What is hypersomnia and why does it occur? How pathological drowsiness manifests itself and how to recognize it. The main methods of diagnosis and treatment of hypersomnia. Hypersomnia is a sleep disorder characterized by increased sleepiness, especially during the day. That is, it is the opposite of insomnia (insomnia). But at the same time, excess sleep is much more tolerated than lack of sleep. Therefore, hypersomnia in clinical practice is quite rare, since it is not perceived by a person as a problem and a reason to see a doctor.
The concept and types of hypersomnia
The normal duration of sleep is considered to be 8 hours, but this figure can vary from 5 to 12 hours, depending on the individual characteristics of the organism and its "exploitation". The latter is especially important, since increased sleepiness can be temporary in nature and be the result of a banal lack of sleep at night due to the same insomnia or certain life circumstances. And in this case, a person gets enough sleep during the day to recover his strength, in contrast to hypersomnia, in which daytime sleep does not bring the expected vigor after waking up.
By itself, hypersomnia rarely acts as an underlying disease. Most often this is a consequence of taking certain medications or the manifestation of pathological changes in the vital systems of the body.
Depending on what caused the increased drowsiness, hypersomnia is divided into the following forms:
- Post-traumatic … It arises as a result of traumas that have "hooked" the central nervous system. Most often after traumatic brain injury.
- Psychophysiological … Drowsiness caused by mental and physiological overload, constant lack of sleep, stressful situations. It can also be the result of taking certain medications. Psychophysiological hypersomnia in a child is most often caused by an unformed mechanism of "inhibition - activation", when a little man walks, as they say, "until he falls," sometimes confusing day and night, and then restores strength by prolonged sleep.
- Narcoleptic … It is caused by narcolepsy, when the patient is unable to control their desire to sleep. The most severe form of sleep disturbance.
- Psychopathic … Associated with pre-existing mental disorders.
- Pathological … It is associated with diseases of the brain of an infectious, malignant, organic nature.
- Idiopathic … It has no direct connection with any of the above factors in the occurrence of pathological drowsiness and occurs more often at a young age. The age range is 15-30 years old.
- Associated with somatic diseases … Namely, with violations of metabolic processes and hormonal balance, liver function, cardiovascular system.
- Presented by sleep-disordered breathing … Occurs due to hypoxia of the brain as a result of sleep apnea.
There is another classification of hypersomnia - according to the symptoms of its manifestation:
- Permanent hypersomnia … A condition with a constant feeling of sleepiness, including during the daytime. It occurs after taking medications, trauma, psychophysiological stress.
- Paroxysmal hypersomnia … A phenomenon with a very strong desire to sleep periodically, which is observed even under inappropriate conditions. This type of hypersomnia develops with narcolepsy, Kleine-Levin syndrome.
Causes of hypersomnia
The mechanism of "sleep-wakefulness" in our body has a complex system of regulation, which involves the cortex and subcortical structures of the brain, as well as the limbic system and the reticular formation. Malfunctions of this mechanism can occur at any "site" for a number of reasons.
The main causes of hypersomnia:
- Chronic physical overwork.
- Significant mental stress.
- Tense emotional sphere, stressful situations, shocks.
- Prolonged lack of sleep, poor sleep quality (intermittent, shallow, sleep in unusual or uncomfortable conditions).
- Taking medicines or narcotic drugs. Antipsychotics can cause drowsiness. Also, these drugs include antidepressants, tranquilizers, antihypertensive, sugar-reducing drugs. In this case, increased drowsiness can occur both due to a side effect from taking the medication, and as an individual reaction to it.
- Traumatic injuries to the skull and brain. This category includes concussions, bruises, hematomas.
- Tumor processes, cysts, brain abscesses, hemorrhagic stroke.
- Infectious processes in the brain. Such conditions are represented by meningitis, encephalitis, neurosyphilis.
- Endocrine disorders such as diabetes mellitus, hypothyroidism.
- Mental disorders, be it schizophrenia, neurasthenia, depression, hysteria.
- Sleep disorders (apnea).
- Chronic diseases of the cardiovascular system, kidneys, liver (cirrhosis).
- Depletion of the body, malnutrition, weakened immunity.
- Kleine-Levin syndrome.
Important! Pathological drowsiness is a conditional signal that the body is overstrained. It remains only to find out whether this overstrain is associated with an incorrect work-rest regime or has deeper roots.
