Hypersomnia
Hypersomnia | |
---|---|
Other names | Hypersomnolence |
Specialty | Psychiatry, neurology, sleep medicine |
Hypersomnia is a
Hypersomnia is a pathological state characterized by a lack of alertness during the waking episodes of the day.[3] It is not to be confused with fatigue, which is a normal physiological state.[4] Daytime sleepiness appears most commonly during situations where little interaction is needed.[5]
Since hypersomnia impairs patients' attention levels (wakefulness), quality of life may be impacted as well.[6] This is especially true for people whose jobs request high levels of attention, such as in the healthcare field.[6]
Symptoms
The main symptom of hypersomnia is excessive daytime sleepiness (EDS), or prolonged nighttime sleep,[7] which has occurred for at least 3 months prior to diagnosis.[8]
Sleep drunkenness is also a symptom found in hypersomniac patients.[9][10] It is a difficulty transitioning from sleep to wake.[10] Individuals experiencing sleep drunkenness report waking with confusion, disorientation, slowness and repeated returns to sleep.[9][11]
It also appears in non-hypersomniac persons, for example after a night of insufficient sleep.[9] Fatigue and consumption of alcohol or hypnotics can cause sleep drunkenness as well.[9] It is also associated with irritability: people who get angry shortly before sleeping tend to experience sleep drunkenness.[9]
According to the American Academy of Sleep Medicine, hypersomniac patients often take long naps during the day that are mostly unrefreshing.[3] Researchers found that naps are usually more frequent and longer in patients than in controls.[12] Furthermore, 75% of the patients report that short naps are not refreshing, compared to controls.[12]
Diagnosis
"The severity of daytime sleepiness needs to be quantified by subjective scales (at least the
Differential diagnosis
Hypersomnia can be primary (of central/brain origin), or it can be secondary to any of numerous medical conditions. More than one type of hypersomnia can coexist in a single patient. Even in the presence of a known cause of hypersomnia, the contribution of this cause to the complaint of excessive daytime sleepiness needs to be assessed. When specific treatments of the known condition do not fully suppress excessive daytime sleepiness, additional causes of hypersomnia should be sought.[14] For example, if a patient with sleep apnea is treated with CPAP (continuous positive airway pressure), which resolves their apneas but not their excessive daytime sleepiness, it is necessary to seek other causes for the excessive daytime sleepiness. Obstructive sleep apnea "occurs frequently in narcolepsy and may delay the diagnosis of narcolepsy by several years and interfere with its proper management."[15]
Primary hypersomnias
The true primary hypersomnias include:[8]
- Narcolepsy (with and without cataplexy)
- Idiopathic hypersomnia
- Recurrent hypersomnias (like Kleine-Levin syndrome)
Primary hypersomnia mimics
There are also several genetic disorders that may be associated with primary/central hypersomnia. These include the following:
There are many
Early
Secondary hypersomnias
Secondary hypersomnias are extremely numerous.
Hypersomnia can be secondary to disorders such as
Sleep apnea is the second most frequent cause of secondary hypersomnia, affecting up to 4% of middle-aged adults, mostly men. Upper airway resistance syndrome (UARS) is a clinical variant of sleep apnea that can also cause hypersomnia.[8] Just as other sleep disorders (like narcolepsy) can coexist with sleep apnea, the same is true for UARS. There are many cases of UARS in which excessive daytime sleepiness persists after CPAP treatment, indicating an additional cause, or causes, of the hypersomnia and requiring further evaluation.[14]
Sleep movement disorders, such as restless legs syndrome (RLS) and periodic limb movement disorder (PLMD or PLMS) can also cause secondary hypersomnia. Although RLS does commonly cause excessive daytime sleepiness, PLMS does not. There is no evidence that PLMS plays "a role in the etiology of daytime sleepiness. In fact, two studies showed no correlation between PLMS and objective measures of excessive daytime sleepiness. In addition, EDS in these patients is best treated with psychostimulants—and not with dopaminergic agents known to suppress PLMS."[14]
Primary hypersomnia in diabetes, hepatic encephalopathy, and acromegaly is rarely reported, but these medical conditions may also be associated with hypersomnia secondary to sleep apnea and periodic limb movement disorder (PLMD).[8]
As with chronic fatigue syndrome,
Most forms of cancer and their therapies can cause fatigue and disturbed sleep, affecting 25-99% of patients and often lasting for years after treatment completion. "Insomnia is common and a predictor of fatigue in cancer patients, and polysomnography demonstrates reduced sleep efficiency, prolonged initial sleep latency, and increased wake time during the night."
