Changes: Hypersomnia

Latest revision as of 12:05, 18 December 2012

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Hypersomnia is a disorder characterized by excessive sleepiness, extended sleep time in a 24-hour cycle, and the inability to achieve the feeling of refreshment that usually comes from sleep. There are two main categories of hypersomnia: primary hypersomnia (also called idiopathic hypersomnia) and recurrent hypersomnia (also called primary recurrent hypersomnia). Both have the same symptoms, but differ in frequency of occurrence.^[1]

Note: In the proposed 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, due for publication in May 2013, hypersomnia is reclassified under Sleep-Wake Disorders as Hypersomnolence, of which there are several subtypes.^[2] Primary hypersomnia is reclassified as Major somnolence disorder.^[3] Idiopathic hypersomnia is not included. As of November 2012, the draft diagnostic criteria for DSM-5 are still in flux and the specific criteria text has been removed from public view on the DSM-5 Development site.^[4]

Symptoms

According to the U. S. National Institute of Neurological Disorders and Stroke:

"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. 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. Certain medications, or medicine withdrawal, may also cause hypersomnia. Medical conditions including multiple sclerosis, chronic fatigue syndrome, depression, encephalitis, epilepsy, or obesity may contribute to the disorder. Some people appear to have a genetic predisposition to hypersomnia; in others, there is no known cause. Hypersomnia typically affects adolescents and young adults, although the most common causes of the condition for the two age cohorts differ."^[5]

Those who suffer from hypersomnia have recurring episodes of excessive daytime sleepiness (EDS), which is different from feeling tired due to lack of or interrupted sleep at night. They 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.

Typically, hypersomnia is first recognized in adolescence or young adulthood.^[5] Patients with hypersomnia often experience prolonged night sleep and have difficulty waking from extended sleep episodes, feeling disoriented upon doing so. This condition is known as sleep inertia or, more descriptively, as sleep drunkenness.^[6] Other symptoms may include anxiety, increased irritation, decreased energy, restlessness, slow thinking, slow speech, loss of appetite, hallucinations, memory difficulty and difficulty regulating body temperature.^[7] Some patients lose the ability to function in family, social, occupational or other settings.^[8] These symptoms are present in both types of hypersomnia. A sufferer of primary hypersomnia displays these symptoms continually for months or years.^[8] 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.

Diagnosis

An adult is considered to have hypersomnia if he or she sleeps more than 10 hours per day on a regular basis for at least two weeks, or if he or she is compelled to nap repeatedly during the day.

Epidemiology

Hypersomnia is an uncommon disorder; fewer than 5% of adults complain of EDS. The disorder usually occurs between ages 15–30 and develops slowly over a period of years.^[6]

Causes

Hypersomnia can be caused by brain damage and disorders such as clinical depression, bipolar disorder, celiac disease, 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 an adverse effect of taking certain medications (e.g. 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.^[5]

Primary hypersomnia can be caused by hyperactive GABA_A receptors in the central nervous system. In this case, neurotransmission is inhibited and the effect is similar to that of chronic medication with benzodiazepines or alcohol.^[9]^[10]

People who are overweight may be more likely to suffer from hypersomnia. This can often exacerbate weight problems as excessive sleeping decreases metabolic energy consumption, making weight loss more difficult. However, 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.

Mononucleosis can cause hypersomnia; one of its major symptoms is fatigue. In children, influenza may do the same.

Two people with excessive daytime sleepiness and prolonged nocturnal sleep were treated for their subclinical hypothyroidism, effecting significantly decreased sleep time and daytime sleepiness.^[11]

In some instances, the cause of the hypersomnia cannot be determined; in these cases, it is considered to be idiopathic hypersomnia.

Hypersomnia may also occur as a side effect of taking certain medications (i.e some psychotropics for depression, anxiety, or bipolar disorder).

