Hypersomnia

Key Takeaways

• Hypersomnia involves excessive daytime sleepiness. There are several types of hypersomnia, each with various causes.

• Individuals with hypersomnia often experience excessive sleepiness even if they get the recommended amount of sleep each night. In many cases, they sleep more than 7-8 hours, but still experience sleepiness and the urge to nap.

• There are no cures, but several treatments and management options may help, such as medication, sleep hygiene, and utilizing support systems.

What is Hypersomnia?

Hypersomnia is a sleep disorder characterized by excessive daytime sleepiness and notable difficulty staying awake; a state also referred to as hypersomnolence. Hypersomnia can occur even in individuals who get a healthy amount of sleep each night. ^[1]

Individuals with hypersomnia often feel a very strong urge or need to sleep during the day, which may also lead to unintentional periods of falling asleep. Due to these issues, hypersomnia can make it difficult to function in school, at work, and in other important life areas, while also increasing the risk of injuries and accidents. ^[1]

How Common is It?

Hypersomnia affects around 4 to 6% of the population. Hypersomnia disorders account for 15 to 30% of all people dealing with sleep problems. ^[2]

Rates are slightly higher in men than women, primarily due to sleep apnea, but the overall rates are similar between genders. Hypersomnia can affect any age, although it is very rare in childhood and most often develops in late adolescence or early adulthood. ^[2]

Is Hypersomnia the Same as Narcolepsy?

Hypersomnia is not the same as narcolepsy. Hypersomnia is a broader term that encompasses various disorders of excessive daytime sleepiness, while narcolepsy is a specific type of hypersomnia.

Narcolepsy is characterized by sudden sleep attacks during the day, usually leading to short sleep periods lasting between a few seconds and up to several minutes. Individuals with narcolepsy may also experience cataplexy, a symptom that causes the loss of voluntary muscle control while awake.

Unlike many other types of hypersomnia, individuals with narcolepsy often feel refreshed in the morning, feel more energized after naps, and sleep for a normal 7 to 8 hours. ^[1][2]

Hypersomnia Symptoms

The exact hypersomnia symptoms can vary from person to person, depending on the unique type and other individual factors. Common symptoms of hypersomnia include: ^[1][3][4]

• Excessive daytime sleepiness.

• Strong urges to sleep or nap during the day.

• Unintentionally falling asleep.

• Difficulty waking up in the morning or after naps (sleep “drunkenness”).

• Disorientation, grogginess, confusion, and/or impaired motor abilities.

• May need to set several loud alarms to wake up.

• Feeling unrefreshed in the morning (even after getting 7 or more hours of sleep).

• Sleeping much longer than normal (e.g.10+ hours), but still feeling tired the next day.

• Failing to feel more alert or refreshed after naps.

• Fatigue and low energy.

• Anxiety.

• Irritability.

• Decreased alertness and concentration.

Causes

There are a variety of possible causes of hypersomnia, such as:^[1][5]

• Genetics/inherited traits.

• Viral infections.

• Immune system abnormalities.

• Arousal deficiency in the central nervous system (CNS).

A variety of health conditions or other issues can also cause hypersomnia, such as:^[1]

• Head injury.

• Overexertion.

• Medication or substance use.

• Not getting enough sleep.

• Poor sleep quality.

Idiopathic Hypersomnia

Sometimes, hypersomnia happens with no known cause. This is referred to as idiopathic hypersomnia.

Individuals with idiopathic hypersomnia experience excessive daytime sleepiness, an irresistible urge to sleep, long, but unrefreshing naps, and difficulty waking up from sleep. This sleepiness occurs despite getting adequate or longer than normal nightly sleep.^[1][5]

Prevention

Some people may be able to prevent or reduce hypersomnia by getting enough sleep each night. This may include addressing any mental or physical conditions that are causing sleep problems and lack of sleep. However, in many cases, hypersomnolence occurs despite getting a normal amount of sleep. Thus, it can’t always be prevented.

Risk Factors

Hypersomnia can occur in anyone, although certain groups are more at risk, such as:^[1]

• Individuals between 17 and 24 years of age.

• Those with a biological relative with hypersomnia.

• Females.

The risk of developing hypersomnia also increases after viral infections, head injuries, changes in sleep-wake habits, and overexertion.^[5]

Types of Hypersomnia

Hypersomnia is broadly divided into two groups: primary and secondary. Both primary and secondary hypersomnia also have specific subtypes.

Primary Hypersomnia

Primary hypersomnia refers to hypersomnia that develops on its own and is not due to another condition. There are three types of primary hypersomnia:^[1][3][4]

• Idiopathic hypersomnia: Idiopathic hypersomnia refers to hypersomnia without a known cause. It is the most common type of primary hypersomnia.

• Kleine-Levin syndrome (KLS): KLS is characterized by severe sleepiness along with behavioral, cognitive, and psychiatric issues. Individuals with KLS sleep for 16 to 20 hours per day. Symptoms don’t occur all the time, but rather during specific episodes lasting around 10 days, although they can extend to several weeks or months in prolonged cases.

