Hypersomnia Disorders

Is it hard to concentrate or remember things? Do you feel like you could nod off at any second during the day — even when you slept eight hours or more at night? And are you feeling anxious or irritable?

Any of these symptoms can be linked to other conditions. But when they show up together, it’s a good sign that you may have a hypersomnia disorder.

Things we always look for when diagnosing one of these conditions are:

• Excessive sleepiness despite at least seven hours of sleep and at least one of these symptoms — sleepiness after abruptly waking up, falling asleep several times a day or not feeling refreshed after nine or more hours of sleep.
• Signs of hypersomnia at least three times a week for at least three months.
• Significant impact on your mental health, your social and professional life, and on other aspects of your daily life.

While the definitions of hypersomnia constantly change, it’s widely understood that there are two main types:

Primary hypersomnia

This means your hypersomnia is its own condition. It has no underlying cause. There are different types, like:

• Narcolepsy types 1 and 2: Type 1 is called narcolepsy with cataplexy (sudden muscle weakness triggered by strong emotion). Low levels of a certain chemical in the brain and spinal fluid (neurotransmitter) can cause this condition. Sleep-related hallucinations and sleep paralysis are common. Type 2 narcolepsy doesn’t have cataplexy, which can make it harder to diagnose.
• Idiopathic hypersomnia disorder: If we don’t know why you’re always so sleepy, we may say you have this condition. Idiopathic means “no known cause.” But this condition has specific symptoms, including sleep inertia — difficulty waking up in the morning, brain fog and, sometimes, a long sleep time (more than 10 hours per night).
• Kleine-Levin syndrome: If you have this type, you’ll have serious hypersomnia that keeps coming back (recurring episodes). You can sleep for long periods — up to 20 hours per day. You might be extremely hungry (polyphagia), irritable, anxious or depressed, and confused. Or you could have amnesia or hallucinations and an increased sex drive (hypersexuality). An episode of these symptoms usually lasts for at least two days and up to 10 days (about a week and a half). It’s often called “Sleeping Beauty syndrome.”

Secondary hypersomnia

Secondary hypersomnia means another (secondary) condition is making you super sleepy. Parkinson’s disease, depression, obstructive sleep apnea or hypothyroidism can all be culprits — as can certain medications and alcohol use. Even getting less than seven to nine hours of sleep — or not having good sleep habits — can make you feel like all you want to do is nap.

Diagnosing Hypersomnia Disorders at Cleveland Clinic

When you have excessive sleepiness, it’s important to work with experienced healthcare providers. Ones who can pinpoint a correct diagnosis and build the best care plan for your needs. If you choose Cleveland Clinic, you’ll meet with our expert team before treatment. This helps us get to know you and better understand what’s been going on.

What to expect at your first appointment

Your story is important to us. We want to hear all about how you’re feeling. That’s why your provider will ask a lot of questions when you come for your first visit, like:

• Have you been diagnosed with any other health conditions?
• Have you been keeping track of your sleep routine?
• How many hours do you sleep at night?
• How often do you feel tired during the day?
• Do you have any other symptoms?
• Can you keep up with your daily activities?

Your provider may also ask you to complete a sleep questionnaire like the Epworth Sleepiness Scale. This questionnaire asks you to rate how likely you are to doze off in certain situations, like watching TV, reading, sitting in traffic in the car and more.

They’ll also listen to your concerns and answer any questions you may have. And they’ll explain what you can expect going forward. We want you to feel comfortable and confident about getting treatment.

Testing for hypersomnia disorders

While you’re here, your provider will also do a physical exam. Then, they’ll give you a small, watch-like device called an actigraphy sensor to wear for seven to 14 days. It tracks your sleep-wake cycle and helps us rule out any other conditions that might be causing your hypersomnia.

Next, your provider will order some tests to help them confirm a diagnosis. They’ll carefully plan and tailor these tests to your specific sleep-wake pattern. You may need to stop taking certain medications for at least 14 days before testing begins. Your provider will let you know if you need to do this.

One of the tests your team may have you do is a sleep study (polysomnography). This overnight sleep test tracks your brain waves, breathing, heart rhythm and muscle movements. This is done while you sleep at one of our special labs under a sleep specialist’s watchful eye.

You may also have a multiple sleep latency test (MSLT) to check how quickly you fall asleep during the day. We track your brain activity and REM sleep (when you may have vivid dreams). We do this during five 20-minute naps about two hours apart.

Meet Our Hypersomnia Disorder Team

Cleveland Clinic focuses on team-based care. This means providers from different specialties work together to confirm your diagnosis and make sure you have the most personalized treatment plan. Depending on your needs, your care team will include providers like:

• Neurologists.
• Pulmonologists.
• Otolaryngologists.
• Psychiatrists.
• Psychologists.
• Primary care providers.
• Dentists.

We build your hypersomnia treatment plan around what’s causing your excessive sleepiness. We may have you take medications. And we might also suggest lifestyle changes to help you sleep better at night.

Medications for hypersomnia disorders

Your care team may decide medications with ingredients that help keep you awake could be a good first start to treatment. They may prescribe modafinil (Provigil^®), solriamfetol (Sunosi^®), armodafinil (Nuvigil^®) or pitolisant (Wakix^®).

You may also take psychostimulant drugs like amphetamines that speed up messages between your brain and body. It’s important to understand that this type of medication has a higher risk of addiction and misuse, so your providers will keep a close eye on you.

There are other medications that your provider may prescribe if these don’t work as well as planned. They’ll go over options with you if this happens.

Improving sleep habits

Getting quality sleep each night is one of the best nonmedical things you can do. It’s important to follow a regular sleeping schedule. You’ll want to go to bed at the same time each night in a cool, dark room with a comfortable bed and pillows.

Limiting caffeine, alcohol and exercise before going to bed is important. So is avoiding smoking or using other nicotine products. They’re stimulants and may keep you awake. Your care team can suggest other ways to improve your sleep. They’re here to listen and help.

Living With Hypersomnia Disorders

There’s no way to prevent hypersomnia, but with the right treatment plan, you can find ways to live with it. It’s important to go to your follow-up appointments. This lets us keep a close eye on how your medications are working and adjust the dose or try something new if they aren’t. We also use this time to answer questions and listen to any concerns you may have about treatment.

When you feel sleepy all day, it can be hard to keep up with work, your social life and other daily activities. And that can be stressful. If you’d like, we can refer you to a psychologist experienced with sleep medicine to talk about what you’re going through. Or we can recommend a support group connecting you to other people with the same diagnosis.

Taking the Next Step

When you can barely keep your eyes open each day, it’s a sign something’s not right. The good news? Hypersomnia disorders are treatable. And Cleveland Clinic’s expert sleep disorder providers are here to help you feel less sleepy during the day. We do careful testing to pinpoint what’s causing your problems. And we find the best treatments to get you back to enjoying your waking hours — and sleeping better at night.