Hypersomnia: Symptoms And Treatment
You have surely had the experience of sleeping longer than you wanted and still feeling sleepy after that. You might also have felt so tired in the middle of a day that you almost couldn’t stand. In this case, you may be suffering from hypersomnia.
Disorders of the sleep-wake rhythm include ten disorders or groups of disorders. Among them, we find insomnia, hypersomnia, narcolepsy, sleep disorders related to breathing, circadian sleep-wake rhythm disorders and restless legs syndrome, among others.
In this article, we’ll take a look at one of them: hypersomnia. To briefly describe it, hypersomnia is synonymous with too much or too much sleep. The one who suffers from hypersomnia does not feel rested and exhibits excessive drowsiness.
What are the characteristics of hypersomnia?
Hypersomnia is a broad diagnostic term. It includes symptoms of excessive amount of sleep (for example, prolonged nighttime sleep or involuntary daytime sleep), a propensity to sleep during the day, and sleep inertia.
People with hypersomnia fall asleep quickly and have good sleep efficiency, over 90%. They may have difficulty waking up in the morning. They sometimes seem confused, combative or ataxic. Ataxia refers to the lack of coordination of certain parts of the body. This prolonged alteration of alertness in the sleep-wake transition is sometimes called sleep inertia. Sleep inertia is colloquially known as “sleep drunkenness”. It can also occur after waking up from a nap.
During this period, the person appears to be awake. However, she exhibits reduced motor skills and the behavior can be very inappropriate. Memory deficits, spatio-temporal disorientation and the feeling of dizziness are also common.
This period can last from a few minutes to several hours. The persistent need to sleep can lead to an automatic behavior that the person performs without any subsequent memory. For example, there are people who find out that they have driven for several miles unconsciously after performing “automatic” driving for the past few minutes.
Even if the sleep is long, it is not restorative
For some people with hypersomnia, nighttime sleep lasts nine hours or more. However, sleep is not often restful, and people find it difficult to wake up after all those hours of sleep.
In this case, excessive sleepiness is characterized by several involuntary naps during the day. These daytime naps tend to be relatively long (an hour or more) and do not lead to an increase in alert level (the person still does not feel rested).
Daytime naps occur almost every day, despite the long duration of nighttime sleep. In addition, the quality of sleep can be good or bad. These people experience drowsiness over a large period of time. This is different from a “sleep attack”.
Involuntary sleep episodes occur in situations of low stimulation and low activity. For example, they take place during conferences or when we read, watch TV or drive long distances. In the most serious cases, they can manifest themselves in situations that require great attention. Examples of these situations are work, meetings or social gatherings.
What are the criteria for diagnosing hypersomnia disorder?
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic criteria for hypersomnia disorder are as follows:
A. Individual reports excessive sleepiness (hypersomnia) after sleeping for a primary period that lasted at least seven hours, with one or more of the following symptoms:
- Recurring periods of sleep or sleep attacks on the same day.
- A main episode of prolonged sleep, lasting more than nine hours, which is not restorative.
- Difficulty being fully awake after waking up suddenly.
B. Hypersomnia occurs at least three times a week for a minimum of three months.
C. Hypersomnia is accompanied by significant discomfort or deterioration in cognitive, social, occupational or any other type in the areas of functioning.
D. Hypersomnia is not best explained by another sleep disorder and does not occur exclusively during another sleep disorder (eg, narcolepsy or parasomnia).
E. Hypersomnia cannot be attributed to the physiological effects of a substance (eg, a drug or medication).
F. The coexistence of mental and medical disorders does not adequately explain the predominant presence of hypersomnia.
In addition, DSM-5 specifies three types of severity of hypersomnia:
- Mild: There are difficulties staying alert during the day, 1-2 days a week.
- Moderate: There are difficulties staying alert during the day, 3-4 days a week.
- Severe: There are difficulties in staying alert during the day, 5-7 days a week.
Features associated with hypersomnia that support the diagnosis
Although we frequently find non-restorative sleep, automatic behavior, difficulty waking up in the morning, and sleep inertia during hypersomnia, these symptoms can also exist in other disorders, such as narcolepsy.
About 80% of people with hypersomnia say their sleep is not restful. They have difficulty waking up in the morning.
Sleep inertia, although less common, is very specific to hypersomnia. Short naps (less than thirty minutes) do not allow you to feel rested.
People with hypersomnia often appear asleep and may even fall asleep in the doctor’s waiting room.
A small proportion of people with hypersomnia have a family history of hypersomnia. In addition, they present a symptom of dysfunction of the autonomic nervous system, such as vascular-type headaches, reactivity of the peripheral vascular system (Raynaud’s phenomenon) and fainting.
How common is hypersomnia disorder?
Hypersomnia is diagnosed in approximately 5-10% of people who go to sleep disorders clinics for daytime sleep problems. About 1% of the overall European and North American population has episodes of sleep inertia.
Hypersomnia affects men and women with equal frequency. In other words, we are dealing with a disorder that affects both men and women.
Treatment of hypersomnia
The treatment of this disorder can be achieved through two fronts. On the one hand, there is pharmacological treatment. The sleep specialist may prescribe specific medications to help the patient stay awake longer.
This is preferable to a consistent intake of psychoactive substances such as coffee. Excessive ingestion of stimulants can have serious health consequences, especially for the heart.
The non-pharmacological treatment for hypersomnia is basically changing sleep patterns. For this, we practice stimuli control training, in order to teach the person to detect when his drowsiness begins. She must then do a series of exercises to help her be more active.
Techniques are also used that make it easier to maintain good concentration. So mindfulness could be advised. Finally, sleep hygiene techniques are very important. Through sleep hygiene, the patient is taught to establish sleep conditions that help them rest better.
These sleep hygiene standards refer to environmental factors (room temperature, light, etc.), dietary factors (not ingesting certain foods before going to sleep) and other types of factors that play a role in level of rest. So, hypersomnia is a medical or psychological condition that can be treated. If, after reading the diagnostic criteria, you feel that you may be suffering from hypersomnia, we recommend that you consult your doctor. Remember that only a professional can make this diagnosis.
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