Treatment

Psychological treatment

Sleep hygiene

Physical treatments

From the website of the National Institute of Neurological Disorders and Stroke:

"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."^[5]

Nevertheless, treatment for primary (or idiopathic) hypersomnia is far from satisfactory. CNS stimulants tend to be less effective for hypersomnia than they are for narcolepsy and may be less well tolerated.^[8] In addition, stimulants provide diminished returns when taken for a period of years, let alone a period of decades. The negative side effects of stimulants, such as hypertension, are also of concern.

A 2012 study found that flumazenil provides relief for some patients whose CSF contains an unknown "somnogen" that enhances the function of GABA_A receptors, making them more susceptible to the sleep-inducing effect of GABA. For one patient, daily administration of flumazenil by sublingual lozenge and topical cream has proven effective.^[12]

References

↑ Hypersomnia — causes, adults, drug, person, people, used, effect, Definition, Description, Causes and symptoms, Demographics, Diagnosis, Treatments, Prognosis. Minddisorders.com. URL accessed on 2010-08-05.
↑ Sleep-Wake Disorders. DSM-5 Development. American Psychiatric Association.
↑ Hypersomnolence Disorders. DSM-5 Development. American Psychiatric Association.
↑ DSM-5: The Future of Psychiatric Diagnosis. DSM-5 Development. American Psychiatric Association.
↑ ^5.0 ^5.1 ^5.2 ^5.3 National Institutes of Health (2008). NINDS Hypersomnia Information Page. URL accessed on 2009-01-23. Cite error: Invalid <ref> tag; name "NINDS" defined multiple times with different content
↑ ^6.0 ^6.1 Sharon L. Schutte-Rodin, MD. Idiopathic Hypersomnia with Long Sleep Time. American Academy of Sleep Medicine.
↑ Vernet, C., Leu-Semenescu, S., Buzare, M.-A. and Arnulf, I. (2010). Subjective symptoms in idiopathic hypersomnia: beyond excessive sleepiness. Journal of Sleep Research 19 (4): 525-534.
↑ ^8.0 ^8.1 ^8.2 Michel Billiard, MD. Idiopathic Hypersomnia. Sleep Disorders I. Gui-de-Chauliac Hospital, Neurology B Department, 34295 Montpellier, Cedex 05, France.
↑ Lynn Marie Trotti, MD. Flumazenil for the Treatment of Primary Hypersomnia. Emory University - Georgia Research Alliance. ClinicalTrials.gov.
↑ Lynn Marie Trotti, MD. Clarithromycin for the Treatment of Primary Hypersomnia. Emory University - Georgia Research Alliance. ClinicalTrials.gov.
↑ Successful treatment with levothyroxine for idiopathic hypersomnia patients with subclinical hypothyroidism. General Hospital Psychiatry - Elsevier Inc. URL accessed on 2010-08-05.
↑ D.B. Rye, D.L. Bliwise, K. Parker, L.M. Trotti, P. Saini, J. Fairley, A. Freeman, P.S. Garcia, M.J. Owens, J.C. Ritchie and A. Jenkins (21 November 2012). Modulation of Vigilance in the Primary Hypersomnias by Endogenous Enhancement of GABAA Receptors. Sci. Transl. Med. 4 (161): 161ra151.

External links

hypersomnia at NINDS

Merck Home 06-081c

Merck Manual 14-173c

GPnotebook -483065848
FPnotebook PSY226
eMedicine med/3129 - "Primary Hypersomnia"

REDIRECT Template:CNS diseases of the nervous system

|}

[1] Hypersomnia — causes, adults, drug, person, people, used, effect, Definition, Description, Causes and symptoms, Demographics, Diagnosis, Treatments, Prognosis. Minddisorders.com. URL accessed on 2010-08-05.

[DSM-5_Sleep-Wake-2] Sleep-Wake Disorders. DSM-5 Development. American Psychiatric Association.

[DSM-5_Hypersomnolence-3] Hypersomnolence Disorders. DSM-5 Development. American Psychiatric Association.

