Hypersomnia - causes, types, symptoms, treatment

Hypersomnia Classification

In clinical neurology, hypersomnia is classified mainly according to the etiological principle. In accordance with the cause of occurrence, hypersomnia is divided into psychophysiological, post-traumatic, narcolepsy, psychopathic, idiopathic, associated with respiratory disorders in a dream and caused by somatic diseases.

By the features of the manifestation, permanent and paroxysmal hypersomnia are distinguished. Permanent hypersomnia is accompanied by constant drowsiness and a drowsy state throughout the day. Paroxysmal hypersomnia is characterized by sudden attacks of irresistible desire to sleep, leading to falling asleep even in the most inappropriate conditions for this. Paroxysmal hypersomnia is noted with narcolepsy and cataplexy.

The following varieties of hypersomnia are distinguished:

Psychophysiological, which occurs in healthy people as a result of overwork, nervous exhaustion and emotional overstrain.
Post-traumatic - develops due to brain injuries.
Narcoleptic, which is characterized by uncontrollable attacks of sleep. A person falls asleep in any places.
Psychopathic - the underlying cause is mental illness.
A drug that occurs while taking certain medications.
Idiopathic - provoked by respiratory distress during sleep.

The frequency and duration of attacks of hypersomnia can be:

Permanent - the desire to sleep does not leave all day.
Paroxysmal, in which uncontrollable drowsiness occurs in the form of seizures, briefly. At the same time, a person can fall asleep in any position and place.

The main criteria for the classification of the pathology in question are the causes of its occurrence. Depending on these factors, the following types of condition are distinguished:

Psychophysiological hypersomnia appears in people who do not experience significant health problems. In this case, daytime sleepiness is caused by emotional or physical exhaustion, which results in a lack of rest at night.
The post-traumatic form occurs after severe injuries affecting the cranium or brain. In some cases, hypersomnia can occur solely due to the stressful situation that a person experienced while receiving a dangerous injury.
The narcolepsy form has fundamental differences from other varieties of hypersomnia, because it is characterized by the emergence of an irresistible desire for sleep, which leads to violent falling asleep. The patient can not resist such attacks, which is why he falls asleep in the most inappropriate places and uncomfortable poses. Over time, a person can learn to recognize an approaching attack, which gives him some time to prepare for falling asleep. Directly in front of him or immediately after awakening, various hallucinations can occur. The first 5-10 minutes after waking up, the patient often cannot exercise motor activity due to decreased muscle tone.
The psychopathic form is characterized by the unpredictability of daytime falling asleep, the clinical picture may vary in each individual case. In the presence of hysteria, which is a consequence of mental trauma, drowsiness and a tendency to fall asleep can be observed for several days without any breaks. Diagnosis of the patient's condition during the day's rest shows a lack of sleep and a person is in intense wakefulness. This is due to the imitation of the correct regime, often a person simply takes a lying position and closes his eyes.
Drug hypersomnia is a side effect of various potent pharmacological drugs.
The idiopathic form is most common among patients from 15 to 30 years old, regardless of their gender. The main symptoms are constant drowsiness, difficulty waking up, maintaining a feeling of tiredness even with a full night's sleep. Resting during daylight hours may provide some relief, but drowsiness usually does not go away completely. With the artificial suppression of drowsiness and the rejection of daytime sleep, a transition to an altered state of consciousness can be observed, which lasts no more than a few seconds.
Lethargic sleep is one of the varieties of hypersomnia, its main sign is continuous sleep, the duration of which is a day or more. In most cases, this pathology is a consequence of the corresponding form of encephalitis or damage to the central nervous system.

There are also two different forms of hypersomnia:

With a permanent form, a person feels sleepy all day, no activity can distract him from thoughts about rest.
With a paroxysmal form with varying periodicity, attacks of drowsiness occur. This is associated with increased danger, since such symptoms often cause automobile accidents, worsening of a person’s position in society and exclusion from work.

Symptomatology

The main symptom of hypersomnia can be called systematically occurring or incessant drowsiness in the daytime with a good rest at night, this manifestation is characteristic of all types of such a condition.

In some cases, there is an increased duration of rest at night, it can be up to 14 hours. Another characteristic sign is the severity of the morning awakening, a person often wakes up, because he can not get up on the alarm clock. The transition from a sleepy state to active wakefulness is also significantly extended.

Constant daytime drowsiness or its attacks adversely affect a person’s attentiveness, in connection with this, his working capacity decreases and he loses the ability to fully carry out labor activity. Even single breaks during daytime sleep contribute to the violation of the rhythm of life and exacerbate the situation. In rare situations, rest during the day provides relief, but in the vast majority of cases after waking up, the main symptoms of hypersomnia persist.

You can highlight other, the most common symptoms of this pathology:

low muscle tone after awakening, which interferes with motor activity;
the occurrence of visual, auditory and other hallucinations with a narcoleptic variety of pathology;
the appearance of the syndrome of sudden falling asleep; attacks are not controlled and can occur in places that are not intended for rest;
increased weakness, a constant feeling of tiredness;
the occurrence of severe headaches, most often in the form of seizures;
a change in heart rate in the direction of its decrease;
convulsive reaction;
visual impairment;
Dizziness
drop in blood pressure;
significant impairment of working capacity;
worsening reaction, general inhibition;
sleeping condition.

Diagnostics

Often it is very difficult for a person to independently diagnose manifestations of hypersomnia in himself, even when the main symptoms appear.

Cases are common when people mistakenly regarded it as a chronic fatigue syndrome. To prevent the commission of such errors, experts have developed special tests to help identify hypersomnia.

