Hypersomnia is a condition of sleeping in abnormal situations. In other words, it's too easy to fall asleep during the day, in situations that most people don't. It is a symptom that can appear in several diseases or be related to taking medication.
The first point is to define what is and what is not normal. Here, the opinion of those who live with it is fundamental. It should be ensured that sleep appears in abnormal situations.
In a second step, you have to know the cause and decide if it is worth establishing a treatment, whether it is the cause or the symptom. For this, it is necessary to carry out additional studies.
What are the common symptoms of hypersomnia?
Excessive sleepiness is reported by the person and/or by the family. There are somnolence assessment scales, with a limit score for normality and light, moderate or marked intensities.
Once referred by the person and observers, the extent of this hypersomnolence should be confirmed.
Excessive sleepiness is a symptom that should be investigated whenever, due to its frequency or intensity, it causes the affected person or those close to them to suspect that sleep is not proportionate to night's rest. Since it can be a red flag for the presence of other diseases, it must be evaluated and the diagnostic study must be carefully followed.
What are the causes?
Excessive sleepiness can be caused by multiple systemic diseases, neurological diseases or diseases specific to the control of the sleep-wake rhythm.
Moreover, taking several drugs may alter the normal state of alertness and produce an abnormal sensation of daytime sleepiness. Therefore, hypersomnia can be classified as secondary (to another process) or primary-idiopathic (when it is the first disease).
Once hypersomnia is confirmed, the first step is to eliminate the drugs that can cause it. Subsequently, it is necessary to investigate, due to the presence of other symptoms or signs, whether there is an associated disease that can produce this symptom.
The range of diseases that will cause hypersomnia is very wide; She goes from respiratory diseases (sleep apnea) to chronic respiratory failure with increased carbon dioxide (emphysema, chronic bronchitis, chronic hypoventilation), diffuse metabolic endocrine encephalopathies (hypothyroidism), kidney or liver disease, heart failure or tumors .
Over many local infectious diseases or diffuse (sepsis, sleeping sickness, transmitted by the tsetse fly) will produce drowsiness, especially if the fever is high and in children or the elderly.
If it is excluded that there is another disease causing hypersomnia, we are faced with sleeping sickness. The most common symptoms in this area are narcolepsy and idiopathic hypersomnia.
When the cause of hypersomnia is not found, it is often referred to as idiopathic hypersomnia; This disease as such usually also begins in young people and has a better course than narcolepsy.
Narcolepsy is a genetic disease that usually begins in young people, and is accompanied by:
- Sudden sleep attacks (falling asleep in class, sitting, standing, watching television, in a bar).
- Cataplexie (sudden loss of voluntary muscle tone) caused by fears, laughter, noise or other phenomena).
- Sleep paralysis (at the beginning or at the end of the dream).
- Hallucinations hypnagogiques (presentation of images generally with a feeling of panic at the onset of sleep).
In this disease, the phase of REM sleep enters very quickly, in 1-10 minutes, and not after 50 minutes, as it happens in other people.
How is it diagnosed?
The most common method is to perform the Multiple Latency Test study to determine the time it takes to fall asleep in 5 separate two-hour naps on the same day; This test is also used to find out if the patient is entering REM.
With this sleep test, the diagnosis of hypersomnia is made if the sleep onset latency is less than 5 minutes.
If you enter REM at the start or within a few minutes of sleep over two or more naps, the most likely diagnosis is a condition known as narcolepsy.
How do we treat it?
The treatment of hypersomnia will first of all be the treatment of the disease which produces it.
For example, in obstructive sleep apnea syndrome, treatment with CPAP will improve drowsiness and the feeling of fatigue very strikingly from the first day of using the device.
Hypersomnia will only be treated by itself when we are faced with a sleeping sickness in which hypersomnia is the basic symptom, that is, especially in narcolepsy and idiopathic hypersomnia, or when despite adequate treatment of the disease, somnolence persists as an important symptom.
In narcolepsy and idiopathic hypersomnia, treatment for hypersomnia will depend on the severity of the symptom. If it is light, it begins with measures of timing, taking care of the night's sleep, maintaining fixed times for going to bed and getting up, and a daily nap. You can also using coffee as a stimulant. If that's not enough, mild stimulants like magnesium can be used.
In the last 4 years, a new drug has been introduced to the market aimed at treating hypersomnia both in narcoleptics and in patients with idiopathic hypersomnia which seems to have less problems than amphetamine derivatives.
Its name is Modafinil. It is a more expensive drug, and it has no effect on the other symptoms of narcolepsy (cataplexy, sleep paralysis, hallucinations.) Cataplexy, hypnogogic hallucinations, and sleep paralysis have traditionally been treated with two classes antidepressant drugs, which include tricyclic antidepressants and selective serotonin reuptake inhibitors.