Hypersomnia

Hypersomnia is a neurological disorder characterized by excessive time spent sleeping or excessive sleepiness, which can lead to distress and problems with functioning. Hypersomnolence, with its various subtypes, is classified under sleep-wake disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Symptoms

The main symptom of hypersomnia is excessive daytime sleepiness (EDS) or prolonged nighttime sleep. Sleep drunkenness, characterized by difficulty transitioning from wake to sleep and waking with confusion and disorientation, is another symptom associated with hypersomnia.

Diagnosis

Diagnosis of hypersomnia involves the quantification of daytime sleepiness using subjective scales such as the Epworth Sleepiness Scale and objective tests like the multiple sleep latency test (MSLT). The Stanford sleepiness scale (SSS) is another commonly used subjective measurement of sleepiness.

Differential Diagnosis

Hypersomnia can be either primary, originating from the central nervous system, or secondary, caused by various medical conditions. More than one type of hypersomnia may coexist in a single patient. Some primary hypersomnias include narcolepsy, idiopathic hypersomnia, and recurrent hypersomnias like Klein-Levin syndrome.

Neurological disorders, genetic disorders, and head trauma can mimic primary hypersomnias, so it's important to complete a full evaluation.

Secondary Hypersomnias

Secondary hypersomnias can be caused by a range of disorders such as clinical depression, multiple sclerosis, encephalitis, epilepsy, or obesity. They can also be symptoms of other sleep disorders like sleep apnea or a side effect of certain medications or substance abuse. Sleep apnea and upper airway resistance syndrome (UARS) are common causes of secondary hypersomnia.

Related Conditions

Chronic fatigue syndrome and fibromyalgia can be associated with hypersomnia. In some cases, these conditions may be misdiagnosed due to the presence of undetected sleep disorders such as sleep apnea or periodic limb movement disorder (PLMD).

Hypersomnia is a condition characterized by excessive sleepiness, affecting about 5-10% of the general population. It has various causes, and the treatment often depends on the specific cause or causes that are diagnosed. Some common causes of hypersomnia include sleep disorders, neurological disorders, autoimmune diseases, thyroid problems, iron deficiency, and mood disorders.

Sleep disorders that can cause hypersomnia include sleep apnea, restless legs syndrome, and periodic limb movement disorder. Neurological disorders associated with hypersomnia include chronic fatigue syndrome, fibromyalgia, and chronic kidney disease. Autoimmune diseases like lupus, rheumatoid arthritis, Morvan's syndrome, and celiac disease can also lead to hypersomnia. Hypothyroidism and iron deficiency with or without anemia are other possible causes. Mood disorders, such as depression, anxiety, and bipolar disorder, can also be associated with hypersomnia.

Other factors that can contribute to hypersomnia include certain medications, sleep deprivation due to lifestyle factors, and brain injuries. Recurrent hypersomnias like Kleine-Levin syndrome and menstrual-related hypersomnia are also possible causes.

Assessment tools for hypersomnia include polysomnography, multiple sleep latency test (MSLT), actigraphy, maintenance of wakefulness test (MWT), Stanford sleepiness scale (SSS), and Epworth sleepiness scale (ESS).

Treatment for hypersomnia generally focuses on addressing the underlying cause and managing symptoms. Behavioral treatments and sleep hygiene are often recommended, but pharmacological agents such as modafinil may be used to help manage excessive sleepiness in some cases.

Treatment

Treatment for hypersomnia generally focuses on addressing the underlying cause and managing symptoms. Behavioral treatments and sleep hygiene are often recommended, but pharmacological agents such as modafinil may be used to help manage excessive sleepiness in some cases. Other treatment options may include:

• Stimulant medications (e.g., methylphenidate, amphetamines)
• Wakefulness-promoting agents (e.g., armodafinil)
• Antidepressants (e.g., selective serotonin reuptake inhibitors or SSRIs)
• Cognitive-behavioral therapy (CBT) for sleep disorders or mood disorders
• Treatment of underlying medical conditions (e.g., thyroid disorders, iron deficiency)
• Lifestyle modifications (e.g., regular exercise, stress management, maintaining a consistent sleep schedule)

It is crucial for individuals with hypersomnia to work closely with their healthcare provider to develop a personalized treatment plan that targets the specific cause or causes of their condition.

Prognosis

The prognosis for hypersomnia depends on the underlying cause and the effectiveness of the treatment plan. For some individuals, symptoms may improve significantly with proper treatment, while others may experience persistent or recurrent sleepiness despite treatment. Regular follow-up with a healthcare provider is essential to monitor progress and make any necessary adjustments to the treatment plan.

See Also

• Narcolepsy
• Sleep apnea
• Restless legs syndrome
• Chronic fatigue syndrome
• Fibromyalgia
• Reticular formation
• Sleep medicine
• Encephalitis lethargica
• Somnolence

External links

Classification	ICD-10: G47.1 , F51.1 MeSH: D006970

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