caused by another sleep disorder such as narcolepsy or sleep apnea, dysfunction of the autonomic nervous system, or drug or alcohol abuse. In some cases it results from a physical problem, such as a tumor, head trauma, or injury to the central nervous system.

Following is a list of causes or underlying conditions that could be diagnosed with Hypersomnia. The condition diagnosed as the underlyning cause will likely be looked into and treated first.  Hypersomnia could also be diagnosed alone due to unknown reasons, leaving athese persons  feeling desperate for a cure. 

Clinical Depression, Narcolepsy, Substance-induced sleep disoreder, Endogenus, Fibromyaligia, Depression/secondary to illness, Bipolar affecting disorder, Gliboblastoma multiforme, Malnutrition/Anerxeia, Kleine-Levin syndrome, Trypanosomiasis.

There are two main categories of hypersomnia: primary hypersomnia/idiopathic hypersomnia and recurrent hypersomnia/primary recurrent hypersomnia. The primary difference between recurrent hypersomnia and primary hypersomnia is that persons experiencing recurring hypersomnia will have extended periods where they do not exhibit any signs of hypersomnia, whereas persons experiencing primary hypersomnia are affected by it nearly all the time. A sufferer from primary hypersomnia displays these symptoms continually, with no end in sight. Recurrent hypersomnia is characterized by recurring periods of symptoms many times throughout the year mixed with periods of normal sleep-wake cycles. Kleine – Levin syndrome is the most well-known form of recurrent hypersomnia, though it is very rare; sufferers often sleep up to eighteen hours a day and yet do not feel refreshed upon waking.

Some may have already tried to conclude from the reading that hypersomnia is a form of chronic fatigue syndrome, which would not be concluded correctly. There is a distinct difference between being truly sleepy and disabling fatigue. Experiencing fatigue is usually caused by a form of depression or medical disorder. In these cases the person may feel very tired or bouts of fatigue (after surgery or during a period of depression), ie; chronic fatigue syndrome. But those experiencing fatigue do not fall asleep uncontrollably or for long periods of time, separating chronic fatigue syndrome from idiopathic hypersomnia.

Typically Hypersomnia is first recognized in adolescence or young adulthood. These symptoms are present in both types of Hypersomnia. Idiopathic Hypersomnia, long sleep time, starts between ages 15–30 and develops slowly over a period of years and before the age of 30. Usually by 30, symptoms are fully recognizable, severe, disabling and usually do not change over time. There have been a few cases when the disorder has improved unexpectedly. Hypersomnia is an uncommon disorder, less than 5% of adults have reported EDS.  It is extremely rare for children to display enough symptoms for diagnosis. Men and women have had an  equal diagnosis. There have been common links or genetic relativity in families, but no gene has been identified.

Hypersomnia can be caused by brain damage and disorders such as clinical depression, uremia, and fibromyalgia. Hypersomnia can also be a symptom of other sleep disorders such as narcolepsy, sleep apnea, and restless leg syndrome. For example; I was diagnosed with Idiopathic Hypersomnia with acute Narcoleptic Disorder. Meaning; when tested for a sleep disorder, possibilities such as sleep apnea where first ruled out. Once all other possibilities where ruled out, doctors proceed to another form of sleep testing. The testing consisted of daytime sleep that was scheduled (1hr-Awake, 30 min of sleep) all day. During each sleep course, test showed I was hitting the level of REM within 2 minutes of being asked to sleep. The fast levels of REM concluded a sign of Narcolepsy, but the symptoms of chronic sleepiness and the ability to sleep when asked during the day, concluded Hypersomnia. The Hypersomnia proved to be more of a problem than the faint signs of Narcolepsy, thus the diagnosis of Hypersomnia with acute narcoleptic disorder.

Prescription Drug Withdrawl

Hypersomina may also occur as an adverse effect of taking certain medications, including some psychotropics drugs such as Loxitane (loxapine), Thorazine (chlorpromazine), Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Wellbutrin (bupropion), Valium (diazepam), Xanax (alprazolam) to list a very few, for depression, anxiety, or bipolar disorder, withdrawal from some medications, or of drug or alcohol abuse.

Causes Rapid Weight Gain

Another cause can be obesity or being simply overweight. Although people who are overweight or obesy may be more likely to suffer from hypersomnia, sleeping at the level of a hypersomniac can and will usually lead to considerable and rapid weight gain, leading persons who are slight overweight to obesity. This is because excessive sleeping decreases metabolic energy consumption, making weight loss very difficult. Sleep disorders of this nature provoke or initiate weight gain due to a tendency to attempt to manage low energy levels by eating non-comples carbohydrates.

Viruses

Another possible cause is an infection of mononucleosis, as several instances of hypersomnia have been found to arise immediately after such an infection. It can also be caused in children by influenza.

Other

Hypersomnia has also been seen in those who have gone through (splenectomy) asurgery to remove a diseased or damaged spleen. The primary function of the spleen is to fight bacteria. The spleen also serves as a filter for old and damaged red blood cells.

