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Sleeping is necessary for good health. REM sleep restores brain function. The lack of enough rest can lead to chronic fatigue, muscle soreness, and compromised cognitive abilities. Everyone loves a good snooze now and then, but how much of it is sufficient for you?
Sadly, sleep experts report that there is something called “too much sleep” or hypersomnia. Sometimes, the subject rests for regular hours at night, yet feels excessive drowsiness throughout the day. A chronic lack of energy and confusion during decision making are problems that occur commonly in all cases of hypersomnia.
As per the data from National Sleep Foundation, over 40% of the people in the US show symptoms of hypersomnia from time to time. Men often suffer more frequently from this disorder as compared to women, due to a higher incidence of sleep apnea syndromes.
What is Hypersomnia?
Experts often use the words hypersomnia and hypersomnolence interchangeably. Hypersomnolence is a somewhat common affliction that causes the people to feel excessive daytime sleepiness (EDS). Their predisposition can be due to primary or secondary hypersomnia. The latter happens when EDS is a result of another persisting medical condition or physical discomfort.
Snoozing for more extended hours does not always qualify as a disorder. Summer temperatures and heightened levels of humidity can cause people to feel dazed. Sometimes the lack of enough energy reserves and an imbalance of electrolytes can cause people to rest for more extended hours. These are not cases of chronic hypersomnia, which usually negatively affects cognition, analysis and overall energy of a person.
Excess daytime sleep can attack a person for several reasons. It is a complex trait that can affect any person irrespective of age, sex, and vocation. Although it sounds like nothing but increasing affection for sleep, hypersomnia has a substantial socioeconomic burden. Students, working people, and homemakers can suffer from pathologically extended hours of sleep. There are a few investigations that classify sleeping sickness as a case of hypersomnolence. There are usually several reasons why a person can exhibit EDS. Therefore, experts classify the disease as primary and secondary hypersomnia.
How to Classify the “Excessive Sleepiness” Disorders?
Hypersomnia can either be a direct effect of another disease, or it can occur independently of other pre-existing medical conditions. When it does not coexist with other illnesses, experts refer to it as primary. When EDS happens as a result of another disease, it becomes a secondary disorder. In the majority of the cases, hypersomnolence is secondary.
- It can happen due to a pre-existing illness or disorder like Parkinson’s or Alzheimer’s. Neurological disorders and neuro-muscular dystrophies can be causes of EDS.
- Several medications, especially somnolent drugs, and antipsychotic medicines can increase the duration of nightly slumber for many people.
- Not getting enough restorative sleep every night can result in hypersomnia. Adults need between 7 and 9 hours of sleep, depending on their diet and profession.
- People with post-traumatic stress disorder (PTSD) have also shown several symptoms of EDS in the past. There are several studies on US veterans that highlight a relationship between PTSD, anxiety, depression and excessive need for rest or sleep.
- Cases of depression, bipolar disorder, and anxiety disorder often exhibit hypersomnia. Psychiatrists don’t yet know which the cause is and which the effect is, but a person diagnosed with depression and hypersomnia has both and should receive treatment for both.
What is Primary Hypersomnia?
Eight different central disorders can cause hypersomnolence. Narcolepsy Type 1 and Type 2, idiopathic hypersomnia and Kleine-Levine syndrome are the leading causes of excessive daytime drowsiness among people.
Kleine-Levin syndrome. This is the infamous sleeping beauty syndrome. It is quite rare, and as a result, the causes or the neuropathy of the disease is largely unknown. The symptoms often include episodic hyper-sleep. The patients can fall asleep suddenly following mood swings, and the sleep episode can continue for 22 hours at a stretch. The affected individuals barely wake up to eat and use the bathroom. KLS starts around puberty, and it usually begins as erratic mood changes, food cravings, hypersexuality, and chronic lethargy. These sudden episodes last for up to 10 years and have a substantial social impact on the patients. EDS due to Kleine-Levin syndrome is the only one that goes away around middle age.
Narcolepsy. Narcolepsy is a sleeping disorder that can cause complete loss of control of muscles, sleep paralysis, and hallucination. People with this sleeping disorder often fall asleep during the day while working, eating or even driving. It is a chronic neurological disorder that usually affects middle-aged men, but it concerns a more significant number of women due to lifestyle changes as well.
Idiopathic hypersomnia. Idiopathic hypersomnia is very different from Narcolepsy. In the former disorder, people experience excessive tedium throughout the day irrespective of their sleep duration at night. People suffering from IH often experience confusion on sudden awakening and have difficulty waking up due to external stimuli. People often tend to confuse idiopathic hypersomnia (IH) with hypersomnia.
In case of IH, the causes are neurological but mostly unknown. Primary hypersomnia and IH are not synonymous. All IH are primary, but all central hypersomnolence disorders are not necessarily idiopathic. As we can see here, the underlying causes of hypersomnolence can be diverse, but the symptoms are similar.
How Do Experts Diagnose Primary Hypersomnia?
