Psychology Facts

▼ Hypersomnolence ▼

Narcolepsy type 1. This type of narcolepsy, also called narcolepsy with cataplexy (sudden muscle weakness triggered by emotions) is caused by having a low level of the brain and cerebrospinal fluid chemical (neurotransmitter) hypocretin (also called orexin). Daytime naps are usually shorter and refreshing compared with daytime naps in other disorders of hypersomnolence. Narcolepsy type 1 commonly begins between the ages of 10 and 25. Hallucinations and sleep paralysis are common.

Narcolepsy type 2. This type of narcolepsy doesn't include cataplexy. Narcolepsy type 2 has less severe symptoms and normal levels of hypocretin. Narcolepsy type 2 commonly begins during adolescence.

Kleine-Levin syndrome. This condition consists of recurring episodes of extreme hypersomnia. It usually occurs with mental, behavioral and sometimes psychiatric disturbances. Each episode can last for about 10 days, with some episodes lasting several weeks to months and recurring several times a year. If you have Kleine-Levin syndrome, you have normal alertness and functioning between episodes. It mainly affects young males. Episodes decrease over eight to 12 years.

Idiopathic hypersomnia. Idiopathic means no known cause, so idiopathic hypersomnia means you feel extremely sleepy for unknown reasons — even after a longer than the adequate amount (9 to 10 hours) of sleep.

》The cause of most cases of hypersomnia remains unknown. Researchers have looked at the potential roles of neurotransmitters in the brain and cerebrospinal fluid including hypocretin/orexin, dopamine, histamine, serotonin and gamma-aminobutyric acid (GABA). A genetic link may be possible since a family history is present in up to 39% of people with idiopathic hypersomnia.

》How is hypersomnia diagnosed?

Your sleep specialist will ask about your symptoms, medical history, sleep history and current medications. You may be asked to keep track of your sleep and wake patterns using a sleep diary. You may be asked to wear an actigraphy sensor, which is a small, watch-like device worn on your wrist that can track disruptions in your sleep-wake cycle over several weeks.

》Other tests your sleep specialist may order include:

Polysomnography.
This overnight sleep study test measures your brain waves, breathing pattern, heart rhythms and muscle movements during stages of sleep. The test is performed in a hospital, sleep study center or other designated site and under the direct supervision of a trained sleep specialist.

Multiple sleep latency test.
This daytime sleep test measures a person's tendency to fall asleep during five, 20-minute nap trials scheduled two hours apart. The test records brain activity, including the number of naps containing REM sleep.

Sleep questionnaires.
You may be asked to complete one or more sleep questionnaires that ask you to rate your sleepiness. Popular sleep questionnaires are the Epworth Sleepiness Scale and the Stanford Sleepiness Scale.

》According to diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, you would be diagnosed with hypersomnia if you:

Experience excessive sleepiness despite at least seven hours of sleep and have at least one of these additional symptoms:
(a) lapse into sleep several times within the same day;
(b) get more than nine hours of sleep and still don't feel refreshed and awake;
or (c) don't feel fully awake after an abrupt awakening.

Experience hypersomnia at least three times a week for at least three months.

Report that the hypersomnia is causing significant distress or impairment in your mental, social, work or other areas of functioning

》Treatment depends on what's causing your hypersomnia. There are both medication approaches and lifestyle changes.

Medications
Wakefulness-promoting agents include modafinil (Provigil®), armodafinil (Nuvigil®) and pitolisant (Wakix®) and solriamfetol (Sunosi®).

Lifestyle changes
Maintain good sleep habits. This includes things like establishing a regular sleeping schedule, having an environment that allows for sleep (cool, dark room; comfortable pillows and bed) and limiting caffeine and exercise before bedtime.

》There's no way to prevent most types of hypersomnia. Hypersomnia is a chronic illness without a cure.

》Consider making some lifestyle changes to help improve the quality of your sleep and keep you safe and avoid injuries and accidents.

Things you can try include:

Go to bed at the same time each night. Make sure your bedroom is well-ventilated, cool in temperature, dark, quiet, and comfortable in terms of mattress, pillows and sheets and blankets.

Avoid caffeinated products (including coffee, cola, tea, chocolate, and various over-the-counter medicines) within several hours of bedtime. Caffeine is a stimulant.

Avoid alcohol before bedtime. Although alcohol is a depressant and seems like it might help you fall asleep, as it's metabolized by your body, it causes awakenings and is often associated with nightmares and sweats.

Avoid tobacco and nicotine-containing products near bedtime. Nicotine is a stimulant.

Ask your sleep specialist about what to avoid in terms of foods or specific medications.

Be careful about driving or operating equipment that can be dangerous to you or others. Work with your healthcare team, family and employer to make adaptations or adjustments to keep you and others around you safe.

Avoid night shift work.

It may be helpful to talk to a psychologist or counselor and find a support group to learn to cope with the challenges of having hypersomnia.

Ask your sleep specialist for referrals and names of support groups. Bring loved ones with you to these sessions. People with hypersomnia are often misunderstood as being lazy or incompetent and educating them on this condition will help your relationships.