[DSM-5-4] DSM-5: The Future of Psychiatric Diagnosis. DSM-5 Development. American Psychiatric Association.

[NINDS-5] 5.0 ^5.1 ^5.2 ^5.3 National Institutes of Health (2008). NINDS Hypersomnia Information Page. URL accessed on 2009-01-23. Cite error: Invalid <ref> tag; name "NINDS" defined multiple times with different content

[YourSleep-6] 6.0 ^6.1 Sharon L. Schutte-Rodin, MD. Idiopathic Hypersomnia with Long Sleep Time. American Academy of Sleep Medicine.

[J.SleepRes-7] Vernet, C., Leu-Semenescu, S., Buzare, M.-A. and Arnulf, I. (2010). Subjective symptoms in idiopathic hypersomnia: beyond excessive sleepiness. Journal of Sleep Research 19 (4): 525-534.

[Billiard-8] 8.0 ^8.1 ^8.2 Michel Billiard, MD. Idiopathic Hypersomnia. Sleep Disorders I. Gui-de-Chauliac Hospital, Neurology B Department, 34295 Montpellier, Cedex 05, France.

[Flumazenil-9] Lynn Marie Trotti, MD. Flumazenil for the Treatment of Primary Hypersomnia. Emory University - Georgia Research Alliance. ClinicalTrials.gov.

[Clarithromycin-10] Lynn Marie Trotti, MD. Clarithromycin for the Treatment of Primary Hypersomnia. Emory University - Georgia Research Alliance. ClinicalTrials.gov.

[GHP-11] Successful treatment with levothyroxine for idiopathic hypersomnia patients with subclinical hypothyroidism. General Hospital Psychiatry - Elsevier Inc. URL accessed on 2010-08-05.

[STM-12] D.B. Rye, D.L. Bliwise, K. Parker, L.M. Trotti, P. Saini, J. Fairley, A. Freeman, P.S. Garcia, M.J. Owens, J.C. Ritchie and A. Jenkins (21 November 2012). Modulation of Vigilance in the Primary Hypersomnias by Endogenous Enhancement of GABAA Receptors. Sci. Transl. Med. 4 (161): 161ra151.