Behaviorally induced insufficient sleep syndrome must be considered in the differential diagnosis of secondary hypersomnia. This disorder occurs in individuals who fail to get sufficient sleep for at least three months. In this case, the patient has
Many medications can lead to secondary hypersomnia. Therefore, a patient's complete medication list should be carefully reviewed for sleepiness or fatigue as side effects. In these cases, careful withdrawal from the possibly offending medication(s) is needed; then, medication substitution can be undertaken.[8]
Posttraumatic hypersomnias
In some cases, hypersomnia can be caused by a brain injury.[26] Researchers found that the level of sleepiness is correlated with the severity of the injury.[27] Even if patients reported an improvement, sleepiness remained present for a year in about a quarter of patients with traumatic brain injury.[27]
Recurrent hypersomnias
Recurrent hypersomnias are defined by several episodes of hypersomnia persisting from a few days to weeks.[28] These episodes can occur weeks or months apart from each other.[28] There are 2 subtypes of recurrent hypersomnias: Kleine-Levin syndrome and menstrual-related hypersomnia.[29]
Kleine-Levin syndrome is characterized by the association of episodes of hypersomnias with behavioral, cognitive and mood abnormalities.
Menstrual-related hypersomnia is characterized by episodes of excessive sleepiness associated with the menstrual cycle.
Assessment tools
Polysomnography
Polysomnography is an objective sleep assessment method.[34] It comprises a lot of electrodes which measure physiological variables related to sleep.[35] Polysomnography often includes electroencephalography, electromyography, electrocardiography, muscle activity and respiratory function.[35][36]
Polysomnography is helpful to identify the very short sleep onset latency period, the very efficient sleep (more than 90%), the increased slow wave sleep, and sometimes an elevated amount of sleep spindles in idiopathic hypersomnia patients.[37]
Multiple sleep latency test (MSLT)
The 'multiple sleep latency test' (MSLT) is an objective tool which indicates the degree of sleepiness by measuring the sleep latency (i.e. the speed of falling asleep).[38][39] It also gives information regarding the presence of abnormal REM sleep onset episodes.[38] During that test, patients have a series of opportunities to sleep at 2-h intervals across the day in a darkened room and with no external alerting influences.[39][40]
The MSLT is often administered the day after recording the polysomnography, and the mean sleep latency score is often found to be around (or less than) 8 minutes in idiopathic hypersomnia patients.[37] Some patients might even have a sleep onset latency of 5 minutes or less. These patients are often even more aware of sleeping during naps than narcolepsy patients.
Actigraphy
Actigraphy, which operates by analyzing the patient's limb movements, is used to record the sleep and wake cycles.[41] In order to report them, the patient has to wear continuously a device on his or her wrist, which looks like a watch and does not contain any electrodes.[41][42][43] The advantage actigraphy shows over polysomnography is that it is possible to record for 24-hours a day for weeks.[41] Furthermore, unlike the polysomnography, it is less expensive and non-invasive.[41]
An actigraphy over several days can show longer sleep periods, which are characteristic for idiopathic hypersomnia.[44] Actigraphy is also helpful in ruling out other sleep disorders, especially circadian disorders, leading to an excess of sleepiness during the day, too.
The maintenance of wakefulness test (MWT)
The 'maintenance of wakefulness test' (MWT) is a test that measures the ability to stay awake.[45] It is used to diagnose disorders of excessive somnolence, such as hypersomnia, narcolepsy or obstructive sleep apnea.[45][46] During that test, patients sit comfortably and are instructed to try to stay awake.[45]
The Stanford sleepiness scale (SSS)
The Stanford sleepiness scale (SSS) is a self-report scale that measures the different steps of sleepiness.[47] For each statement, patients report their level of sleepiness using a 7-point scale, going from very alert to excessively sleepy.[48] Researchers found that the SSS was highly correlated with performances to monotonous and boring tasks, which are found to be very sensitive to sleepiness.[47] These results suggest that the SSS is a good tool to assess sleepiness in patients.[47]
The Epworth sleepiness scale (ESS)
The 'Epworth sleepiness scale' (ESS) is also a self-reported questionnaire that measures the general level of sleepiness in a day [49][50] The patients have to rate specific daily situations by means of a scale going from 0 (would never doze) to 3 (high chance of dozing).[51] The results found in the ESS correlate with the sleep latency indicated by the Multiple Sleep Latency Test.[49][52]
Treatment
Although there has been no cure of chronic hypersomnia, there are several treatments that may improve patients' quality of life—depending on the specific cause or causes of hypersomnia that are diagnosed.[8]
Because the causes of hypersomnia are unknown, it is only possible to treat symptoms and not directly the cause of this disorder.[53] Behavioral treatments, as well as sleep hygiene, have to be discussed with the patient and are recommended.