These include the following types of events:

Polysomnography allows you to analyze not only the time of falling asleep, but also the duration of each phase of sleep. A short period, anxiety and frequent disturbances of night rest with subsequent waking up, too rapid a transition to the phase of REM sleep are all the main signs of the presence of hypersomnia. However, this diagnostic method is ineffective in idiopathic or narcoleptic form, since they are characterized by a slightly different course.
Passing a series of tests to assess the state of mental health in general.
Carrying out a complex of neurological research.
Conducting magnetic resonance imaging and computed tomography, as well as echoencephalography. Such studies are primarily carried out to exclude the presence of malignant tumors in the brain and impaired functioning of certain areas.
Laboratory analysis of cerebrospinal fluid.
Appointment of an additional examination by a therapist, endocrinologist, nephrologist, gastroenterologist and ophthalmologist if necessary. Such measures are necessary to determine the state and characteristics of the functioning of individual body systems and to exclude the presence of serious diseases.

Diagnosis is also aimed at differentiation from other types of disorders and diseases, including chronic fatigue and deep depression.

The diagnosis can be made by a neurologist if the main symptomatology persists for one month and cannot be associated with a lack of rest at night, as well as drug use or taking pharmacological drugs.

With the reappearance of symptoms within a few years after getting rid of the pathology, a diagnosis of chronic hypersomnia can be made.

Treatment

Therapy is usually aimed at eliminating the underlying disease that led to the occurrence of the pathology in question.

In cases where it is recognized as incurable, an individual therapy course is selected that is aimed at gradually eliminating the symptoms of daytime sleepiness. Particular attention is paid to the regime of rest and wakefulness, therefore, experts give the following recommendations:

normalize the work schedule, do not carry out work activities in the evening and night shifts;
to develop a regimen according to which it is daily necessary to go to bed at night and wake up in the morning;
allocate at least 8-9 hours for a night's rest;
Do not consume alcoholic beverages or foods with a high fat content in the evening or at night.

Sometimes a course of drug therapy is prescribed, which includes taking analeptics or antidepressants. You can take such drugs only as directed by your doctor, who will also determine the acceptable dosage.

Prevention

The following is a list of preventive measures that can minimize the risk of hypersomnia:

go to bed and get up always at the same time, take asleep at night for at least 8-9 hours;
give up smoking, drinking alcohol and lead a healthy lifestyle;
to be more calm about life's difficulties in order to limit the number of stressful situations;
competently determine the amount of permissible physical exertion, avoid overwork.

At the first sign of increased drowsiness or insomnia, you must seek professional medical help, and in the presence of diabetes mellitus or mental disorders, you should regularly undergo a medical examination.

Causes of hypersomnia

The causes of this disease (and this is precisely a disease!), Doctors still have not been able to accurately determine. Research is hampered by the fact that such disorders are rare. And only a small percentage of patients seek medical help, considering excessive drowsiness an individual feature of the body.

But according to the results of the few studies that have been carried out, an interesting fact has come to light. The disease is neither genetic nor infectious and against its background there are no noticeable changes in the hormonal background. It is also relatively related to neurological disorders and stresses - they can enhance the manifestations of the disease, but not provoke it.

Perhaps that is why idiopathic hypersomnia is called so, because this diagnosis is made to the patient only after a thorough examination, after which all other possible causes of pathological drowsiness are excluded.

True, in some cases it precedes the first manifestation of narcolepsy - a genetically determined sleep disorder in which a person not only sleeps a lot at night, but also periodically suddenly “turns off” during the day.

The etiological reasons and the mechanism for the development of idiopathic hypersomnia are not well understood. There is no precise understanding of the origin of the disease in academia. There is a version that the source of the problem is disruptions in circadian rhythms.

The alleged cause of the disease is the destruction of neurons in the noradrenergic structures of the brain. The study found a pathological drop in the level of histamine in the cerebrospinal fluid. Histamine receptors perform neuronal functions associated with the regulation of sleep and wakefulness, acting as an exciting mediator. A decrease in histamine levels does not allow the body to maintain a high level of wakefulness.

All patients show an abnormally high sensitivity to gamma-aminobutyric acid, the most important inhibitory neurotransmitter of the central nervous system. Studies have also found a small amount of unclassified active biological substance in the cerebrospinal fluid of the examined patients.

The mechanisms of alternating sleep and wakefulness are regulated in the human body by a complex system of interactions of activating and inhibitory processes occurring in the cerebral cortex, subcortical structures, and the limbic system. If the interaction is disrupted at least in one area, this causes a violation. Failures in the cycle regulation system are due to a number of reasons.

It can be:

Prolonged and constant lack of sleep;
Physical or mental overwork;
Transferred emotional shocks and stresses;
The use of narcotic substances or drugs - antipsychotics, antihistamines and sugar-lowering drugs, tranquilizers (drug hypersomnia is called iatrogenia);
Traumatic injuries of the skull, concussions and bruises of the brain;
Intracerebral hematomas, tumors and brain cysts;
Infectious diseases (meningitis, encephalitis, brain syphilis);
Respiratory failure (apnea) and concomitant hypoxia (oxygen deficiency) of brain tissue;
Mental disorders (neurasthenia, schizophrenia);
Diseases associated with impaired endocrine function (hypothyroidism - thyroid pathology, diabetes mellitus);
Other serious ailments (heart or kidney failure, cirrhosis).

Some types of hypersomnia have an unexplained etiology (nature). Such forms belong to the idiopathic variety of disorders.

The human body has a complex system that is responsible for the process of changing periods of wakefulness. Its mechanisms affect various parts of the cerebral cortex, and even local malfunctions in their interaction can provoke the occurrence of hypersomnia.