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@@ Line 1: / Line 1: @@
+{{ClinPsy}}
-{{DiseaseDisorder infobox |
-  Name           = Hypersomnia |
-  ICD10          = {{ICD10|F|51|1|f|50}}, {{ICD10|G|47|1|g|40}} |
-  ICD9           = {{ICD9|291.82}}, {{ICD9|292.85}}, {{ICD9|307.43}}-{{ICD9|307.44}}, {{ICD9|327.1}}, {{ICD9|780.53}}-{{ICD9|780.54}} |
-}}
-'''Hypersomnia''' is an excessive amount of [[sleep|sleepiness]], resulting in an inability to stay [[awake]].
+'''Hypersomnia''' is a disorder characterized by excessive [[somnolence|sleepiness]], extended sleep time in a 24-hour cycle, and the inability to achieve the feeling of refreshment that usually comes from sleep. There are two main categories of hypersomnia: ''[[primary hypersomnia]]'' (also called '''idiopathic hypersomnia''') and '''recurrent hypersomnia''' (also called '''primary recurrent hypersomnia''').  Both have the same symptoms, but differ in frequency of occurrence.<ref>{{cite web|url=http://www.minddisorders.com/Flu-Inv/Hypersomnia.html |title=Hypersomnia&nbsp;— causes, adults, drug, person, people, used, effect, Definition, Description, Causes and symptoms, Demographics, Diagnosis, Treatments, Prognosis |publisher=Minddisorders.com |date=1999-02-15 |accessdate=2010-08-05}}</ref>
-Even though people with hypersomnia sleep for more hours at night than is considered necessary (or even healthy), they may still need to take frequent naps in order to remain awake and alert during the day.
+'''Note:''' In the proposed 5th edition of the [[DSM-5 | Diagnostic and Statistical Manual of Mental Disorders]], due for publication in May 2013, hypersomnia is reclassified under Sleep-Wake Disorders as '''Hypersomnolence''', of which there are several subtypes.<ref name="DSM-5 Sleep-Wake"> {{cite web |url=http://www.dsm5.org/ProposedRevision/Pages/Sleep-WakeDisorders.aspx |title=Sleep-Wake Disorders |author= |work=DSM-5 Development |publisher= American Psychiatric Association |accessdate= }}</ref> Primary hypersomnia is reclassified as Major [[somnolence]] disorder.<ref name="DSM-5 Hypersomnolence"> {{cite web |url=http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=579# |title=Hypersomnolence Disorders |author= |work=DSM-5 Development |publisher= American Psychiatric Association |accessdate= }}</ref> Idiopathic hypersomnia is not included. As of November 2012, the draft diagnostic criteria for DSM-5 are still in flux and the specific criteria text has been removed from public view on the DSM-5 Development site.<ref name="DSM-5"> {{cite web |url=http://www.dsm5.org/Pages/Default.aspx |title=DSM-5: The Future of Psychiatric Diagnosis |author= |work=DSM-5 Development |publisher= American Psychiatric Association |accessdate= }}</ref>
-==Diagnosis==
-An adult is considered to have hypersomnia if he or she sleeps more than 10 hours per day on a regular basis for at least two weeks.
+==Symptoms==
+According to the U. S. National Institute of Neurological Disorders and Stroke:
+:"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. 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. Certain medications, or medicine withdrawal, may also cause hypersomnia. Medical conditions including [[multiple sclerosis]], [[chronic fatigue syndrome]], [[Clinical depression|depression]], [[encephalitis]], [[epilepsy]], or [[obesity]] may contribute to the disorder. Some people appear to have a genetic predisposition to hypersomnia; in others, there is no known cause. Hypersomnia typically affects adolescents and young adults, although the most common causes of the condition for the two age cohorts differ."<ref name= "NINDS">{{cite web |url= http://www.ninds.nih.gov/disorders/hypersomnia/hypersomnia.htm |title= NINDS Hypersomnia Information Page |accessdate= 2009-01-23 |author= National Institutes of Health   |year= 2008 |month= June  |format= |publisher= |pages= |doi=  |quote= }}</ref>
+Those who suffer from hypersomnia have recurring episodes of [[excessive daytime sleepiness]] (EDS), which is different from feeling tired due to lack of or interrupted sleep at night. They 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.
+Typically, hypersomnia is first recognized in adolescence or young adulthood.<ref name="NINDS">{{cite web |url= http://www.ninds.nih.gov/disorders/hypersomnia/hypersomnia.htm |title= NINDS Hypersomnia Information Page |accessdate= 2009-01-23 |author= National Institutes of Health |year= 2008 |month= June  |publisher= |pages= |doi=  |quote= }}</ref> Patients with hypersomnia often experience prolonged night sleep and have difficulty waking from extended sleep episodes, feeling disoriented upon doing so. This condition is known as [[sleep inertia]] or, more descriptively, as sleep drunkenness.<ref name="YourSleep">{{cite web |url=http://yoursleep.aasmnet.org/disorder.aspx?id=48 |title=Idiopathic Hypersomnia with Long Sleep Time |author= Sharon L. Schutte-Rodin, MD |publisher= American Academy of Sleep Medicine |date= January 12, 2006 |accessdate= }}</ref> Other symptoms may include [[anxiety]], increased [[irritation]], decreased [[energy]], [[anxiety|restlessness]], slow thinking, slow speech, loss of [[appetite]], [[hallucinations]], memory difficulty and difficulty regulating body temperature.<ref name="J.SleepRes">{{cite journal |title=Subjective symptoms in idiopathic hypersomnia: beyond excessive sleepiness |author=Vernet, C., Leu-Semenescu, S., Buzare, M.-A. and Arnulf, I. |year=2010 |journal=Journal of Sleep Research |volume=19 |issue=4 |pages=525-534 |doi=10.1111/j.1365-2869.2010.00824.x |quote= }}</ref> Some patients lose the ability to function in family, social, occupational or other settings.<ref name="Billiard">{{cite web |url= http://www.beatcfsandfms.org/references/IdiopathicHypersomnia.html |title=Idiopathic Hypersomnia |accessdate= |author= Michel Billiard, MD |work=Sleep Disorders I |year= |month= |pages=573-582 |publisher=Gui-de-Chauliac Hospital, Neurology B Department, 34295 Montpellier, Cedex 05, France  |doi=  |quote= }}</ref> These symptoms are present in both types of hypersomnia. A sufferer of primary hypersomnia displays these symptoms continually for months or years.<ref name="Billiard" /> 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.
+==Diagnosis==