There are several pharmacological agents that have been prescribed to patients with hypersomnia, but few have been found to be efficient.[44] Modafinil has been found to be the most effective drug against the excessive sleepiness, and has even been shown to be helpful in children with hypersomnia.[54] The dosage is started at 100 mg per day, and then slowly increased to 400 mg per day.[55]
In general, patients with hypersomnia or excessive sleepiness should only go to bed to sleep or for sexual activity.[56] All other activities, such as eating or watching television, should be done elsewhere.[56] For those patients, it is also important to go to bed only when they feel tired, rather than trying to fall asleep for hours.[56] In that case, they probably should get out of bed and read or watch television until they get sleepy.[56]
Epidemiology
Hypersomnia affects approximately 5% to 10% of the general population,[57][58] "with a higher prevalence for men due to the sleep apnea syndromes".[8]
See also
References
- ^ "Sleep Disorders". American Psychiatric Association. 2015. Retrieved 12 January 2017.
- ^ "Recent Updates to Proposed Revisions for DSM-5: Sleep-Wake Disorders". DSM-5 Development. American Psychiatric Association.
- ^ a b c d e American Academy of Sleep Medicine. The international classification of sleep disorders: diagnostic & coding manual (2nd ed). Westchester, IL: American Academy of Sleep Medicine, 2005.
- ^ Grossman, A., Barenboim, E., Azaria, B., Sherer, Y., & Goldstein, L. (2004). The maintenance of wakefulness test as a predictor of alertness in aircrew members with idiopathic hypersomnia. Aviation, space, and environmental medicine, 75(3), 281–283.
- ^ Wise, M. S., Arand, D. L., Auger, R. R., Brooks, S. N., & Watson, N. F. (2007). Treatment of narcolepsy and other hypersomnias of central origin. Sleep, 30(12), 1712–1727.
- ^ a b Morgenthaler, T. I., Kapur, V. K., Brown, T. M., Swick, T. J., Alessi, C., Aurora, R. N., … Zak, R. (2007). Practice Parameters for the Treatment of Narcolepsy and other Hypersomnias of Central Origin. Sleep, 30(12), 1705‑1711. https://doi.org/10.1093/sleep/30.12.1705
- ^ "NINDS Hypersomnia information page". Archived from the original on 2009-08-25. Retrieved 2009-01-23.
- ^ S2CID 43410010.
- ^ a b c d e Roth, B. (1972). Hypersomnia With « Sleep Drunkenness ». Archives of General Psychiatry, 26(5), 456. https://doi.org/10.1001/archpsyc.1972.01750230066013
- ^ a b Trotti, L. M. (2017). Waking up is the hardest thing I do all day: Sleep inertia and sleep drunkenness. Sleep medicine reviews, 35, 76–84.
- ^ Vernet, C., & Arnulf, I. (2009). Idiopathic hypersomnia with and without long sleep time: A controlled series of 75 patients. Sleep, 32(6), 753–759.
- ^ a b Vernet, C., Leu-Semenescu, S., Buzare, M.-A., & Arnulf, I. (2010). Subjective symptoms in idiopathic hypersomnia: Beyond excessive sleepiness. Journal of sleep research, 19(4), 525–534.
- ^ Neil Freedman, MD. "Quantifying sleepiness". Retrieved 2013-07-23.
- ^ PMID 12530999.
- PMID 19699146.
- ^ "International classification of sleep disorders, revised: Diagnostic and coding manual" (PDF). American Academy of Sleep Medicine. 2001. Archived from the original (PDF) on 26 July 2011. Retrieved 25 January 2013.
- ^ a b c d e National Institutes of Health (June 2008). "NINDS Hypersomnia Information Page". Archived from the original on 2009-08-25. Retrieved 2009-01-23.
- ^ a b "MedLink Clinical Summary: Sleep and neuromuscular and spinal cord disorders". MedLink. Retrieved 7 January 2014.
- S2CID 681023.
- PMID 23794547.
- S2CID 34100321.
- S2CID 27588469.
- ^ ISBN 978-1-4443-3557-6.
- ^ PMID 20937049.
- ^ a b "Abstractverwaltung Congrex". Archived from the original on August 12, 2014. Retrieved Aug 10, 2014.
- ^ Guilleminault, C., Faull, K. F., Miles, L., & Van den Hoed, J. (1983). Posttraumatic excessive daytime sleepiness: A review of 20 patients. Neurology, 33(12), 1584–1584.
- ^ a b Watson, N. F., Dikmen, S., Machamer, J., Doherty, M., & Temkin, N. (2007). Hypersomnia following traumatic brain injury. Journal of Clinical Sleep Medicine, 3(04), 363–368.
- ^ a b Dauvilliers, Y., & Buguet, A. (2005). Hypersomnia. Dialogues in clinical neuroscience, 7(4), 347.
