Hypersomnia

What is hypersomnia?

Hypersomnia is a condition in which you feel extreme daytime sleepiness despite getting sleep that should be adequate (or more than adequate). If you have hypersomnia, you fall asleep several times during the day. Hypersomnia affects your ability to function at work and socially, affects your quality of life and increases your chance of accidents.

Who gets hypersomnia?

Hypersomnia is more common in females than males. It's thought to affect about 5% of the population. It’s usually diagnosed in adolescence or young adulthood (mean age is 17 to 24 years).

What are the signs and symptoms of hypersomnia?

Signs and symptoms of hypersomnia include:

• Constant, recurrent episodes of extreme sleepiness during the day.
• Sleeping longer than average (10 or more hours) yet still being very sleepy during the day and having difficulty remaining awake during the day.
• Difficulty waking up in the morning (“sleep drunkenness”) or after daytime naps, sometimes appearing confused or combative.
• Daytime naps don’t lead to improved alertness. They are unrefreshing and nonrestorative.
• Anxiety, irritability.
• Decreased energy.
• Restlessness.
• Slow thinking, slow speech, inability to focus/concentrate, memory problems.
• Headache.
• Loss of appetite.
• Hallucinations.

What causes hypersomnia?

The cause of most cases of hypersomnia remains unknown. Researchers have looked at the potential roles of neurotransmitters in the brain and cerebrospinal fluid including hypocretin/orexin, dopamine, histamine, serotonin and gamma-aminobutyric acid (GABA). A genetic link may be possible since a family history is present in up to 39% of people with idiopathic hypersomnia. Researchers are also exploring the role of certain genes in circadian rhythm that may be different in people with idiopathic hypersomnia.

How is hypersomnia diagnosed?

Your sleep specialist will ask about your symptoms, medical history, sleep history and current medications. You may be asked to keep track of your sleep and wake patterns using a sleep diary. You may be asked to wear an actigraphy sensor, which is a small, watch-like device worn on your wrist that can track disruptions in your sleep-wake cycle over several weeks.

Other tests your sleep specialist may order include:

• Polysomnography. This overnight sleep study test measures your brain waves, breathing pattern, heart rhythms and muscle movements during stages of sleep. The test is performed in a hospital, sleep study center or other designated site and under the direct supervision of a trained sleep specialist. This test helps diagnose disorders believed to cause sleepiness.
• Multiple sleep latency test. This daytime sleep test measures a person’s tendency to fall asleep during five, 20-minute nap trials scheduled two hours apart. The test records brain activity, including the number of naps containing REM sleep.
• Sleep questionnaires. You may be asked to complete one or more sleep questionnaires that ask you to rate your sleepiness. Popular sleep questionnaires are the Epworth Sleepiness Scale and the Stanford Sleepiness Scale.

According to diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, you would be diagnosed with hypersomnia if you:

• Experience excessive sleepiness despite at least seven hours of sleep and have at least one of these additional symptoms: (a) lapse into sleep several times within the same day; (b) get more than nine hours of sleep and still don’t feel refreshed and awake; or (c) don’t feel fully awake after an abrupt awakening.
• Experience hypersomnia at least three times a week for at least three months.
• Report that the hypersomnia is causing significant distress or impairment in your mental, social, work or other areas of functioning.

Are there different types of hypersomnias?

Different sleep organizations and psychiatric organizations have different classification systems and subcategories for hypersomnia. Complicating matters, these classifications continue to evolve.

More commonly accepted criteria is that there are two main types of hypersomnia: secondary hypersomnia and primary hypersomnia.

Secondary hypersomnia

Secondary hypersomnia means your excessive sleepiness is due to some other known cause. Causes include:

• Hypersomnia due to a medical condition. Diseases and conditions that can cause hypersomnia include epilepsy, hypothyroidism, encephalitis, multiple sclerosis, Parkinson’s disease, obesity, obstructive sleep apnea, delayed sleep phase syndrome, multiple systems atrophy, myotonic dystrophy and other genetic disorders, mood disorders (including depression, bipolar disorder, seasonal depression). Hypersomnia can also result from head trauma, tumors and central nervous system diseases.
• Hypersomnia due to medications or alcohol. Sedating medications (includes benzodiazepines, barbiturates, melatonin and sleeping aids), anti-hypertensive drugs, anti-epileptic drugs, anti-parkinsonian agents, skeletal muscle relaxants, antipsychotics, opiates, cannabis and alcohol can cause hypersomnia. Withdrawal from stimulant drugs (includes medications used to treat attention deficit hyperactivity disorder) can cause hypersomnia.
• Hypersomnia due to not getting enough sleep (insufficient sleep syndrome). You may have hypersomnia simply because you're not going to bed and allowing yourself the chance for seven to nine hours of sleep (for adults). Perhaps you're not practicing good sleep habits (like avoiding exercise and caffeine within a few hours of bedtime) to help you get enough quality sleep.