+An adult is considered to have hypersomnia if he or she sleeps more than 10 hours per day on a regular basis for at least two weeks, or if he or she is compelled to nap repeatedly during the day.
+==Epidemiology==
+Hypersomnia is an uncommon disorder; fewer than 5% of adults complain of EDS. The disorder usually occurs between ages 15–30 and develops slowly over a period of years.<ref name="YourSleep" />
 ==Causes==
+Hypersomnia can be caused by [[brain damage]] and disorders such as [[clinical depression]], [[bipolar disorder]], [[celiac disease]], [[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 an [[Side effect|adverse effect]] of taking certain medications (e.g. some psychotropics for depression, anxiety, or bipolar disorder), of withdrawal from some medications, or of drug or alcohol abuse. A [[Genetics|genetic]] predisposition may be a factor.<ref name="NINDS" />
+Primary hypersomnia can be caused by hyperactive [[GABAA receptor|GABA<sub>A</sub> receptors]] in the [[central nervous system]]. In this case, [[neurotransmission]] is inhibited and the effect is similar to that of [[chronic_(medicine)|chronic]] medication with [[benzodiazepines]] or [[ethanol|alcohol]].<ref name="Flumazenil">{{cite web |url=http://clinicaltrials.gov/show/NCT01183312 |title=Flumazenil for the Treatment of Primary Hypersomnia |author=Lynn Marie Trotti, MD |work=Emory University - Georgia Research Alliance |publisher= ClinicalTrials.gov |date= August 9, 2010 |accessdate= }}</ref><ref name="Clarithromycin">{{cite web |url=http://clinicaltrials.gov/show/NCT01146600 |title=Clarithromycin for the Treatment of Primary Hypersomnia |author=Lynn Marie Trotti, MD |work=Emory University - Georgia Research Alliance |publisher= ClinicalTrials.gov |date= June 15, 2010 |accessdate= }}</ref>
+People who are [[overweight]] may be more likely to suffer from hypersomnia. This can often exacerbate weight problems as excessive sleeping decreases metabolic energy consumption, making [[weight loss]] more difficult. However, 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.
-Hypersomnia can be caused by [[genetics]] (heredity), [[brain damage]], and disorders such as [[clinical depression]] and [[fibromyalgia]]. Hypersomnia can also be a symptom of other [[sleep disorders]] such as [[narcolepsy]], [[sleep apnea]], and [[restless leg syndrome]].
+[[Infectious mononucleosis|Mononucleosis]] can cause hypersomnia; one of its major symptoms is [[Fatigue (medical)|fatigue]]. In children, [[influenza]] may do the same.
-People who are [[overweight]] may be more likely suffer from hypersomnia. This can often exacerbate weight problems as excessive sleeping decreases metabolic energy consumption, making [[weight loss]] more difficult.
+Two people with excessive daytime sleepiness and prolonged nocturnal sleep were treated for their subclinical [[hypothyroidism]], effecting significantly decreased sleep time and daytime sleepiness.<ref name="GHP">{{cite web|url=http://www.ghpjournal.com/article/S0163-8343(08)00130-8/abstract |title=Successful treatment with levothyroxine for idiopathic hypersomnia patients with subclinical hypothyroidism |publisher=General Hospital Psychiatry - Elsevier Inc |date= |accessdate=2010-08-05}}</ref>
+In some instances, the cause of the hypersomnia cannot be determined; in these cases, it is considered to be [[idiopathic]]  hypersomnia.
+Hypersomnia may also occur as a side effect of taking certain medications (i.e some [[psychotropics]] for depression, anxiety, or bipolar disorder).<includeonly></includeonly>
-Another possible cause is an infection of [[mononucleosis]], as several instances of [[idiopathic]] hypersomnia have been found to arise immediately after such an infection (Dr. Givan, MD, [[Riley Hospital]]).
 ==Treatment==
-Hypersomnia can be treated with stimulants such as [[Modafinil]] or other medications that increase the amount of neurotransmitters in the brain, such as [[tricyclic antidepressants]].
+===Psychological treatment===
+*[[Sleep hygiene]]
+===Physical treatments===
+From the website of the National Institute of Neurological Disorders and Stroke:
+:"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."<ref name= "NINDS" />
+Nevertheless, treatment for primary (or idiopathic) hypersomnia is far from satisfactory. [[Central nervous system | CNS]] stimulants tend to be less effective for hypersomnia than they are for [[narcolepsy]] and may be less well tolerated.<ref name="Billiard" /> In addition, stimulants provide [[drug tolerance | diminished returns]] when taken for a period of years, let alone a period of decades. The negative side effects of stimulants, such as [[hypertension]], are also of concern.
+A 2012 study found that [[flumazenil]] provides relief for some patients whose CSF contains an unknown "somnogen" that enhances the function of GABA<sub>A</sub> receptors, making them more susceptible to the sleep-inducing effect of [[gamma-Aminobutyric acid|GABA]]. For one patient, daily administration of flumazenil by sublingual lozenge and topical cream has proven effective.<ref name="STM">{{cite journal |title=Modulation of Vigilance in the Primary Hypersomnias by Endogenous Enhancement of GABAA Receptors |author=D.B. Rye, D.L. Bliwise, K. Parker, L.M. Trotti, P. Saini, J. Fairley, A. Freeman, P.S. Garcia, M.J. Owens, J.C. Ritchie and A. Jenkins |journal=Sci. Transl. Med. |volume=4 |issue=161 |pages=161ra151 |date=21 November 2012 |doi=10.1126/scitranslmed.3004685 |accessdate=21 November 2012}}</ref>
 ==See also==
+* [[Fatigue]]
 * [[Kleine-Levin syndrome]]
 * [[Reticular_formation#Introduction|Reticular Formation]] (includes info about hypersomnia)
 * [[Somnolence]]
-* [[Nonorganic hyposomnia]]
+* [[Narcolepsy]]
+* [[Nonorganic hypersomnia]]
+==References==
+<references/>
 ==External links==
@@ Line 37: / Line 69: @@
 * {{eMedicine|med|3129}} - "Primary Hypersomnia"
+{{Mental and behavioural disorders}}
-{{psych-stub}}
+{{Diseases of the nervous system}}
+{{SleepSeries2}}
+{{Bipolar disorder}}
+[[Category:Hypersomnia]]
 [[Category:Sleep disorders]]
+[[Category:Symptoms]]
+<!--
+[[da:Hypersomni]]
 [[es:Hipersomnia primaria]]
+[[et:Hüpersomnia]]
+[[eu:Hipersomnia]]
 [[fr:Hypersomnie]]
+[[it:Ipersonnia]]
 [[nl:Hypersomnia]]
-[[pl:Hipersomnia]]
+[[no:Hypersomni]]
+[[pl:Nadmierna senność]]
+[[fi:Liikaunisuus]]
+[[sv:Hypersomni]]
+-->

