After a night spent tossing and turning, you’re bound to feel a little sleepy. When you don’t get a good night’s rest, staying awake and alert during the day can be a challenge. But what if you get plenty of sleep at night and still feel sleepy? Or more than enough sleep?
Hypersomnia is a condition characterized by excessive daytime sleepiness despite a good night’s rest. Many sleep disorders include daytime sleepiness as a symptom, but this condition is different – it persists even with adequate sleep and generally isn’t relieved by sleep.
In this article, we’ll explore the topic of hypersomnia in depth, providing an overview of what it is, what symptoms it produces, and how it differs from other sleep disorders. We’ll also provide information about diagnosis and treatment options for hypersomnia.
What is Hypersomnia?
According to the National Sleep Foundation, the average adult needs 7 to 9 hours of sleep per night. Getting a good night’s rest is the key to feeling awake and alert during the day, able to complete daily tasks and fulfill responsibilities without excessive sleepiness. Individual sleep requirements vary, but this is the recommended range for adults between the ages of 26 and 64.
People who have hypersomnia may get the recommended amount of sleep but will still feel tired during the day.
They may even get more than the recommended amount with the same result. Most people who feel tired during the day feel that way because they didn’t sleep well or get enough sleep, but this is not the case for hypersomnia.
Hypersomnia is also known as excessive daytime sleepiness (EDS) which is a common symptom of several sleep disorders including narcolepsy and obstructive sleep apnea. In fact, hypersomnia can cause the patient to fall asleep at any time, much like narcolepsy, but the two conditions are actually very different.
EDS is the only symptom that is required to diagnose narcolepsy, but the condition is also commonly associated with additional symptoms such as:
- Cataplexy (sudden loss of muscle tone)
- Hypnagogic or hypnopompic hallucinations
- Sleep paralysis
- Disturbed night sleep and insomnia
The biggest difference between hypersomnia and narcolepsy is the underlying cause. Narcolepsy was recently discovered to be a neurological condition linked to hypocretin levels in the brain whereas the cause for hypersomnia remains unclear. In fact, it is often referred to as “idiopathic hypersomnia” because it has no known cause.
What Are the Symptoms of Hypersomnia?
There are two types of hypersomnia: primary and secondary. Primary hypersomnia occurs in the absence of any underlying medical condition, and the only symptom is excessive daytime fatigue.
Secondary hypersomnia, on the other hand, is caused by some kind of underlying factor such as a concurrent sleep disorder, a medical condition, or the use of certain substances.
The biggest symptom of hypersomnia is recurrent episodes of excessive daytime sleepiness, though many people also experience prolonged nighttime sleep.
People who have hypersomnia feel very tired during the day and may feel compelled to nap repeatedly, often at inappropriate times such as during work or in the middle of a conversation.
The urge to sleep can strike a person with hypersomnia at any time, though they may be able to resist the urge – this is not the case with narcolepsy.
It is also worth mentioning that, while normal sleep deprivation can typically be relieved by sleep, hypersomnia is not – napping provides no relief from symptoms in most cases.
In addition to excessive daytime sleepiness, people with hypersomnia may experience the following symptoms as well:
- Difficulty waking from a long sleep
- Feeling disoriented upon waking
- Unrefreshing or nonrestorative sleep
- Anxiety or increased irritability
- Decreased energy levels
- Restlessness
- Slow thinking or speech
- Trouble with memory
- Loss of appetite
Hypersomnia is a chronic condition that develops over the course of weeks to months.
Symptoms typically appear during the teens or early twenties, though it is possible for them to develop both at an earlier and a later age.
The intensity of symptoms can vary from one week to the next or for months or years. Many women with hypersomnia find that their symptoms worsen prior to menses. According to the Hypersomnia Foundation, about 10% to 15% of patients experience a spontaneous remission.
If you experience a worsening in the frequency or intensity of your symptoms, you should talk to your doctor.
Your doctor may refer you to a sleep specialist who can take a more complete medical history to rule out other sleep disorders and underlying medical conditions to determine whether you need a sleep study or additional testing.
What Causes Hypersomnia?
Hypersomnia can be either primary or secondary. Primary hypersomnia is also sometimes referred to as idiopathic hypersomnia because there is no known cause while secondary hypersomnia is linked to some other condition.
Some of the potential causes for secondary hypersomnia include the following:
- Concurrent sleep disorders (like narcolepsy and sleep apnea)
- Medical problems (like kidney disease, depression, hypothyroidism, or heart disease)
- Sleep deprivation, not getting enough sleep at night
- Being overweight or obese
- Overuse or abuse of alcohol or drugs
- Head injury or neurological disease (like MS or Parkinson’s)
- Use of certain prescription drugs (like tranquilizers or antihistamines)
In addition to these causes, there are certain factors which may increase your risk for hypersomnia. For example, having a relative with the condition may increase your risk for developing it.
According to the American Sleep Association, hypersomnia is more common in men than women, and some evidence suggests that people who smoke or drink regularly may have a higher risk as well.
Though hypersomnia is a completely different disorder than narcolepsy, it is possible that the two are both linked to the mechanisms in the brain that promote sleep.
Narcolepsy is caused by the degeneration of a chemical messenger in the brain known as hypocretin. These neurons are found in the hypothalamus region of the brain which helps keep the brain awake and, for reasons unknown, they have been found to degenerate and die in people with narcolepsy. As these neurons are destroyed, the patient’s level of alertness decreases which leads to the development of excessive daytime sleepiness.