- ^ a b Billiard, M., & Podesta, C. (2013). Recurrent hypersomnia following traumatic brain injury. Sleep Medicine, 14(5), 462‑465. https://doi.org/10.1016/j.sleep.2013.01.009
- ^ Arnulf, I., Zeitzer, J. M., File, J., Farber, N., & Mignot, E. (2005). Kleine–Levin syndrome: A systematic review of 186 cases in the literature. Brain, 128(12), 2763–2776
- ^ Manber, R., & Bootzin, R. R. (1997). Sleep and the menstrual cycle. Health Psychology, 16(3), 209.
- ^ Rocamora, R., Gil-Nagel, A., Franch, O., & Vela-Bueno, A. (2010). Familial Recurrent Hypersomnia: Two Siblings with Kleine-Levin Syndrome and Menstrual-Related Hypersomnia. Journal of Child Neurology, 25(11), 1408‑1410. https://doi.org/10.1177/0883073810366599
- ^ a b c d e f Harris, S. F., Monderer, R. S., & Thorpy, M. (2012). Hypersomnias of Central Origin. Neurologic Clinics, 30(4), 1027‑1044. https://doi.org/10.1016/j.ncl.2012.08.002
- ^ Ibáñez, V., Silva, J., & Cauli, O. (2018). A survey on sleep assessment methods. PeerJ, 6, e4849. https://doi.org/10.7717/peerj.4849
- ^ a b Marino, M., Li, Y., Rueschman, M. N., Winkelman, J. W., Ellenbogen, J. M., Solet, J. M., … Buxton, O. M. (2013). Measuring sleep: Accuracy, sensitivity, and specificity of wrist actigraphy compared to polysomnography. Sleep, 36(11), 1747–1755.
- ^ Chesson Jr, A. L., Ferber, R. A., Fry, J. M., Grigg-Damberger, M., Hartse, K. M., Hurwitz, T. D., … Rosen, G. (1997). The indications for polysomnography and related procedures. Sleep, 20(6), 423–487.
- ^ ISBN 9781416066453
- ^ a b Carskadon, M. A. (1986). Guidelines for the multiple sleep latency test (MSLT): A standard measure of sleepiness. Sleep, 9(4), 519–524.
- ^ a b Littner, M. R., Kushida, C., Wise, M., G. Davila, D., Morgenthaler, T., Lee-Chiong, T., … Berry, R. B. (2005). Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. Sleep, 28(1), 113–121.
- PMID 1621030.
- ^ a b c d Ancoli-Israel, S., Cole, R., Alessi, C., Chambers, M., Moorcroft, W., & Pollak, C. P. (2003). The role of actigraphy in the study of sleep and circadian rhythms. Sleep, 26(3), 342–392.
- ^ Lichstein, K. L., Stone, K. C., Donaldson, J., Nau, S. D., Soeffing, J. P., Murray, D., … Aguillard, R. N. (2006). Actigraphy validation with insomnia. Sleep, 29(2), 232–239.
- ^ Sadeh, A., & Acebo, C. (2002). The role of actigraphy in sleep medicine. Sleep medicine reviews, 6(2), 113–124.
- ^ )
- ^ PMID 3283909.
- PMID 1555459.
- ^ a b c Hoddes, E., Zarcone, V., Smythe, H., Phillips, R., & Dement, W. C. (1973). Quantification of Sleepiness: A New Approach. Psychophysiology, 10(4), 431‑436. https://doi.org/10.1111/j.1469-8986.1973.tb00801.x
- ^ Herscovitch, J., & Broughton, R. (1981). Sensitivity of the Stanford sleepiness scale to the effects of cumulative partial sleep deprivation and recovery oversleeping. Sleep, 4(1), 83–92.
- ^ a b Johns, Murray W. (1991). A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep, 14(6), 540–545.
- ^ Johns, Murray W. (1993). Daytime sleepiness, snoring, and obstructive sleep apnea: The Epworth Sleepiness Scale. Chest, 103(1), 30–36.
- ^ Johns, Murray W. (1992). Reliability and factor analysis of the Epworth Sleepiness Scale. Sleep, 15(4), 376–381.
- PMID 9076642.
- ISBN 9780123786111
- PMID 17969461.
- PMID 14607353.
- ^ a b c d McWhirter, D., Bae, C., & Budur, K. (2007). The Assessment, Diagnosis, and Treatment of Excessive Sleepiness. Psychiatry (Edgmont), 4(9), 26‑35.
- ^
Geddes, J., Gelder, M., Price, J., Mayou, R., McKnight, R. Psychiatry. 4th ed. Oxford University Press; 2012. p365. ISBN 978-0199233960
- ISBN 978-0890425558.
External links
- Help: I can't stay awake! Archived 2014-08-08 at the Wayback Machine - Public Radio Interview with Dr. David Rye
- med/3129 at eMedicine - "Primary Hypersomnia"