v·d·e WHO ICD-10 mental and behavioural disorders (F · 290–319)
Neurological/ symptomatic	Dementia (Alzheimer's disease, multi-infarct dementia, Pick's disease, Creutzfeldt-Jakob disease, Huntington's disease, Parkinson's disease, AIDS dementia complex, Frontotemporal dementia) · Delirium · Post-concussion syndrome
Psychoactive substance	alcohol (drunkenness, alcohol dependence, delirium tremens, Korsakoff's syndrome, alcohol abuse) · opiods (opioid dependency) · sedative/hypnotic (benzodiazepine withdrawal) · cocaine (cocaine dependence) · general (Intoxication, Drug abuse, Physical dependence, Withdrawal)
Psychotic disorder	Schizophrenia (disorganized schizophrenia) · Schizotypal personality disorder · Delusional disorder · Folie à deux · Schizoaffective disorder
Mood (affective)	Mania · Bipolar disorder · Clinical depression · Cyclothymia · Dysthymia
Neurotic, stress-related and somatoform	Anxiety disorder (Agoraphobia, Panic disorder, Panic attack, Generalized anxiety disorder, Social anxiety) · OCD · Acute stress reaction · PTSD · Adjustment disorder · Conversion disorder (Ganser syndrome) · Somatoform disorder (Somatization disorder, \Body dysmorphic disorder, Hypochondriasis, Nosophobia, Da Costa's syndrome, Psychalgia) · Neurasthenia
Physiological/ physical behavioural	Eating disorder (anorexia nervosa, bulimia nervosa) · Sleep disorder (dyssomnia, insomnia, hypersomnia, parasomnia, night terror, nightmare) · Sexual dysfunction (erectile dysfunction, premature ejaculation, vaginismus, dyspareunia, hypersexuality) · Postnatal depression
Adult personality and behaviour	Personality disorder · Passive-aggressive behavior · Kleptomania · Trichotillomania · Voyeurism · Factitious disorder · Munchausen syndrome · Ego-dystonic sexual orientation
Intellectual disability	Intellectual disability
Psychological development (developmental disorder)	Specific: speech and language (expressive language disorder, aphasia, expressive aphasia, receptive aphasia, Landau-Kleffner syndrome, lisp) · Scholastic skills (dyslexia, dysgraphia, Gerstmann syndrome) · Motor function (developmental dyspraxia) · Pervasive: Autism/Asperger syndrome · Rett syndrome
Behavioural and emotional, childhood and adolescence onset	ADHD · Conduct disorder · Oppositional defiant disorder · Separation anxiety disorder · Selective mutism · Reactive attachment disorder · Tic disorder · Tourette syndrome · Speech (stuttering · cluttering)