Hypersomnia is thought to be caused by pathology within the brain, though the exact cause is still the subject of study.
According to the Hypersomnia Foundation, idiopathic hypersomnia is thought to be a nervous system disorder in which some patients present with an overproduction of a small molecule that has an anesthetic or sedative effect on the brain.
The exact nature of this molecule has yet to be determined, but it is known to interact with y-aminobutyric acid (GABA) which is involved in the brain mechanisms that promote sleep.
Because the exact nature of hypersomnia is not fully understood, it is unclear whether it can be prevented or not. Certain lifestyle changes may help mitigate the symptoms, and there are medical treatments available, but it is generally a lifelong condition.
How is Hypersomnia Diagnosed?
The diagnosis of hypersomnia can sometimes be tricky because not only is it a symptom of several sleep disorders, but it is a condition in itself as well.
The first step in diagnosis is talking to your doctor. Your doctor will ask for your medical history and complete a physical exam to rule out underlying causes for your hypersomnia.
From there, you might be referred to a sleep specialist for a more complete history and to potentially complete a sleep diary and/or polysomnography.
In order to be diagnosed with hypersomnia, you must meet the following criteria:
- Having symptoms occurring regularly for at least 3 months
- Symptoms not occurring within 18 months of head trauma
- Absence of medical or psychiatric disease that could account for symptoms (such as sleep disorders like narcolepsy or post-traumatic hypersomnia)
- Normal results of a polysomnogram
- Multiple Sleep Latency Test of 10 minutes or less
A polysomnography is also known as a sleep study, and it is frequently used to diagnose sleep disorders. This test should be conducted in a certified sleep lab and involves monitoring your brain waves, heart rate, breathing, body temperature, and body movements while you sleep.
When diagnosing hypersomnia, a polysomnography should be immediately followed by a Multiple Sleep Latency Test.
A Multiple Sleep Latency Test (MSLT) measures how quickly you fall asleep. This test involves taking five scheduled naps separated by two hours, each lasting 20 minutes.
The amount of time it takes you to fall asleep is called the sleep latency, and a sleep latency under 10 minutes is one of the diagnostic criteria for hypersomnia.
Another test that may be used to diagnose hypersomnia is the Epworth Sleepiness Scale (ESS). This scale was developed by Dr. Johns in 1990 and later modified in 1997.
It is used to determine the level of daytime sleepiness in patients with sleep disorders. The ESS is a self-administered questionnaire having 8 questions where the patient is asked to rate their chances of falling asleep during certain activities on a four-point scale from 0 to 3.
The higher the score, the higher their level of daytime sleepiness which is a strong indicator for hypersomnia.
It is important to receive an accurate diagnosis from your doctor before pursuing any treatment options for hypersomnia. In cases where hypersomnia is a symptom rather than an independent condition, the proper course of treatment can be drastically different. Keep reading to learn about treatment options.
What Are the Treatment Options for Hypersomnia?
Treatment for hypersomnia depends on the underlying cause of the condition if there is one. In cases where hypersomnia is a symptom of another sleep disorder, you must first obtain a diagnosis of that disorder and discuss the treatment options with your doctor. Some sleep disorders can be managed with medication or other therapies in addition to lifestyle changes.
In cases where hypersomnia is not linked to a sleep disorder or underlying medical condition, there are several options for treatment, including the following:
- Wakefulness-promoting medications
- Lifestyle changes to promote a regular sleep schedule
- Avoiding certain activities near bedtime
- Limiting or avoiding alcohol, caffeine, and drug use
- Using or avoiding naps to control daytime wakefulness
Stimulant medications are often prescribed for narcolepsy because they promote wakefulness. These same medications can also be used to treat hypersomnia, though they do come with a risk of tolerance, dependence, and side effects.
Modafinil is the most common medication used to treat narcolepsy and has also been studied in two placebo-controlled trials for patients with idiopathic hypersomnia.
Everyone’s tolerance for such medications is difference, however, and they may stop working as well over time or could cause unpleasant side effects.
Lifestyle changes to improve sleep quality and to promote a regular sleep schedule may also be of benefit. Proper sleep hygiene is important for getting a good night’s rest and includes things such as keeping your bedroom cool, dark, and quiet.
You should also try to go to bed and get up at the same times each day, making sure to get some natural sunlight during the day and avoiding blue light at night. In some cases, wearing earplugs or using a sound machine to cancel out noise can help you sleep.
When possible, avoid work and activities that might keep you up late or prevent you from falling asleep quickly – this includes eating large meals before bed, drinking alcohol and caffeine, and exercising within 2 hours of bedtime.
If you’re still struggling with daytime sleepiness, you might need to take short naps from time to time to stay awake.
Otherwise, avoiding naps might help you become tired enough for more restful sleep at night which could improve your daytime energy levels.
Hypersomnia affects up to 6% of the general population and, while it may not be a life-threatening condition, it can greatly impact your quality of life.
If you suffer from excessive daytime sleepiness independent of a sleep disorder or underlying medical condition, you may want to talk to your doctor.
Better sleep is possible, but you’ll need to take responsibility for your own health and start by seeking help to get it.
Disclaimer: The information on this website is not intended to be used as a substitute for professional medical advice, clinical diagnosis, or treatment. Always seek the advice of your personal physician or another qualified health provider with any questions you may have regarding a medical condition.
