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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]


SymptomsEdit

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.


DiagnosisEdit

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.

EpidemiologyEdit

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]

CausesEdit

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 GABAA 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).


TreatmentEdit

Psychological treatmentEdit

Physical treatmentsEdit

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 GABAA 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]

See alsoEdit

ReferencesEdit

  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.
  2. Sleep-Wake Disorders. DSM-5 Development. American Psychiatric Association.
  3. Hypersomnolence Disorders. DSM-5 Development. American Psychiatric Association.
  4. DSM-5: The Future of Psychiatric Diagnosis. DSM-5 Development. American Psychiatric Association.
  5. 5.0 5.1 5.2 5.3 National Institutes of Health (2008). NINDS Hypersomnia Information Page. URL accessed on 2009-01-23.
  6. 6.0 6.1 Sharon L. Schutte-Rodin, MD. Idiopathic Hypersomnia with Long Sleep Time. American Academy of Sleep Medicine.
  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.
  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.
  9. Lynn Marie Trotti, MD. Flumazenil for the Treatment of Primary Hypersomnia. Emory University - Georgia Research Alliance. ClinicalTrials.gov.
  10. Lynn Marie Trotti, MD. Clarithromycin for the Treatment of Primary Hypersomnia. Emory University - Georgia Research Alliance. ClinicalTrials.gov.
  11. Successful treatment with levothyroxine for idiopathic hypersomnia patients with subclinical hypothyroidism. General Hospital Psychiatry - Elsevier Inc. URL accessed on 2010-08-05.
  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.

External linksEdit


  1. REDIRECT Template:CNS diseases of the nervous system


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