To be diagnosed with hypersomnia, one must display symptoms for at least a month and the disorder must have a significant impact on the person’s life. A sleep test is usually done to rule out treatable sleep disorders. The diagnosis is not given if the hypersomnia is a result of medication or of another disorder.

Treatment is symptomatic in nature. Stimulants, such as amphetamine, methlphenidate, and modafinil, may be prescribed. Other drugs used to treat hypersomnia caused by an underlyning disorder include clonidine, levopa, bromocriptine, antidepressents, monoamine oxidase inhibitors. Accompanied with medication, a change in personal behavior may be suggested (for example avoiding night work and social activities that delay bed time) may be accomplished.

These drug therapies may or may not work, medication are often changed or increased. Hypersomnia is a lifelong disorder and recent research theorizes to treat the hypothalamus as a probable solution. The attacks usually continue indefinitely.

The prognosis for a person with Hypersomnia depends on the cause of the disorder. While the disorder itself is not life threatening, it can have serious consequences, such as loss of employment, education, and injury or death due to automobile accidents caused by falling asleep while driving. Despite these, health, safety, and quality of life consequences, there are no FDA-approved therapies for Hypersomnia. Currently, Hypersomnia is treated using therapies approved for narcolepsy, despite a lack of clinical trial data and a consensus that treatment response is poor. Treatments include traditional psychostimulants, as well as wake-promoting agents with unknown mechanisms of action such as modafanil and sodium oxybate. In addition to side effects, including high abuse potential, tachycardia, and altered mental status, treatments are often ineffective and substantial residual sleepiness frequently persists despite poly-therapy.

Adults

The amount of sleep each person needs depends on many factors, including age. For most adults, 7 to 8 hours a night appears to be the best amount of sleep, although some people may need as few as 5 hours or as many as 10 hours of sleep each day. Women in the first trimester of pregnancy often need several more hours of sleep than usual. The amount of sleep a person needs also increases if he or she has been deprived of sleep in previous days. Getting too little sleep creates a sleep debt. Eventually, your body will demand that the debt be repaid. We don't seem to adapt to getting less sleep than we need; while we may get used to a sleep-depriving schedule, our judgment, reaction time, and other functions are still impaired.

Elderly Sleep Patterns

People tend to sleep more lightly and for shorter time spans as they get older, although they generally need about the same amount of sleep as they needed in early adulthood. About half of all people over 65 have frequent sleeping problems. Insomnia is ratted the number one sleep disorder diagnosed in ages 65 years or older. Deep sleep stages in many elderly people often become very short or stop completely. This change may be a normal part of aging, or it may result from medical problems that are common in elderly people and from the medications and other treatments for those problems.

Sleep Deprivation and Microsleep

Experts say feel drowsy during the day, even during boring activities, likely means a person hasn't had enough sleep. If you routinely fall asleep within 5 minutes of lying down, you probably have severe sleep deprivation, possibly even a sleep disorder. Microsleep (very brief episodes of sleep in an otherwise awake person), are another mark of sleep deprivation. In many cases, people are not aware that they are experiencing microsleeps. The widespread practice of being over worked with little sleep in western industrialized societies has created so much sleep deprivation that what is really abnormal sleepiness is now almost the norm.

The history is the most important influential element in the evaluation of patients with hypersomnia.

Medications A detailed review of prescription and/or over-the-counter medications can suggest a basis for Hypersomnia. Somnolence is a side effect of many classes of medications, such as antidepressants, antihistamines, and beta-blockers. The medical problem for which the drug is prescribed may itself explain Hypersomnia; ie, hypothyroidismor BAD.

Sleep pattern A detailed history of sleep pattern are essential.

What time does the individual go to bed, fall asleep, and wake up?

How many times does the individual awaken at night?

Any obvious reason such as nocturia or paroxysmal nocturnal dyspnea (PND)?

Does the individual feel rested on awakening?

Bed partner can supply information about snoring and apneic periods. Work schedules and travel history are important for determining environmental causes. Questions specific for narcolepsy should address cataplexy (sudden weakness or loss of muscle tone without loss of consciousness that is elicited by emotion), which is pathognomonic; sleep paralysis; sleep-related hallucinations; irresistible sleepiness; and short and refreshing naps without difficulty awakening.

Past medical history Is there evidence of prior head injury, endocrine abnormalities such as hypothyroidism and glucose or cortisol shifts, chronic pulmonary disease with hypoxia, cardiovascular disease with low output state, and myotonic dystrophy.

Mental health Depressive symptoms warrant attention, including seasonal patterns and those interspersed with manic episodes.

Family history Narcolepsy and idiopathic hypersomnia often have familial patterns.

Social history Many substances cause hypersomnia. Alcohol consumed near bedtime causes disrupted sleep; benzodiazepines, opioids, and barbiturates obviously cause lethargy; and withdrawal from amphetamines, nicotine, or caffeine can lead to hypersomnia. Prior and severs abuse of benzodiazepines, opioids, and barbiturates, can cause hypersomnia after the drug is no longer used