Patients with idiopathic hypersomnia tend to keep extended sleep hours, but that is not always the case. The diagnosis of hypersomnolence is not perpetually straightforward. Experts classify central disorders using advanced daytime nap tests. Narcolepsy Type 2 and IH also sleep for long durations up to 11 hours per day, but that is not a specific diagnostic criterion for these diseases. These Multiple Sleep Latency Tests analyze the REM and non-REM sleep phases in patients with Narcolepsy Type 1 and Type 2, and IH.
Experts also opt for cerebrospinal fluid analysis via spinal tap for diagnostic procedures. Narcolepsy has autoimmune origins, and the cerebrospinal fluid from patients ubiquitously contains reduced levels of Hypocretin. The hypothalamus sustains damage due to the immune system’s attack on the human brain in Narcolepsy Type 1 only. For Type 2 narcolepsy and IH, the level of hypocretin is standard in the CSF.
What are the Criteria for the Diagnosis of Hypersomnolence?
The International Classification of Sleep Disorders – 3 categorizes IH into several primary and secondary types. The criteria for the diagnosis include;
- There should be an absence of cataplexy.
- Daytime drowsiness and indomitable need to sleep for at least three months.
- One or no REM phase as per Multiple Sleep Latency Test. The REM latency is lesser than 15 minutes as per the polysomnogram.
- Sleep latency is of maximum 8 minutes as per the MSLT.
- The total duration of night-time slumber is more than 660 minutes or 12 to 14 hours.
- Doctors should be able to rule out all chances of insufficient sleep syndrome.
- The EDS is not a result of any other sleep disorder or is not explainable by other medical or psychiatric disorders.
Sadly, there is still no consensus on how to define idiopathic hypersomnia. There is a lack of biological markers that can concretely point towards the precedence of IH. Hypocretin, multidimensional fatigue inventory, and sleep studies help in the differential diagnosis of IH.
Why is it Tricky to Diagnose Hypersomnia?
The severity of this disease varies from subject to subject. The Multiple Sleep Latency Test is a powerful tool with which experts can qualitatively categorize the incidence of EDS in patients. The Epworth sleepiness scale also helps medical professionals determine the seriousness of the condition.
Sleep experts often use the Stanford sleepiness scale to measure the sleepiness of a subject subjectively. Without a complete medical examination of the patient, experts find it impossible to state the prevalence of primary or secondary hypersomnia conclusively.
What are the Primary Hypersomnia Mimics?
Excessive need for rest, daytime drowsiness and the lack of energy are popular symptoms of multiple ailments. A multitude of genetic disorders, neurological disorders, and neurodegenerative conditions can mimic the primary causes of IH. In many cases, researchers have noticed Narcolepsy-like Sleep Onset REM Periods (SOREMP) in their test groups.
Several genetic diseases like the Norrie Disease, Prader-Willi Syndrome, Myotonic Dystrophy and Niemann-Pick Disease (Type C) show EDS. Several neurological “accidents” like brain strokes, lesions that lead to cerebral strokes, hypothalamus or thalamus injuries, and injuries to the brainstem can cause similar symptoms. Alzheimer’s and Parkinson’s can also increase the body’s need for sleep. Sometimes, significant head trauma can also elicit symptoms of EDS. However, head trauma also causes headaches, cognition impairment and memory loss in the typical cases, which is different from people with IH.
What are the Other Causes of Excessive Sleep?
Sometimes, patients undergoing treatment for various types of cancer can exhibit extended hours of daytime dozing. Experts refer to this kind of EDS as somnolence syndrome. Some chemotherapy drugs, anti-nausea medication, and pain medication can cause excessive sleepiness.
Antidepressants, antihistamines, and sedatives can cause it too. Here are a few other causes for which you might be experiencing daytime drowsiness, confusion, and unreasonable sleep .
- Anemia or low RBC count.
- Sudden hormonal fluctuations like the kind caused by menopause or pregnancy.
- Increased concentration of calcium in the blood.
- The lack of enough potassium in the system.
- Hypothyroidism or the decrease in levels of thyroid hormone.
Some simple changes in metabolism and shifts in the daily regimen can increase your daytime sleepiness. Although they do not classify as idiopathic hypersomnia, experts can consider them as sporadic instances of EDS.
Why do People with Excessive Daytime Sleepiness Experience Vivid Nightmares?
The exact causes of nightmares are mainly unknown, but studies point towards emotional stress as the leading cause. A detailed investigation into the causes have revealed a few contributing factors.
- Heart medications
- Withdrawal from painkillers, sedatives, and anti-anxiety medications
- Bodily discomfort including chronic pain
Detailed nightmares are very common in people suffering from somnolence syndrome as a result of chemotherapy, radiation and cancer diagnosis.
What are the Physical Impacts of Sleeping Too Much?
The need for sleep varies from one person to another. There are people, who have gone through the better part of their lives with just 5 to 6 hours of sleep per day. Then there are others, who need 9 to 10 hours of rest per night to be functional the next day. The amount of sleep an average person needs is still debatable, but sleep experts generally settle for 8 hours. Children are likely to sleep more. Most prepubescent kids need about 10 to 12 hours of sleep. Adolescents require about 8 to 10 hours of sleep per night to accommodate their changing body and replenish the high levels of energy they lose from activities per day. There is one question you must ask your doctor or expert – “how much sleep is too much?”