Among the main reasons that can provoke a malfunction of the system described above, the following factors can be distinguished:

systematic night sleep, which does not allow full recovery of strength;
daily increased physical activity;
mental or mental overwork;
emotional upheaval, frequent stressful situations, mental trauma;
the presence of drug addiction;
taking potent pharmacological drugs, first of all, this concerns various tranquilizers, antipsychotics and medicines aimed at lowering the amount of sugar;
concussion, damage to the skull, and other head injuries;
the presence of tumors or hematomas in the brain;
complications after infectious diseases, primarily after encephalitis, syphilis of the brain or meningitis;
violation of respiratory functions, which leads to oxygen starvation of brain tissue;
the presence of mental disorders, mainly with schizophrenia or neurasthenia;
violation of the functioning processes of the endocrine, cardiovascular system, kidneys;
diabetes;
cirrhosis of the liver.

Specialists also identify the idiopathic form of pathology, in which the nature of its origin remains unclear.

There are many reasons why this pathological condition develops.

Most often, the main etiological factors will be:

various neurological, somatic, mental diseases;
sleep phenomena (motor disorders in sleep, sleep apnea syndrome);
traumatic head injuries;
circadian rhythm disorder (as a result of transtemporal flights, shift work schedule);
adverse effects after taking medications;
insomnia (insomnia), etc.

The cause of psychophysiological hypersomnia, as a rule, will be lack of sleep at night, so it can be observed in healthy people and can be easily eliminated with normalization of the rhythm of life, as well as minimization of mental stress.

According to studies of the mechanism and causes of the development of hypersomnia, it is known that most often it occurs against the background of narcolepsy. Narcolepsy often occurs as a result of an existing genetic disease. At the same time, there is expressive daytime sleepiness and episodes of involuntary, a kind of violent, falling asleep.

Residually often hypersomnic conditions can occur due to neurological dysfunctions. The most unpredictable course of increased drowsiness is the clinic of hysteria. With this disease, a pathological dream can last a very long time, in some cases several days.
The manifestations of hypersomnia against the background of slight brain injuries are difficult to distinguish from the clinical manifestations of mental disorders. Differential diagnosis is to identify pronounced structural changes in the brain resulting from trauma. The absence of such injuries in case of hypersomnia indicates that the cause of this pathological condition is not brain damage, but a stress state caused by trauma.
Another cause of hypersomnia can be depressive disorders.
In some cases, drug therapy of various diseases becomes the cause of drug hypersomnia, in particular, this form of increased drowsiness is included in the list of side effects when certain hypotensive, hypoglycemic and psychotropic drugs are used.
Insufficient sleep at night due to insomnia, circulatory rhythm dysfunction caused by shift work and various external factors often provokes sleep disturbances and the development of a hypersomnic state.

Based on the foregoing, it is clear that hypersomnia is polyetiological in nature, and its diagnosis requires a planned approach.

The main causes of hypersomnia are the following:

chronic lack of sleep;
prolonged stress, nervous exhaustion;
overwork;
drug use;
taking a number of drugs;
brain damage (concussion, bruise, compression, hematoma);
neoplasms, infectious lesions and oxygen starvation of the brain;
mental illness (schizophrenia);
diabetes mellitus, toxic goiter;
renal failure.

People with sleep disorders are experiencing serious problems in everyday life. They often cannot fully fulfill their professional duties and run the risk of falling asleep in the most inappropriate place.

One of these disorders is hypersomnia. When this ailment appears, you need to seek the help of a doctor, because only a qualified specialist will be able to diagnose the pathology and choose the appropriate treatment.

This term refers to an increase in the duration of sleep by about a quarter. So, a healthy person sleeps 5-12 hours a day.

On weekdays, the average can be 7.5 hours, and on weekends - 8.5. At the same time, the duration of sleep for women is slightly longer compared to men.

Physiological and pathological hypersomnia is distinguished. So, the physiological state is observed with emotional or physical stress. It can not last more than a few days.

Pathological conditions are spoken of if a long night's sleep is accompanied by high drowsiness in the daytime. In this case, hypersomnia must be distinguished from other conditions.

With asthenic syndrome, drowsiness is also observed in the daytime, however, this pathology is not distinguished by an increase in the time of night sleep. There are also disorders when daytime drowsiness is the cause or effect of insomnia at night.

There is another kind of this pathology, namely idiopathic hypersomnia. This condition is characterized by increased drowsiness, which has no obvious reasons.

This pathology is in no way associated with the loss of muscle control due to strong experiences, and it differs from conditions such as narcolepsy, sleep paralysis, hypnagogic hallucinations. Therefore, the diagnosis of idiopathic hypersomnia is usually made by exclusion.

The regimen of sleep and wakefulness in the human body is regulated by a complex system of mutual activating and inhibitory effects occurring between the cerebral cortex, subcortical structures, the limbic system and the reticular formation. Hypersomnia develops as a result of a disruption in the functioning of this system, which may be due to a number of various reasons.

Psychophysiological hypersomnia can occur in healthy people after prolonged sleep deprivation, physical and mental fatigue, and stress. The development of this type of hypersomnia may be associated with the use of certain medications, for example, antipsychotics, tranquilizers, antihistamines, hypoglycemic and hypotensive drugs.

Post-traumatic hypersomnia is caused by functional disorders of the central nervous system that occur after a traumatic brain injury. Along with trauma, the cause of hypersomnia can be organic brain damage: an intracerebral tumor, an abscess of the brain, an intracerebral hematoma, infectious diseases (neurosyphilis, meningitis, encephalitis), vascular disorders (hemorrhagic stroke, chronic ischemia, ischemic stroke). The development of hypersomnia in patients with respiratory disorders occurring in a dream occurs most likely due to chronic hypoxia of brain tissue.

Hypersomnia is the main clinical symptom of narcolepsy and is often noted with cataplemia. Hypersomnia can also occur with mental disorders (neurasthenia, hysteria, schizophrenia) and somatic diseases (hypothyroidism, diabetes mellitus, heart failure, cirrhosis of the liver, chronic renal failure). In cases where increased drowsiness occurs for no specific reason and is not associated with any disease, it is referred to as idiopathic hypersomnia.

