(medicine) Excessive sleepiness.
Hypersomnia
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Neurological Disorder:
Hypersomnia |
Definition
Hypersomnia refers to a set of related disorders that involve excessive daytime sleepiness.
Description
There are two main categories of hypersomnia: primary hypersomnia (sometimes called idiopathic hypersomnia) and recurrent hypersomnia (sometimes called recurrent primary hypersomnia). Both are characterized by the same signs and symptoms and differ only in the frequency and regularity with which the symptoms occur.
Primary hypersomnia is characterized by excessive daytime sleepiness over a long period of time. The symptoms are present all, or nearly all, of the time. Recurring hypersomnia involves periods of excessive daytime sleepiness that can last from one to many days, and recur over the course of a year or more. The primary difference between this and primary hypersomnia is that persons experiencing recurring hypersomnia will have prolonged periods where they do not exhibit any signs of hypersomnia, whereas persons experiencing primary hypersomnia are affected by it nearly all the time. One of the best documented forms of recurrent hypersomnia is Kleine-Levin syndrome, although there are other forms as well.
There are many different causes for daytime sleepiness that are not considered hypersomnia, and there are many diseases and disorders in which excessive daytime sleepiness is a primary or secondary symptom. Feelings of daytime sleepiness are often associated with the use of common substances such as caffeine, alcohol, and many medications. Other common factors that can lead to excessive daytime sleepiness that is not considered hypersomnia include shift work and insomnia. Shift work can disrupt the body's natural sleep rhythms. Insomnia can cause excessive daytime sleepiness because of lack of nighttime sleep, and is a separate disorder.
Demographics
Hypersomnia is an uncommon disorder. In general, 5% or fewer of adults complain of excessive sleepiness during the daytime. That does not mean all those who complain of excessive sleepiness have hypersomnia. There are many other possible causes of daytime sleepiness. Of all the people who visit sleep clinics because they feel they are too sleepy during the day, only about 5–10% are diagnosed with primary hypersomnia. Kleine-Levin syndrome is present in about three times more males than females, but it is a very rare syndrome.
Hypersomnia generally appears when the patient is between 15 and 30 years old. It does not begin suddenly, but becomes apparent slowly, sometimes over years.
Causes and symptoms
People experiencing hypersomnia do not get abnormal amounts of nighttime sleep. However, they often have problems waking up in the morning and staying awake during the day. People with hypersomnia nap frequently, and upon waking from the nap, do not feel refreshed. Hypersomnia is sometimes misdiagnosed as narcolepsy. In many ways the two are similar. One significant difference is that people with narcolepsy experience a sudden onset of sleepiness, while people with hypersomnia experience increasing sleepiness over time. Also, people with narcolepsy find daytime sleep refreshing, while people with hypersomnia do not.
People with Kleine-Levin syndrome have symptoms that differ from the symptoms of other forms of hypersomnia. These people may sleep for 18 or more hours a day. In addition, they are often irritable, uninhibited, and make indiscriminate sexual advances. People with Kleine-Levin syndrome often eat uncontrollably and rapidly gain weight, unlike people with other forms of hypersomnia. This form of recurrent hypersomnia is very rare.
The causes of hypersomnia remain unclear. There is some speculation that in many cases it can be attributed to problems involving the hypothalamus, but there is little evidence to support that claim.
Diagnosis
Hypersomnia is characterized by excessive daytime sleepiness, and daytime naps that do not result in a more refreshed or alert feeling. Hypersomnia does not include lack of nighttime sleep. People experiencing problems with nighttime sleep may have insomnia, a separate sleep disorder. In people with insomnia, excessive daytime sleepiness may be a side effect.
The Diagnostic and Statistical Manual of Mental Disorders which presents the guidelines used by the American Psychiatric Association for diagnosis of disorders, states that symptoms must be present for at least a month, and must interfere with a person's normal activities. Also, the symptoms cannot be attributed to failure to get enough sleep at night or to another sleep disorder. The symptoms cannot be caused by another significant psychological disorder, nor can they be a side effect of a medicinal or illicit drug or a side effect of a general medical condition. For a diagnosis of recurrent hypersomnia, the symptoms must occur for at least three days at a time, and the symptoms have to be present for at least two years.
Treatment team
A number of specialists deal with sleep problems, including internal medicine physicians, psychiatrists, neurologists, and sleep disorder specialists.
Treatments
There have been some attempts at using drugs to treat hypersomnia. No substantial body of evidence supports the effectiveness of these treatments. Stimulants are not generally recommended to treat hypersomnia as they treat the symptoms but not the base problem. Some researchers believe that treatment of the hypothalamus may be a possible treatment for hypersomnia.
Prognosis
Kleine-Levin syndrome has been reported to occasionally resolve by itself around middle age. Except for that syndrome, hypersomnia is considered both a lifelong disorder and one that can be significantly disabling. There is no body of evidence that concludes there is a way to treat the majority of hypersomnia cases successfully.