v·d·e Articles on sleep
Sleep stages	Rapid eye movement sleep · Non-rapid eye movement sleep · Slow-wave sleep · Beta wave sleep · Delta wave sleep · Gamma wave sleep · Theta wave sleep
Sleep disorders	Advanced sleep phase syndrome · Automatic behavior · Circadian rhythm sleep disorder · Delayed sleep phase syndrome · Dyssomnia · Hypersomnia · Insomnia · Narcolepsy · Night terror · Nocturia · Nocturnal myoclonus · Non-24-hour sleep-wake syndrome · Ondine's curse · Parasomnia · Sleep apnea · Sleep deprivation · Sleepeating · Sleeping sickness · Sleeptalking · Sleepwalking
Benign phenomena	Consciousness states ·Dream · Dream content · Exploding head syndrome · False awakening · Hypnagogia · Hypnic jerk · Lucid dream · Nightmare · Nocturnal emission · Sleep paralysis · Somnolence ·
Other Sleep-related Topics	Chronotype · Electrosleep treatment · Hypnotic drugs · Napping · Jet lag · Lullaby · Polyphasic sleep · Segmented sleep · Siesta · Sleep and learning · Sleep debt · Sleep inertia · Sleep onset · Sleep treatment · Sleep wake cycle · Snoring