Symptoms

The idiopathic hypersomnia is characterized by the absence of clear marked signs of the disease. The only symptom present in all patients is excessive causeless drowsiness in the daytime, not associated with a lack of rest or excessive mental and physical overload. An excessive need for daytime sleep occurs in humans, despite a high-quality full-fledged night rest of normal duration. Patients, according to their stories, are in a state similar to mild intoxication.

Patients sleep sound deep sleep. They do not even respond to strong irritants. It is very difficult to wake them up even with a loud alarm signal. A night's rest does not bring them a sense of vivacity and a surge of strength. They awaken lethargic, lethargic. After the morning rise, disorientation may occur in the surroundings. If they arrange a siesta in the daytime, then sleep, again, does not give them a feeling of freshness.

Concomitant symptoms that are determined in some patients are:

carotid paralysis;
Hypnogy phenomenon - staying on the verge of sleep and reality;
heart rate increase;
digestive tract dysfunction;
spontaneous increase or decrease in body temperature;
memory impairment;
difficulty concentrating;
numbness and cooling of the distal parts of the body;
cephalgia;
pre-syncope.

Lethargy, weakness, lack of energy, drowsiness significantly worsen the quality of human life. The patient does not cope with professional duties and household chores. The learning process is difficult for him.

Idiopathic hypersomnia differs from other sleep disorders in that the patient falls asleep quite easily and sleeps from 8 to 10 hours at night, and if possible even up to several hours during the day. But at the same time, sleep does not bring the usual refreshing effect. It is very difficult for a person to wake up, and during the day he is almost constantly accompanied by rather unpleasant symptoms:

excessively long sleep at night - up to 10 hours or more;
the occurrence of snoring or obstructive sleep apnea syndrome;
partial loss of orientation upon waking;
a feeling of chronic fatigue;
pathological drowsiness throughout the day;
gradual decrease in visual acuity;
increased nervous irritability;
low blood pressure;
chronic headaches;
fatigue, weakness, distraction;
decreased performance;
inability to prolong concentration.

Patients with idiopathic hypersomnia periodically set records for various manifestations of sleep. For example, a record for the speed of falling asleep: in a normal person, this process lasts 20-30 minutes, and in a hypersomnia - up to 5 minutes.

Record for the duration of sleep (not lethargic!) - one of the patients slept 46 hours in a row. The record for the shortest period of wakefulness is only 15 minutes. But, unfortunately, these are not achievements that we should be proud of ...

Increased drowsiness or in medicine it is called hypersomnia is not a separate disease. Most likely, this is a symptom indicating a severe disorder in the body.

What to do How to get rid of hypersomnia?

Causes

In medicine, a permanent and paroxysmal type of disease is distinguished. In the first case, we are talking about Klein-Levine syndrome, Pickquick syndrome or narcolepsy. The paroxysmal type is a neurotic disorder or mental failure after taking psychotropic substances, tranquilizers and antidepressants.

The following common causes can be distinguished:

Infectious disease lasts for a long time.
Concerned about chronic ailments, most often failures in the endocrine system.
Nervous exhaustion of the body, starvation.
Stress.
Weak immunity.
Nervous breakdown.
Physical activity.
Increased mental stress.

Important! Hypersomnia appears even during the day, despite the fact that the person had a good rest.

Most often, before increased drowsiness develops, a person suffers for a long time from insomnia, apnea and other unpleasant anomalies.

You can learn about pathological drowsiness only after an examination, but a person should be alert for such symptoms - passivity, apathy, decreased performance.

As a rule, hypersomnia develops with overwork, constant lack of sleep. Sometimes pathology is a consequence of taking various medications to stimulate the nervous system. Less commonly, hypersomnia indicates brain damage.

Symptoms

Are you constantly sleep deprived and very nervous? Do you have to undergo different physical activities? Want to sleep hard? This is a natural physiological reaction of the body. A man simply can not help but sleep. It is dangerous when drowsiness is associated with a pathological process in the body.

Idiopathic hypersomnia

With the disease, you constantly want to sleep during the day, despite a long night's sleep. In addition, consciousness is confused, there is an incomprehensible lethargy, intoxication. A person feels depressed, broken. The disease can be caused by hereditary causes.

Psychophysiological hypersomnia

You are constantly nervous, in a stressful situation. Sooner or later your body will say: “Stop!”. Often this condition is characteristic of the child. With this form of hypersomnia, the patient sleeps around the clock, his wakefulness and sleep phases are completely disturbed, and irritability increases.

Neurotic hypersomnia

Please note, increased drowsiness is often a reaction of failures in the nervous system. Sleep problems may indicate a depressive syndrome, schizophrenia, a serious disorder of consciousness.

A person behaves inappropriately, he is constantly alarmed.

In addition, the patient is concerned about gluttony, constant panic attacks, lack of appetite, increased fussiness, and mood swings.

Sometimes hypersomnia develops after a person has been taking various sedatives for a long time. This condition is dangerous! It leads to inhibition of the central nervous system.

Diagnostics

Having trouble sleeping? You can not refuse the examination. A specialist for you will conduct a special test for sleep latency, measures the Stanford drowsiness scale.

Additionally, you need to undergo polysomnography. The procedure helps to fix the night unplanned awakening, the emotional state of the patient. It is very important that the doctor in time learns about the disease. Often, increased drowsiness is the first signal of a particular disease.

Many hypersomnia is a consequence of constant lack of sleep. To prevent the development of the disease, it is necessary:

Sleep in a room that is well ventilated.
Do not undergo stress, increased physical exertion.
Timely treat all diseases related to the central nervous system.

There is no special treatment. It is important to adhere to a special daily routine - sleep at night for at least 8 hours. Important! Do not sleep for more than 9 hours, otherwise you will suffer from constant drowsiness during the day.