Resources
BOOKS
Aldrich, Michael S. Sleep Medicines. New York: Oxford University Press, 1999.
American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington DC: American Psychiatric Association, 2000.
Chokroverty, Susan, ed. Sleep Disorders Medicine: Basic Science, Technical Considerations, and Clinical Aspects. 2nd ed. Boston: Butterworth-Heinemann, 1999.
Sadock, Benjamin J. and Virginia A. Sadock, eds. Comprehensive Textbook of Psychiatry. 7th edition, vol. 2. Philadelphia: Lippincott Williams and Wilkins, 2000.
Thorpy, Michael J, ed. Handbook of Sleep Disorders. New York: Marcel Dekker Inc, 1990.
PERIODICALS
Boris, Neil W., Owen R. Hagina, Gregory P. Steiner. "Case Study: hypersomnolence and precocious puberty in a child with pica and chronic lead intoxication." Journal of the American Academy of Child and Adolescent Psychiatry 35, no. 8 (August 1996): 1050-1055.
National Center on Sleep Disorders Research Working Group, Bethesda, Maryland. "Recognizing Problem Sleepiness in Your People." American Family Physician (February 15, 1999): 937-38.
ORGANIZATIONS
American Academy of Sleep Medicine. 6301 Bandel Road NW, Suite 101, Rochester, MN 55901. (507) 287-6006. www.asda.org.
Tish Davidson, AM
Rosalyn Carson-Dewitt, MD
| Veterinary Dictionary: hypersomnia |
Pathologically excessive sleep or drowsiness.
| Wikipedia: Hypersomnia |
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This article contains too many quotations for an encyclopedic entry. Please help improve the article by removing excessive quotations or transferring them to Wikiquote. Help is available. (March 2009) |
| Hypersomnia | |
|---|---|
| Classification and external resources | |
| ICD-10 | F51.1, G47.1 |
| ICD-9 | 291.82, 292.85, 307.43-307.44, 327.1, 780.53-780.54 |
| eMedicine | med/3129 |
| MeSH | D006970 |
Hypersomnia is a disorder characterized by excessive amounts of sleepiness.
From the website of the U.S. National Institute of Neurological Disorders and Stroke (NINDS):
- Hypersomnia is characterized by recurring episodes of excessive daytime sleepiness (EDS) or prolonged nighttime sleep. Different from feeling tired due to lack of or interrupted sleep at night, persons with hypersomnia are compelled to nap repeatedly during the day, often at inappropriate times such as at work, during a meal, or in conversation. These daytime naps usually provide no relief from symptoms.
- Patients often have difficulty waking from a long sleep, and may feel disoriented. Other symptoms may include anxiety, increased irritation, decreased energy, restlessness, slow thinking, slow speech, loss of appetite, hallucinations, and memory difficulty. Some patients lose the ability to function in family, social, occupational or other settings. (...) Typically, hypersomnia is first recognized in adolescence or young adulthood.[1]
Contents |
Causes
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, restless leg syndrome and periodic limb movement disorder. It may also occur as a side effect of taking certain medications (i.e some psychotropics for depression, anxiety, or bipolar disorder), of withdrawal from some medications, or of drug or alcohol abuse. A genetic predisposition may be a factor.[1]
People who are overweight may be more likely to suffer from hypersomnia. Although studies have shown a correlation between a lack of sleep and weight gain, sleeping at the level of a hypersomniac can also lead to considerable weight gain. This is because excessive sleeping decreases metabolic energy consumption, making weight loss more difficult. It is also the case that sleep disorders of this nature provoke or initiate weight gain due to a tendency to attempt to manage low energy levels by eating non-complex carbohydrates.[citation needed]
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.
When the cause of the hypersomnia cannot be determined, it is considered to be idiopathic hypersomnia.
Treatment
From the website of NINDS:
- Treatment is symptomatic in nature. Stimulants, such as amphetamine, methylphenidate, and modafinil, may be prescribed. Other drugs used to treat hypersomnia include clonidine, levodopa, bromocriptine, antidepressants, and monoamine oxidase inhibitors. Changes in behavior (for example avoiding night work and social activities that delay bed time) and diet may offer some relief. Patients should avoid alcohol and caffeine.[1]
See also
- Kleine-Levin syndrome
- Reticular Formation (includes info about hypersomnia)
- Somnolence
References
- ^ a b c National Institutes of Health (June 2008). "NINDS Hypersomnia Information Page". http://www.ninds.nih.gov/disorders/hypersomnia/hypersomnia.htm. Retrieved 2009-01-23.
External links
- 06-081c. at Merck Manual of Diagnosis and Therapy Home Edition
- 14-173c. at Merck Manual of Diagnosis and Therapy Professional Edition
- -483065848 at GPnotebook
- med/3129 at eMedicine - "Primary Hypersomnia"
- National Sleep Foundation
- Sleep Education.com: Idiopathic Hypersomnia
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