Hypersomnia is a pathological condition that manifests itself with an increased sleep duration by 20-25% in comparison with the individual daily sleep duration. Often pathologically prolonged sleep will be a manifestation of other pathologies. In some cases, it occurs in healthy people against the background of psychoemotional overstrain or lack of sleep for several days in a row.
The content of the article:
Classification of hypersomnia
Causes of hypersomnia
Clinical signs of hypersomnia
Additional symptoms
Diagnosis of hypersomnia
Treatment of hypersomnia
Prognosis of hypersomnia
Hypersomnia
Patients with hypersomnia may experience a periodic increase in daytime drowsiness, such episodes are accompanied by a deterioration in general well-being and cause a number of complications. The diagnosis is made by analyzing the patient’s anamnesis, according to the results of various testing methods, as well as polysomnography.
Therapeutic tactics regarding hypersomnia consists in eliminating the cause of the disease, observing the necessary sleep regime and using medications, the mechanism of action of which is aimed at normalizing sleep. Hypersomnia affects the patient’s psyche, his emotional and volitional sphere, thinking, intelligence. Such an impact on the patient’s psyche causes a decrease in working capacity, reserve and adaptive capabilities of the body and provokes the development of serious diseases.
The concept of normal sleep duration is purely individual, since each person has his own life rhythm, which is caused by many factors, in particular, the type of activity, lifestyle, genetic characteristics, the presence of concomitant pathologies, etc. Hypersomnia can be a manifestation of brain lesions, sleep apnea syndrome, side effect of a drug, a manifestation of mental illness, etc. therefore, a thorough examination of the patient is necessary for its phenomena. In the process of diagnosing this pathology, it is very important to perform differential diagnostics, since increased daytime sleepiness may not be a pathology or a symptom of any disease, but the norm for insufficient duration of night sleep, and therapy for such a condition often consists in normalizing night sleep, stable rest and minimizing stressful situations.
Classification of hypersomnia
The classification of this pathology depends on the cause of its development. Based on the etiology , the following types of hypersomnia are distinguished:
post- traumatic;
psychophysiological;
psychopathic;
idiopathic;
narcolepsy;
associated with respiratory dysfunction during sleep and various somatic diseases.
According to clinical features, paroxysmal and permanent hypersomnia are distinguished. A feature of the paroxysmal form of this disease will be sudden bouts of drowsiness, regardless of external factors and circumstances. The phenomenon of paroxysmal hypersomnia is often a sign of cataplexy or narcolepsy. With permanent hypersomnia, patients complain of drowsiness and constant drowsiness during the day.
Causes of hypersomnia
There are many reasons why this pathological condition develops.
Most often , the main etiological factors will be:
various neurological, somatic, mental diseases;
sleep phenomena (motor disorders during sleep, sleep apnea syndrome);
traumatic head injuries;
circadian rhythm disorder (as a result of transtemporal flights, shift work schedule);
adverse events after taking medications;
insomnia (insomnia), etc.
The cause of psychophysiological hypersomnia, as a rule, will be lack of sleep at night, so it can be observed in healthy people and is easily eliminated with the normalization of the rhythm of life, as well as minimizing mental stress.
According to studies of the mechanism and causes of hypersomnia, it is known that it most often occurs against the background of narcolepsy. Narcolepsy often occurs as a result of an existing genetic disease. At the same time, there is an expressive daytime drowsiness and episodes of involuntary, a kind of violent, falling asleep.
Quite often hypersomnic conditions can occur due to neurological dysfunctions. The most unpredictable course of increased drowsiness is the hysteria clinic. With this disease, pathological sleep can last a very long time, in some cases several days.
Manifestations of hypersomnia on the background of mild brain injuries are difficult to distinguish from clinical manifestations of mental disorders. Differential diagnosis consists in identifying pronounced structural changes in the brain that have appeared as a result of trauma. The absence of such injuries in hypersomnia indicates that the causal cause of this pathological condition will not be brain damage, but a stressful state caused by trauma.
Depressive disorders can be another cause of hypersomnia.
In some cases, drug therapy of various diseases causes drug hypersomnia, in particular, this form of increased drowsiness is included in the list of side effects when using some hypotensive, hypoglycemic and psychotropic drugs.
Insufficient sleep duration at night against the background of insomnia, dysfunction of circadian rhythms caused by shift work and various external factors often provokes sleep disorders and the development of hypersomnia.
Based on the above, it is clear that hypersomnia has a polyethological character, and its diagnosis requires a systematic approach.