The main symptoms of hypersomnia in humans
The manifestations of increased drowsiness mainly depend on what causes it. But at the same time, there are general symptoms of hypersomnia, which are present in any of its forms.
These include:
- The duration of a night's sleep is more than 10 hours a day (up to 12-14 hours);
- Difficult, long process of falling asleep and waking up - a person remains in a sluggish state for a long time and cannot "join" the process of wakefulness;
- Daytime sleepiness - constant or intermittent, even with proper rest and night sleep;
- Lack of effect from daytime sleep - the state of sleepiness does not go away;
- Passivity, apathy, loss of strength, decreased performance.
The main signs of pathological drowsiness, depending on the form of hypersomnia:
- Psychophysiological form of increased drowsiness … It manifests itself as a feeling of fatigue, irritability and a desire to sleep in response to the usual overwork or stressful situation. Often in children.
- Psychopathic form of hypersomnia … Combines the manifestations of mental disorders (sudden mood swings, panic attacks, inappropriate behavior, appetite swings towards gluttony or refusal to eat, etc.) and the patient's desire to sleep, especially during the day. Hypersomnia can be a response to a traumatic situation in patients with hysteria.
- Narcoleptic form and hypersomnia in Kleine-Levin syndrome … They are manifested by bouts of falling asleep, which a person simply cannot consciously control. Because of this, he can suddenly fall asleep anywhere and in any position. At the same time, the process of awakening in him can be accompanied by hallucinations and a decrease in muscle tone, up to sleep paralysis. This state of the body does not allow the first time after waking up to make the patient any arbitrary movements.
- Post-traumatic form … It can manifest itself in a variety of symptoms, which depend on the nature and intensity of the traumatic injury.
- Pathological form … It can provoke both transient bouts of drowsiness and cause prolonged drowsiness in a person. Infectious diseases, malignant and vascular lesions of the brain can generally "drive" it into lethargic sleep (encephalitis, lesions of the reticular formation, etc.).
- Idiopathic form … It has no clearly established causes and is characterized by the classic manifestations of hypersomnia, as well as the persistence of a feeling of intoxication after awakening. Daytime sleep in such people brings them slight relief, but does not completely eliminate drowsiness. Sometimes idiopathic hypersomnia can provoke in the patient the appearance of short-term (for a few seconds) periods of outpatient automatism, that is, wakefulness with switched off consciousness, when he refuses to sleep during the day.
- Sleep apnea hypersomnia … Combines snoring and daytime sleepiness. In addition, there are pathological cessations of breathing during sleep (more than 5 apnea per hour lasting more than 10 seconds). At the same time, the sleep is inadequate - restless, superficial. There are headaches in the morning, overweight, arterial hypertension, decreased intelligence, sexual desire.
- Hypersomnia in Kleine-Levin syndrome … It is characterized by a combination of periodic bouts of drowsiness with increased appetite and confusion. In addition, psychomotor agitation, hallucinations and anxiety are present. Such an attack can last from several days to a couple of weeks. At the same time, attempts to wake up the patient during such an attack can cause him to behave aggressively. Most often, the syndrome manifests itself in boys at puberty.
Diagnosis of hypersomnia
If the feeling of constant lack of sleep becomes noticeable not only to your surroundings, but also to you, you should not postpone the visit to the doctor, since the consequences of hypersomnia can not only worsen the quality of your life (loss of work, tensions in the family, etc.), but also lead to more sad consequences. Especially if there is a serious illness at its source.
In the case of hypersomnia, the doctor cannot rely on interviewing the patient, since he simply cannot adequately assess and describe his problem with sleep. Therefore, experts use the following methods to diagnose pathological drowsiness: multiple sleep latency test, Stanford sleepiness scale, polysomnography.
The multiple sleep latency test gives an estimate of how much the body needs at the moment, that is, its biological need for sleep. It is carried out in the morning, 2 hours after waking up. In this case, the patient is placed in a darkened room with sound insulation and comfortable conditions of stay, fixing electrodes to his head and body. He is given several attempts of short-term sleep (4-5 attempts for 15-20 minutes) with an interval of at least 2 hours. Thus, you can get important information about the characteristics of the patient's sleep - its duration, onset, the presence of various phases and stages, confirm or deny the presence of hypersomnia.