Do you like to eat up near the TV in the evening? Forget about it! You will also have to give up loud music, outdoor games. All these methods violate the regime of falling asleep.

Do you have all the symptoms of hypersomnia? Perhaps Modafinil, Mazindol, Propranolol, Pemolin will be prescribed. If you constantly want to sleep because of a specific disease, an appropriate course of treatment is prescribed.

Attention! As long as a person does not completely get rid of increased drowsiness, he must not drive a car, otherwise everything may end in an accident.

You are increasingly beginning to notice that the forces are leaving you, so you want to lie down and sleep somewhere? First of all, sleep well. Take leave from work if necessary.

Remember, the bosses need responsible and valuable employees, so they will understand you. Moreover, working in a drowsy state does not lead to proper results.

As a rule, a person begins to make many mistakes, cannot concentrate, all his thoughts on a warm bed, a blanket and a soft pillow.

In addition to the main symptoms, there are a number of clinical manifestations characteristic of certain diseases that cause hypersomnia. So, for example, with narcolepsy, patients can feel irresistible drowsiness and fall asleep even at the most inappropriate moments. Over time, patients begin to sense in advance the approach of these attacks of violent drowsiness and take the most comfortable postures for sleep.

Symptoms of this form of pathologically increased drowsiness also include hallucinations at the time of falling asleep or awakening and cataplexy of awakening, which is characterized by atony of the muscular system, as a result of which the patient loses the ability to make any movements for several minutes after waking up.

Psychopathic hypersomnia is characterized by the unpredictable nature of daytime sleepiness, the features of which are due to specific psychopathology. Sleep can be quite long, but the results of a polysomnographic study indicate that the patient’s body is not in a state of sleep, and intense wakefulness is often determined on the electroencephalogram.

The phenomenon of idiopathic hypersomnia is most often characteristic of persons from 15 to 30 years. This form of hypersomnia is manifested by difficulty waking up, constant drowsiness, in some cases, patients have outpatient automatism for several seconds.

With damage to the reticular formation, as well as with epidemic encephalitis, lethargic sleep can develop, which is a continuous sleep for a day or more.

Clinical signs of hypersomnia

The main sign of hypersomnia is periodic or constant daytime drowsiness with a long duration of night sleep. Often hypersomnia is accompanied by an increase in the duration of night sleep up to 12-14 hours. It is characterized by a difficult awakening, the inability to get up on an alarm clock, an increase in the transition time from sleep to wakefulness. For some time after waking up, patients with hypersomnia may remain inhibited and not quite awake. Moreover, their condition resembles intoxication, for which this symptom was called "intoxication with sleep."

Daytime drowsiness in various forms of hypersomnia can be permanent or paroxysmal. It reduces attentiveness and working capacity, interferes with full-fledged labor activity, complicates the normal life rhythm and forces patients to take breaks for daytime sleep. In some cases, patients experience relief after a daytime sleep, but more often the state of drowsiness persists even after prolonged or repeated daytime sleep.

Narcolepsy hypersomnia is characterized by the presence of attacks of violent falling asleep, in which the desire to sleep is so irresistible that patients fall asleep in the most inappropriate places and poses for sleep. Over time, patients with narcolepsy develop a premonition of an upcoming attack and they try to take a more comfortable sleeping position in advance. Narcolepsy hypersomnia can be accompanied by the appearance of hallucinations during the time of falling asleep and awakening, as well as cataplexy of awakening - a significant decrease in muscle tone, which does not allow the patient to make any voluntary movements in the first minutes after sleep.

Psychopathic hypersomnia is characterized by an unpredictable clinical picture of daytime sleepiness. For example, in patients with hysteria after a traumatic situation, a "dream" may last for several days. However, polysomnography in the daytime does not find any real signs of sleep in them, but on the contrary, the EEG demonstrates a state of intense wakefulness. It often turns out that patients simply lie with their eyes closed.

Post-traumatic hypersomnia often develops after injuries that are not accompanied by significant damage to brain tissue, and is most likely associated with stress experienced during trauma. In such cases, its clinical presentation may be similar to manifestations of psychopathic hypersomnia.

Idiopathic hypersomnia often occurs in young people (15-30 years). Patients complain of constant drowsiness, difficulty waking from sleep, a feeling of sleeplessness in the morning with a sufficient duration of a night's sleep. The symptom of "intoxication with sleep" may be noted. Daytime sleep in these patients brings some relief, but does not completely relieve them of drowsiness. In some cases, idiopathic hypersomnia may be accompanied by episodes of ambulatory automatism lasting several seconds. Most often, a similar symptom is observed in patients who refuse to sleep during the day.

A state of continuous sleep that lasts more than a day is called lethargic sleep. Such hypersomnia is often a manifestation of epidemic lethargic encephalitis or various lesions of the reticular formation.

The clinical manifestations of this pathology have a direct relationship with the etiological premises. Nevertheless, among all the signs of hypersomnia, its main symptoms are highlighted, which are represented by periodic or stable sleepiness during the day and a long duration of night sleep. As a rule, night sleep with hypersomnia takes 12-14 hours.

Often, patients complain of difficulty waking up, lack of reaction to alarms and an increase in the period from a sleepy state to complete awakening. Therefore, after some time after waking up, patients with hypersomnia can feel inhibited and sleepy. This condition resembles a clinic of intoxication; it is also sometimes found in the medical literature under the phrase “sleepy intoxication”.

The phenomenon of daytime sleepiness, regardless of its nature, is often accompanied by a decrease in working capacity and attentiveness, which ultimately disrupts normal labor activity, provokes a malfunction in the normal life rhythm and forces it to interrupt sleep during the daytime. Sometimes after a day's sleep, patients may notice a relief in their general condition, but in most cases the drowsiness remains the same.