Clinical signs of hypersomnia
Clinical manifestations of this pathology have a direct relationship with etiological prerequisites. Nevertheless, among all the signs of hypersomnia, its main symptoms are highlighted, which are represented by periodic or stable drowsiness during the day and a long duration of night sleep. As a rule, a night’s sleep with hypersomnia takes 12-14 hours. Often patients complain of difficulty waking up, lack of response to alarm clocks and an increase in the period from sleepiness to full awakening. Therefore, some time after waking up, patients with hypersomnia may feel lethargy and drowsiness. This condition resembles a clinic of intoxication, also sometimes found in the medical literature under the phrase “drowsy intoxication”.
The phenomenon of daytime sleepiness, regardless of its nature, is often accompanied by a decrease in efficiency and attentiveness, which ultimately disrupts normal work activity, provokes a failure of the normal rhythm of life and forces you to stop sleeping during the daytime. Sometimes, after a nap, patients may notice relief of the general condition, but in the majority of cases, drowsiness remains the same.
Additional symptoms
In addition to the main symptoms, there are a number of clinical manifestations characteristic of certain diseases that cause hypersomnia. So, for example, with narcolepsy, patients may feel irresistible drowsiness and fall asleep even at the most inopportune moments. Over time, patients begin to feel in advance the approach of these attacks of violent drowsiness and take the most comfortable sleeping positions. Symptoms of this form of pathologically increased drowsiness also include hallucinations at the moments of falling asleep or waking up and cataplexy of awakening, which is characterized by atony of the muscular system, as a result of which the patient loses the ability to perform any movements for several minutes after waking up.
Psychopathic hypersomnia is characterized by the unpredictable nature of daytime sleepiness, the features of which are due to specific psychopathology. Sleep can be quite long, but the results of a polysomnographic study indicate that the patient’s body is not in a state of sleep, and an electroencephalogram often determines intense wakefulness.
The phenomenon of idiopathic hypersomnia is most often characteristic of persons from 15 to 30 years old. This form of hypersomnia is manifested by difficulty waking up, constant drowsiness, in some cases, patients have outpatient automatism for several seconds.
With the defeat of the reticular formation, as well as with epidemic encephalitis, lethargic sleep may develop, which is a continuous sleep for a day or more.
Diagnosis of hypersomnia
The correct diagnosis of hypersomnia requires a complex of diagnostic procedures, since it is very important to clarify the form of hypersomnia and its etiology, the only way to prescribe appropriate therapy. Therefore, in addition to the standard neurological examination and anamnesis collection, a number of additional studies may be required, and in some cases it is advisable to involve additional specialists (traumatologist, psychiatrist, ophthalmologist, cardiologist, gastroenterologist).
In the process of collecting anamnesis, attention is focused on the presence of genetic diseases, recent head injuries, concomitant pathologies, as well as on the general life rhythm of the patient.
Additional methods for the study of hypersomnia include specific tests (sleep latency test, Stanford School of Drowsiness).
An important diagnostic role in the detection of pathologically increased drowsiness is the performance of a polysomnographic study. Polysomnography makes it possible to clarify the form and features of the clinical course of hypersomnia.
It is also important to differentiate hyposomnia, which has developed against the background of other pathologies, from increased drowsiness with an organic etiology (as a result of asthenia, chronic fatigue syndrome, depression), since this is the only way to prescribe optimal therapy. Such differentiation often involves the implementation of Echo-EG, CT of the brain, ophthalmoscopy, etc.
Treatment of hypersomnia
The treatment of hypersomnia has a direct relationship with the accuracy of the diagnostic results and the elimination of the underlying disease. In some cases, the disease that causes hypersomnia cannot be completely cured, then therapeutic tactics are aimed at minimizing symptoms that negatively affect the quality of life of the patient.
An important point in the fight against this pathological condition will be the normalization of sleep. Patients need to abandon their daily work schedule and go to bed at the same time. It is also necessary to include 1-2 times of daytime sleep in the daily schedule, while the duration of night sleep should not be more than 9 hours. To achieve positive results in the treatment of hypersomnia, it is necessary to refrain from drinking alcohol, exclude heavy food from the diet (too fatty, smoked) and try to avoid meals immediately before going to bed.
Drug therapy of hypersomnia involves the use of such stimulating drugs:
propranolol;
modafinil;
dextroamphitamine;
mazindol.
With cataplexic phenomena, patients are shown antidepressants:
viloxazine;
clomipramine;
protriptyline;
fluoxetine, etc.
After the implementation of all therapeutic measures, the patient must be provided with dynamic monitoring, since hypersomnia is prone to relapses.
Prognosis of hypersomnia
The prognosis, as well as the treatment of hypersomnia, depends on the cause of its development. For example, with post-traumatic hyposomnia, in most cases it is favorable, very often increased drowsiness disappears upon completion of therapeutic measures and rehabilitation of the patient. With narcoleptic hypersomnia, as well as organic brain lesions, the prognosis is less favorable. Hypersomnia itself is not a deadly pathology, but it significantly increases the risk of injury, since the patient can fall asleep at any time.