The Stanford Sleepiness Scale is a questionnaire where the patient is asked to choose the most accurate answer to a question from the 7 options presented. In this case, the selected answer option should correspond as much as possible to the level of sleepiness at the time of filling out the questionnaire. A similar method for diagnosing hypersomnia is used in the Epvor scale, which is successfully used to identify drowsiness caused by pathological processes in the body. Here, the questionnaire consists of 8 monotonous situations in which the patient has to rate the probability of falling asleep on a scale from 0 to 3 points. According to the final sum of points, the specialist determines the degree of drowsiness and the presence of hypersomnia.
There is another scale for determining sleepiness, which is widely used to assess this indicator in pilots, machinists, professional drivers, in drug testing - the Carolina Sleepiness Scale. It is in many ways similar to the Stanford one, only in it the patient is offered not 7 options describing his condition at the time of the research, but 9.
Polysomnography is a method that makes it possible to assess the work of all body systems during sleep, as well as the quality of sleep itself (stages and their duration). A complete study includes EEG, ECG, myograms, recording of the movement of the eyeballs and respiratory movements, blood oxygen saturation, and body position. The procedure is carried out at night under the constant supervision of specialists and allows you to identify not only hypersomnia, but also its cause. She is able to record important moments for this pathology - unplanned awakenings, a reduction in the period of falling asleep, the emotional state of the patient.
To exclude the somatic nature of chronic drowsiness, additional research methods can be performed - ophthalmoscopy, MRI, CT of the brain. Specialists of other specialties can also be involved - ophthalmologist, cardiologist, oncologist, endocrinologist, nephrologist, therapist.
The diagnosis of "hypersomnia" in most cases is made by a neurologist after a full examination if the state of chronic sleepiness has lasted for more than a month and has no connection with medication or sleep disturbance at night.
Features of the treatment of hypersomnia
Since pathological drowsiness is often one of the manifestations of another disease, the scheme of its treatment will go in parallel with the therapy of the underlying disease. That is, the goal is to remove the root cause of sleep disorders. If this is not possible, as in the case of narcolepsy, the doctor's actions and prescriptions will be aimed at improving the patient's quality of life as much as possible. For sleep disorders, which are based on a neuropsychic disorder or overstrain, the treatment of hypersomnia will be based on lifestyle correction and drug therapy (if necessary).
Lifestyle changes with hypersomnia
To eliminate all external factors that can affect the quality of sleep, the following guidelines are used:
- Ensuring the duration of a night's sleep is not less than 8 hours and not more than 9;
- Developing the habit of going to bed at the same time;
- Inclusion in the daily routine of daytime sleep - 1-2 "sessions" lasting no more than 45 minutes each;
- The exclusion of any vigorous activity in the evening and at night, listening to loud music, watching TV, etc., that is, all actions that stimulate brain activity;
- Abstaining from alcohol, tonic drinks and heavy food before bedtime.
Drug therapy for hypersomnia
The purpose of medical correction of pathological daytime sleepiness is to stimulate the nervous system. Therefore, most often, specialists include stimulants such as Modafinil, Pemolin, Propranolol, Mazindol, Dexamphetamine in the treatment regimen.
For the correction of cataplexy (muscle weakness after waking up), drugs from the kind of antidepressants can be additionally prescribed: Imipramine, Fluoxetine, Protriptyline, Viloxazin, Clomipramine.
If pathological drowsiness is a symptom of a somatic disease, drugs aimed at treating this disease are included in the prescription list.
The appointment and dosage of medications is determined solely by the doctor, taking into account the individual special course of the disease, as well as in order to comply with the principle "maximum effect - minimum side effects."
Also, in the practice of treating pathological drowsiness, non-drug methods of treatment can also be used: psychotherapeutic practices (methods of limiting stimulation and limiting sleep, relaxation techniques), physiotherapy.
Important! Nowadays, when chronic lack of sleep is becoming the norm, it is important to be able to maintain an optimal balance of activity and rest. This is the best preventive remedy for hypersomnia. How to treat hypersomnia - watch the video:
Hypersomnia is a condition that only seems harmless. In fact, "sleepyhead" not only does not get the expected rest from sleep, but it can also "oversleep" all the best in life and its health. Therefore, you need to try not to bring yourself to such a state and not be afraid to seek help from specialists.