Additional symptoms

You can highlight other, the most common symptoms of this pathology:

low muscle tone after awakening, which interferes with motor activity;
the occurrence of visual, auditory and other hallucinations with a narcoleptic variety of pathology;
the appearance of the syndrome of sudden falling asleep; attacks are not controlled and can occur in places that are not intended for rest;
increased weakness, a constant feeling of tiredness;
the occurrence of severe headaches, most often in the form of seizures;
a change in heart rate in the direction of its decrease;
convulsive reaction;
visual impairment;
Dizziness
drop in blood pressure;
significant impairment of working capacity;
worsening reaction, general inhibition;
sleeping condition.

Provocative Factors

People who have cases of hypersomnia in the family have a greater risk of developing this sleep pathology.

Despite the fact that the direct causes of the development of idiopathic hypersomnia have not yet been identified, scientists have identified provocative factors that contribute to the development or exacerbation of this disease. It is often observed:

with serious violations of the endocrine system;
after prolonged or against a background of chronic infectious diseases;
with frequent or too severe stress, emotional upheaval;
with constant physical stress;
with too much mental stress;
against the background of a strong decrease in immunity caused by any reason;
after concussion or other brain damage;
against the background of mental or neurological diseases;
after a sharp change in climate, time zones or lifestyle;
against the background of the use of certain drugs.

It is especially sad when young girls fall ill who, in pursuit of a modeling career, starve themselves and torment themselves with ill-conceived diets.

One girl said that she slept literally 16 hours a day, and her personal sleep record was 26 hours. But even after that, she felt tired and completely broken. She describes her condition as follows: “Many have made comments to me that I have been sleeping too long. His condition was completely inhibited, like a slow movie watching.

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Diagnostics

Diagnosing the cause of this phenomenon is sometimes not so simple. Often patients do not go to the doctor, linking drowsiness to constant fatigue, vitamin deficiency, and bad weather. But there are a number of methods for diagnosis. These include:

Polysomnography. This is a way to determine the nature of sleep and human behavior during this period. The patient falls asleep, various sensors are fixed on it to determine the electrical activity of the brain, blood pressure, heart rate, blood oxygen are monitored, and an electrocardiogram is taken. A video camera works, by recording then you can observe a person in different phases of sleep. For hypersomnia, a very short period of falling asleep, an early onset of REM sleep, and frequent awakenings are noted.
Patients are examined by specialists such as a psychiatrist and narcologist. The presence of signs of drug or alcohol dependence, mental illness is determined.
To examine the structures of the brain for hematomas, cysts, malignant and benign neoplasms, computed or magnetic resonance imaging is performed.
To assess the presence of infectious diseases of the brain, spinal cord puncture and cerebrospinal fluid sampling are performed.
In order to exclude endocrine pathologies, kidney diseases, the patient should be examined by an endocrinologist, therapist and nephrologist.

The correct diagnosis of hypersomnia requires a set of diagnostic procedures, since it is very important to clarify the form of hypersomnia and its etiology, only in this way appropriate therapy can be prescribed. Therefore, in addition to the standard neurological examination and medical history, a number of additional studies may be required, and in some cases it is advisable to involve additional specialists (traumatologist, psychiatrist, ophthalmologist, cardiologist, gastroenterologist).

In the process of collecting an anamnesis, attention is focused on the presence of genetic diseases, recent head injuries, concomitant pathologies, as well as on the general life rhythm of the patient.

Additional tests for hypersomnia include specific tests (sleep latency test, Stanford School of Drowsiness).

An important diagnostic role in identifying pathologically increased drowsiness is the performance of a polysomnographic study. Polysomnography allows you to clarify the form and characteristics of the clinical course of hypersomnia.

It is also important to differentiate hypersomnia, which developed against the background of other pathologies, from increased drowsiness with an organic etiology (as a result of asthenia, chronic fatigue syndrome, depressive state), since this is the only way to prescribe optimal therapy. Such differentiation often involves the implementation of Echo-EG, CT of the brain, ophthalmoscopy, etc.

The disease is difficult to identify. Previously, such a diagnosis was made to people who suffered from ideopathic hypersomnia for more than one year. Since the primary signs are often manifested in adolescents, it is at this age that real sleep records can be set, linking them with hormonal changes and psychophysical adulthood.

the patient complains of a long and very deep sleep;
frequent manifestations of daytime sleep are observed against the background of a good night's rest, both in winter and summer;
a steady habit of constant daytime sleep formed up to 25 years;
in previous periods there were no head injuries;
hypersomnia is inherent in the patient for 5-6 months;
lack of psychopathic diseases.

If the combination of these signs coincides, the doctor can decide on the presence of ideopathic hypersomnia.

The degree and clinical picture of the disease is determined using special scientific tests for sleep latency (MTLS - a method of the theory of sleep latency). Subjective research data is also used on the Epworth or Stanford Drowsiness Scale.

It is difficult for patients to independently diagnose this ailment, so doctors have developed special tests that can detect hypersomnia - such as the Stanford sleepiness scale or sleep latency test.

The main method of sleep research is also used - polysomnography. This hardware diagnostic method allows you to identify a shortening of the period of falling asleep and earlier the onset of the REM sleep stage - factors characteristic of hypersomnia.

Hypersomnia requires differential diagnosis to exclude asthenia, chronic fatigue syndrome, and other functional disorders of the body that have drowsiness in the symptoms. To identify the organic nature of the disease, computed tomography is used.

Often it is very difficult for a person to independently diagnose manifestations of hypersomnia in himself, even when the main symptoms appear.

Cases are common when people mistakenly regarded it as a chronic fatigue syndrome. To prevent the commission of such errors, experts have developed special tests to help identify hypersomnia.