• Narcolepsy: Narcolepsy is characterized by excessive sleepiness and sudden sleep attacks throughout the day. These individuals also have one or more of the following characteristics: cataplexy, which is a sudden, brief loss of muscle tone brought on by strong emotions, such as laughter; hypocretin deficiency; entering into rapid-eye movement (REM) sleep in 15 minutes or less; and falling asleep at night within 8 minutes or less.

Secondary Hypersomnia

Secondary hypersomnia refers to cases of hypersomnia that are caused by medical conditions or other issues. Specific causes of secondary hypersomnia include:^[1][4]

• Drug/substance use, such as with alcohol, cannabis, and opiates.

• Medications, such as sedatives, hypnotics, anti-hypertensives, anti-epileptics, antipsychotics, muscle relaxants, and anti-Parkinsonian agents.

• Head Injury.

• Neurodegenerative disorders, such as Parkinson’s and Huntington's disease

• Psychiatric disorders, such as major depressive disorder (MDD), bipolar disorder (BD), and seasonal affective disorder.

• Sleep apnea.

• Decreased sleep quality.

Diagnosing Hypersomnia

Diagnosing hypersomnia requires a detailed evaluation by your doctor. They may also refer you to a sleep specialist if further testing is needed. During the evaluation, your doctor will ask you about your symptoms, how they’re affecting your life, and how long these have lasted. You may also be asked to track your sleep habits by using a sleep journal or diary.

A detailed medical history and physical exam are also often necessary, particularly to identify and/or rule out other causes, ensuring a more accurate diagnosis. This may include:

• Complete blood count.

• Biochemistry tests.

• Thyroid-stimulating hormone tests.

• Drug screen.

• Neurological testing.

Hypersomnia Tests and Assessments

If hypersomnolence is still suspected, there are a variety of established tests and assessments to help confirm a hypersomnolence diagnosis. Initial assessment often uses subjective assessments of sleepiness, such as:^[4]

• Epworth Sleepiness Scale: This is the most common subjective measure of sleepiness. It asks about how likely you are to fall asleep during different situations, such as reading, sitting, talking to someone, and sitting quietly after a meal.

• Stanford Sleepiness Scale: This scale measures sleepiness at a specific moment in time. Patients simply mark their level of sleepiness on a scale of 1 (wide awake/alert) to 7 (fighting sleep, sleep-onset soon).

After these measures, objective assessments are very important for confirming the sleepiness issues. Common objective measures are:^[1][4][5]

• Polysomnography: A polysomnography, or sleep study, is conducted by a sleep specialist. It measures various body functions as you sleep or attempt to sleep, which can help indicate possible sleep disorders.

• Multiple Sleep Latency Test (MSLT): The MLST, or nap study, involves 5 separate opportunities to nap throughout the day. This measures sleep latency at each opportunity, which is how quickly you fall asleep.

• Actigraphy: In this test, a watch-like device called an actigraph is worn on the wrist during sleep. It detects active vs inactive periods, which helps identify sleep-wake cycles.

Treatment Options

Treatment for hypersomnia is first directly tailored to the causes, if there are any identified. Factors affecting sleep quality and quantity are first addressed before implementing therapy.

Hypersomnia treatment can be grouped into non-pharmacological and pharmacological approaches.

Non-pharmacological treatments for hypersomnia include:^[4]

Sleep hygiene: This refers to specific habits and behaviors that promote better sleep, such as:

• Having consistent sleep/wake times.

• Sleeping in a cool, dark, comfortable room.

• Eliminating alcohol, caffeine, nicotine, and heavy meals several hours before bed.

Scheduled naps: Short naps of 15 to 20 minutes can be useful for some forms of hypersomnia, such as narcolepsy. However, they are often unhelpful in other forms, given that many people with hypersomnia feel unrefreshed after naps.

Regular physical activity: This may promote greater alertness in some individuals.

Pharmacological approaches for hypersomnia include:^[4][5]

• Non-amphetamine stimulants, especially Modafinil and Armodafinil.

• Amphetamines, such as methylphenidate and dextro-amphetamine. These are stronger, but with a higher likelihood of side effects, compared to non-amphetamine stimulants.

• Sodium oxybate.

• Pitolisant.

• GABA-antagonists, such as flumazenil and clarithromycin.

• Caffeine.

Living with Hypersomnia

Hypersomnia often negatively impacts well-being and makes it difficult to function. However, there are several things you can do to make living with hypersomnia more manageable. These should not be used on their own, but alongside professional treatment. The following tips may help:^[6]

• Build a support community with family and friends, and join a support group for hypersomnia.

• Let others in your life know about hypersomnia and its effects. Tell close family, friends, coworkers, teachers, etc.

• Try to exercise, especially earlier in the day.

• Eat regular, healthy meals. If you get sleepy after big meals, try smaller, more frequent meals.

• Consider a service animal. They can help wake you up when needed and offer other benefits.

• Use a sleep-wake journal to track sleep, medicines, activities, and other factors to help identify what makes symptoms better or worse.

• Consider using naps throughout the day. Experiment with different times of day, different nap lengths, etc., and then monitor symptoms.

• Stress management techniques, such as meditation/mindfulness.

Living with hypersomnia can be difficult, but remember that you’re not alone. If you’re experiencing symptoms of hypersomnia that are significantly impacting your daily life or well-being, it’s important to seek professional treatment as soon as you can.