Primary hypersomnia

Primary hypersomnia means that hypersomnia is its own condition. It’s not caused by other medical conditions or a symptom of another medical condition. Four conditions are classified as primary hypersomnias:

• Narcolepsy type 1. This type of narcolepsy, also called narcolepsy with cataplexy (sudden muscle weakness triggered by emotions) is caused by having a low level of the brain and cerebrospinal fluid chemical (neurotransmitter) hypocretin (also called orexin). Daytime naps are usually shorter and refreshing compared with daytime naps in other disorders of hypersomnolence. Narcolepsy type 1 commonly begins between the ages of 10 and 25. Hallucinations and sleep paralysis are common.
• Narcolepsy type 2. This type of narcolepsy doesn’t include cataplexy. Narcolepsy type 2 has less severe symptoms and normal levels of hypocretin. Narcolepsy type 2 commonly begins during adolescence.
• Kleine-Levin syndrome. This condition consists of recurring episodes of extreme hypersomnia. It usually occurs with mental, behavioral and sometimes psychiatric disturbances. Each episode can last for about 10 days, with some episodes lasting several weeks to months and recurring several times a year. If you have Kleine-Levin syndrome, you have normal alertness and functioning between episodes. It mainly affects young males. Episodes decrease over eight to 12 years.
• Idiopathic hypersomnia. Idiopathic means no known cause, so idiopathic hypersomnia means you feel extremely sleepy for unknown reasons — even after a longer than the adequate amount (9 to 10 hours) of sleep.

How is hypersomnia treated?

Treatment depends on what’s causing your hypersomnia. There are both medication approaches and lifestyle changes.

Medications

Wakefulness-promoting agents include modafinil (Provigil®), armodafinil (Nuvigil®) and pitolisant (Wakix®) and solriamfetol (Sunosi®). One of these medications is usually tried first.

• Psychostimulants include amphetamine, methylphenidate (Ritalin®, Daytrana®, Methylin®, Concerta®) or dextroamphetamine (Procentra®, Dexedrine®, Zenzedi®). These drugs have more abuse potential and side effects than first-line agents.
• Other drug options, when other medications fail, including sodium oxybate (Xyrem® or Xywav®), flumazenil (Romazicon®) and clarithromycin (Biaxin®).

It’s important to see your sleep specialist for follow-up appointments. Your healthcare provider will need to find out how you’re feeling and determine how well your medication is working, if dose adjustment is needed or if a switch to another medication should be made.

Lifestyle changes

Maintain good sleep habits. This includes things like establishing a regular sleeping schedule, having an environment that allows for sleep (cool, dark room; comfortable pillows and bed) and limiting caffeine and exercise before bedtime.

Can hypersomnia be prevented?

There’s no way to prevent most types of hypersomnia. Hypersomnia is a chronic illness without a cure.

What can I do to better cope with having hypersomnia?

Consider making some lifestyle changes to help improve the quality of your sleep and keep you safe and avoid injuries and accidents.

Things you can try include:

• Go to bed at the same time each night. Make sure your bedroom is well-ventilated, cool in temperature, dark, quiet, and comfortable in terms of mattress, pillows and sheets and blankets.
• Avoid caffeinated products (including coffee, cola, tea, chocolate, and various over-the-counter medicines) within several hours of bedtime. Caffeine is a stimulant.
• Avoid alcohol before bedtime. Although alcohol is a depressant and seems like it might help you fall asleep, as it’s metabolized by your body, it causes awakenings and is often associated with nightmares and sweats.
• Avoid tobacco and nicotine-containing products near bedtime. Nicotine is a stimulant.
• Ask your sleep specialist about what to avoid in terms of foods or specific medications.
• Be careful about driving or operating equipment that can be dangerous to you or others. Work with your healthcare team, family and employer to make adaptations or adjustments to keep you and others around you safe.
• Avoid night shift work.

It may be helpful to talk to a psychologist or counselor and find a support group to learn to cope with the challenges of having hypersomnia. Ask your sleep specialist for referrals and names of support groups. Bring loved ones with you to these sessions. People with hypersomnia are often misunderstood as being lazy or incompetent and educating them on this condition will help your relationships.

What can I expect if I have hypersomnia?

Your outcome depends on the cause of the disorder. Although hypersomnia is not life-threatening, it can have a significant impact on the quality of your life. It can cause you to lose your ability to function around your family, in social situations, at work or in other settings. It can cause vehicle accidents if you fall asleep while driving. Medications and lifestyle changes can help improve some symptoms in some people with hypersomnia. Other people may not achieve full relief.

Is narcolepsy the same as hypersomnia?

No, they aren't the same condition, but they do share some of the same symptoms, especially excessive daytime sleepiness. One of the main differences is that narcolepsy is associated with abrupt sleep attacks. This isn't a symptom of hypersomnia. Also, naps in a person with hypersomnia often are longer than an hour and aren't refreshing. A person with narcolepsy may feel refreshed after a short nap. Narcolepsy can be clearly diagnosed according to polysomnographic testing.

Can anxiety cause hypersomnia?

No. Anxiety doesn’t cause hypersomnia. However, having hypersomnia can cause anxiety.

A note from Cleveland Clinic
Not being able to stay awake and alert during the day despite an adequate amount of sleep at night can have a major impact on the quality of your life and even be dangerous to yourself and the people around you. If these symptoms sound like something you're experiencing, seek help from your primary healthcare provider or directly from a sleep specialist. There may be some medications and non-drug therapies that can help improve your symptoms. Learning about hypersomnia, joining a support and educating family, friends and work colleagues can help with adjustments that may need to be made to help you better function and cope with this sleep disorder.