These include the following types of events:

Polysomnography allows you to analyze not only the time of falling asleep, but also the duration of each phase of sleep. A short period, anxiety and frequent disturbances of night rest with subsequent waking up, too rapid a transition to the phase of REM sleep are all the main signs of the presence of hypersomnia.
However, this diagnostic method is ineffective in idiopathic or narcoleptic form, since they are characterized by a slightly different course.
Passing a series of tests to assess the state of mental health in general.
Carrying out a complex of neurological research.
Conducting magnetic resonance imaging and computed tomography, as well as echoencephalography. Such studies are primarily carried out to exclude the presence of malignant tumors in the brain and impaired functioning of certain areas.
Laboratory analysis of cerebrospinal fluid.
Appointment of an additional examination by a therapist, endocrinologist, nephrologist, gastroenterologist and ophthalmologist if necessary. Such measures are necessary to determine the state and characteristics of the functioning of individual body systems and to exclude the presence of serious diseases.

Diagnosis is also aimed at differentiation from other types of disorders and diseases, including chronic fatigue and deep depression.

The diagnosis can be made by a neurologist if the main symptomatology persists for one month and cannot be associated with a lack of rest at night, as well as drug use or taking pharmacological drugs.

With the reappearance of symptoms within a few years after getting rid of the pathology, a diagnosis of chronic hypersomnia can be made.

Since patients themselves cannot always objectively evaluate their sleep problems, generally accepted tests are used to diagnose hypersomnia: the Stanford drowsiness scale and sleep latency test.

An important diagnostic value is polysomnography. In the case of narcolepsic hypersomnia during polysomnography, a shortening of the period of falling asleep, frequent nocturnal awakenings and the early onset of the REM sleep phase are detected, while normal REM sleep occurs on average 80 minutes after falling asleep. A similar pattern of sleep can be observed with hypersomnia associated with carotid apnea syndrome. In this case, the correct diagnosis allows the identification of concomitant respiratory disorders during polysomnography. For idiopathic hypersomnia, as well as for narcolepsy, a shortening of the period of falling asleep is characteristic, but at the same time, the normal ratio of the phases of sleep and night sleep without frequent awakenings remains.

Hypersomnia requires differentiation from asthenia, depression, chronic fatigue syndrome. To exclude the organic nature of pathological drowsiness, a thorough neurological examination is carried out, an ophthalmologist consults with an ophthalmoscopy, Echo-EG, MRI or CT of the brain. Revealing the connection of hypersomnia with the presence of somatic disease may require additional consultation of a therapist, endocrinologist, cardiologist, gastroenterologist, nephrologist.

The diagnosis of hypersomnia is usually established by a neurologist if its symptoms are observed for at least 1 month and are not associated with impaired night sleep or medication. If after the disappearance of hypersomnia for up to 2 years, its symptoms reappear, then they speak of a relapse form of the disease.

Treatment

Diagnostics

Idiopathic hypersomnia should be treated in accordance with the doctor's recommendations. Therapy will depend on the underlying disease. In the presence of an infectious brain lesion, antibacterial drugs are prescribed depending on the pathogen selected. Tumors, hematomas are treated surgically. With endocrinological diseases, hormone therapy is often performed. With the normalization of the work of organs, all manifestations of hypersomnia will go away.

If possible, get rid of annoying factors, reduce the likelihood of stressful situations. It is necessary to refuse to take alcohol and drugs. Physical activity should be dosed.

Successful treatment of hypersomnia is closely related to the effective treatment of the disease, of which it is one of the symptoms. If a complete cure of the underlying disease is impossible (for example, in the case of narcolepsy), then the treatment of hypersomnia is aimed at maximizing the patient's quality of life.

Of great importance in the treatment of hypersomnia is compliance with sleep patterns. The patient needs to exclude work in the evening and night shifts, adhere to the same time of going to bed, be sure to include 1-2 daytime sleep in your routine. It is advisable that the duration of night sleep does not exceed 9 hours. For idiopathic hypersomnia, the recommended duration of daytime sleep is 45 minutes. Along with sleep hygiene, the use of alcoholic beverages and too heavy food should be avoided, as well as eating immediately before bedtime.

To eliminate daytime drowsiness with hypersomnia, stimulants are used: pemoline, dexamphetamine, modafinil, mazindol, propranolol. If the patient has cataplexy, then he is shown taking antidepressants: protriptyline, imipramine, clomipramine, fluoxetine, viloxazine. Dosages of these drugs are selected individually, trying to achieve maximum therapeutic efficacy with minimal side effects.

Therapy is usually aimed at eliminating the underlying disease that led to the occurrence of the pathology in question.

normalize the work schedule, do not carry out work activities in the evening and night shifts;
to develop a regimen according to which it is daily necessary to go to bed at night and wake up in the morning;
allocate at least 8-9 hours for a night's rest;
Do not consume alcoholic beverages or foods with a high fat content in the evening or at night.

Prevention

The following is a list of preventive measures that can minimize the risk of hypersomnia:

go to bed and get up always at the same time, take asleep at night for at least 8-9 hours;
give up smoking, drinking alcohol and lead a healthy lifestyle;
to be more calm about life's difficulties in order to limit the number of stressful situations;
competently determine the amount of permissible physical exertion, avoid overwork.

At the first sign of increased drowsiness or insomnia, you must seek professional medical help, and in the presence of diabetes mellitus or mental disorders, you should regularly undergo a medical examination.

The treatment of hypersomnia is directly related to the accuracy of the diagnostic results and the elimination of the underlying disease. In some cases, the disease that causes hypersomnia cannot be completely cured, then therapeutic tactics are aimed at minimizing the symptoms that adversely affect the patient's quality of life.

An important moment in the fight against this pathological condition will be the normalization of sleep patterns. Patients need to abandon the daily work schedule and go to bed at the same time. You also need to include 1-2 times of daytime sleep in the daily schedule, while the duration of night sleep should not be more than 9 hours.

Drug therapy of a hypersomic condition involves the use of such stimulating drugs:

propranolol;
modafinil;
dextroamphetamine;
mazindol.

With cataplexic phenomena, patients are shown antidepressants:

viloxazine;
clomipramine;
protriptyline;
fluoxetine, etc.

After all therapeutic measures have been completed, the patient must be provided with dynamic observation, since hypersomnia is prone to relapse.

The treatment of idiopathic hypersomnia is selected individually, since it manifests itself in different ways and is provoked by various factors. Doctors try to identify all disorders in the body that could lead to a similar sleep disorder. Therefore, you will have to undergo a comprehensive medical examination in order to at least somehow understand them.

Such medications as Dextroamphetamine, Propranolol, Mazindol, etc. are often prescribed to help the patient. They are able to relieve drowsiness for a while, but they are not a panacea. In no case should you prescribe and use them yourself!

Physiotherapeutic procedures help some patients very well: electrosleep, pressure chamber, etc. It is possible to relieve muscle and nervous tension with the help of physiotherapy exercises and massage. Hypnosis sessions are sometimes used if the patient has experienced severe stress or mental trauma.

During treatment, doctors usually advise you to abandon serious mental stress, intense sports training and driving vehicles. It is not recommended to plan relocations, weddings, job changes and other major life changes. A change of scenery can be beneficial, but without long journeys and especially flights.

The treatment of hypersomnia aims to eliminate the etiological factor (pathogenetic therapy), signs of the disease (symptomatic therapy), prevent the recurrence of attacks, the development of complications.

Apply medication, psychotherapy, treatment with folk remedies. The correct mode of the day is of great importance.

Drug therapy includes:

drugs that restore the balance of neurotransmitters;
correction of somatic, endocrine, psychological and oncological diseases;
detoxification therapy in a hospital with intoxication;
antibiotic therapy in case of infections;
nootropic drugs - to improve brain function in organic pathologies;
drugs that calm the nervous system during psychogeny in etiology;
psychostimulants to eliminate daytime sleepiness;
antidepressants for catalepsy symptoms;
vitamin therapy and immunostimulants to strengthen the body.

With the medicinal and iatrogenic forms, the dosages of the drugs that caused the hypersomnia are corrected.

It must be remembered that the use of medicines should occur only under the supervision of a doctor! Doses are prescribed strictly individually, depending on the condition, age of the patient, the duration and frequency of hypersomnia, the presence of concomitant diseases.

How to treat hypersomnia without medication? Since psychotraumas are the leading trigger in the etiology of the disease, psychotherapy aimed at training plays an important role in treatment:

stress management;
emotions management;
constructive problem solving;
non-conflict communication;
stress relief through music, painting, dancing, sculpting, practicing with sand (art, sand therapy).

Traditional medicine is used in addition to medicines. These are infusions and decoctions on a plant basis, with a sedative (with nervous tension) or tonic (with constant daytime drowsiness) effect.

Idiopathic hypersomnia is an incurable disease today. Conducted medical treatment can only reduce the severity of drowsiness, eliminate cognitive deficits, improve the general well-being of a person. An approved treatment protocol does not exist, therefore, in clinical practice, symptomatic agents are used to stop the symptoms of sleep disorders.

To improve the intellectual potential, the patient is prescribed vitamin complexes, natural stimulants and adaptogens, nootropic drugs. To activate motor activity and improve mental activity, psycho-stimulating agents are prescribed to the patient. The treatment program also includes analeptics and dopamine reuptake inhibitors. Their intake increases the time of wakefulness and reduces the duration of sleep.

In the treatment of hypersomnia, the determination of the causes of the condition and their elimination is crucial. If hypersomnia is an independent neuropsychic disorder, it is treated with medication, as well as by correcting the patient’s lifestyle. It is necessary that patients observe sleep hygiene, diet, and control the duration of night sleep.

Stimulants are eliminated by daytime drowsiness (pemoline, mazindol, etc.) and antidepressants. The dosage is selected by the doctor individually in order to achieve the maximum effect with a minimum of adverse reactions. Psychotherapeutic effects and physiotherapy are used.

Preventive measures to prevent excessive drowsiness include monitoring your health and timely treatment of infectious and other diseases. Meals at bedtime and the use of medications not prescribed by a doctor should be avoided.

Hypersomnia prognosis

Symptoms of post-traumatic hypersomnia are often reversible. The situation is worse with hypersomnia that develops with narcolepsy or as a result of organic damage to the brain. And although hypersomnia in itself does not pose a threat to the life of the patient, it significantly increases the risk of his death from an accident at work or while driving a car.

The prognosis, as well as the treatment of a hypersomnic condition, depends on the cause of its development. For example, with post-traumatic hypersomnia, in most cases it is favorable, very often increased drowsiness disappears at the end of treatment and rehabilitation of the patient. With narcoleptic hypersomnia, as well as organic brain damage, the prognosis is less favorable.

Possible complications and consequences

Hypersomnia has the risk of developing the following diseases and conditions:

Obesity. A decrease in motor activity leads to a low metabolism and contributes to the formation of excess weight and obesity. And this, in turn, has a definite connection with the onset of diabetes.
Prolonged sleep can cause frequent headaches. They are also prone to people who do not sleep at night and sleep excessively in the daytime.
Another common complication of hypersomnia is back pain. They are associated with prolonged stay in bed, decreased physical activity during the day.
Hypersomnia can lead to depression.
People with this sleep disorder are more prone to developing coronary heart disease.

Constant drowsiness and a decrease in reaction can lead to traffic accidents when driving in this condition, to damage of a different nature in the workplace and in domestic conditions.

By: Dr. Cynthia Harden