Too much sleep can hinder social interactions. It can create psychological boundaries. Restricted social time stuns the personal and psychical growth of a person. Nonetheless, there are a few more noticeable physical problems that people often face as a result of snoozing too much.
Elevated blood glucose. Diabetes may depend on your genetic makeup, but recent research has established a robust connection between diabetes and unnaturally long sleeping hours. Sleeping too much for years can decrease insulin production and increase glucose levels.
Obesity. Over 33% of the US citizens suffer from obesity. Sleeping too much can cause an increase in fat buildup in your system. People who sleep over 10 hours per day have 21% more chances of gaining weight than those who sleep for about 8 hours per day. Snoozing for long hours signals our bodies to go into “hibernation” mode. That happens when our metabolism senses a lack of regularized intake of food. The metabolisms that keep us active and warm slow down as a result of prolonged hours of sleeping. It sends a signal to increase fat deposits, which contributes to the higher risks of obesity.
A headache. Sleeping longer than usual can cause migraines in most. Some people experience debilitating headaches when they make up for lost sleep during the weekends or holidays. Scientists believe that this is due to deregulation of hormone and neurotransmitter levels in the brain. Serotonin is one of the factors that experience fluctuations in secretion during extended hours of sleep.
Depression. Oversleeping might contribute to depression just like the lack of enough sleep does. About 15% of the people suffering from depression also suffer from EDS. That can be a subconscious decision to avoid social interactions, but instead of improving psychological health, it makes matters worse. Irregular sleeping habits have a deleterious effect on depression.
Back pain. The lack of physical activity due to oversleeping can increase muscle stiffness and weaken back muscles. It can exacerbate cases of arthritis and spondylosis in middle-aged men and women. There was indeed a time when doctors advised people with back pain to hit the hay early and sleep it off, but modern research shows that sweating the pain out might be a better way than resting.
Heart diseases. Irregularities of different hormones, increasing levels of cholesterol and fat tissues in the body can have a grave effect on the cardiovascular health of people. A study involving almost 72,000 women (the Nurse’s Health Study) showed that women who slept for more than 11 hours per night had 38% increased risk, of having coronary diseases. Women who slept for 8 hours were less likely to get heart problems.
Link with death. A recent study involving sleeping disorders in adults shows a marked connection between shorter lifespan and lasting sleeping hours. People who are more likely to rest for 10 or 11 hours experience shorter lives than people who sleep for 8 hours at a stretch. Scientists have not yet been able to lay down concrete correlations between the higher death rate and extended slumbers, but they have shown a link between prolonged sleep and low socioeconomic statuses.
How to avoid Sleeping for Unnaturally Long Hours?
All problems of daytime sleepiness begin at night. Children are very likely to feel sleepy during the daytime at least once a week. Sometimes, our bodies crave more sleep than what we can manage at night. However, for some people, EDS can become a chronic problem. It can get in the way of their education, daily work, family responsibilities and personal health.
People who nod off while driving are a risk to themselves as well as to their co-riders and others on the road. Along with genetic predispositions, the lack of proper sleeping hygiene can interrupt your rest and cause you to feel excessively worn out during the daytime. Try these tips and tricks to avoid oversleeping and EDS.
- Try to sleep well at night. There is no substitute for straight 8 hours of deep sleep at night. It means your work from home, conference calls, emergency meetings, and extra office work should not eat up the dedicated 9 hours you need to prep for bed and to rest. We often give up an hour or two of our daily sleep for work, studies, family or fun, but none of these activities can restore your energy levels for the next day.
- Practice waking up at the same time. Most working folks wake up by 6:30 am or 7:00 am on the weekdays. The weekend late mornings usually motivate them. Sleeping for just 5 to 6 hours per day and sleeping for 12 hours on the weekends is not the way to embrace a healthy lifestyle. Stick to even wake-up time. Try to go to bed by 11 pm, so you can wake up effortlessly by 7 am. Keep the routine same for the weekends as well.
- Make your bed a no-mobile zone: Keep your mobile phones, tablets, and laptops away from the bed. All work should happen in the study or the living room. Even if you have to work on something in your bedroom, make sure you are away from the bed. It will retrain your brain that bed is only for sleeping. You should stop watching TV, chatting online and playing video games on the bed effective immediately. The increasing levels of blue light will leave you awake and sleep deprived throughout the night.
- Improve your mealtimes. In the mornings, do not leave home without a high-calorie meal. A high carbohydrate breakfast recharges the body and provides the energy reserve you can use throughout the day. Follow this up with a quick snack and then lunch. Skipping meals sends the wrong message to your metabolism that causes you to feel sleepier throughout the day. Always finish eating dinner at least 2 hours before bedtime. Keep your meal light. Eating a high carb dinner might send your system on a tizzy and cause you to stay awake till late.
- Regularize your workout schedule. You need to exercise to feel better and sleep better. Working out can smoothen out the fluctuations in hormones, neurotransmitters, and other biochemical signals in the body. Research shows that people with chronic idiopathic hypersomnia can benefit from the inclusion of regular exercise in their daily schedule. Aerobic exercise is especially helpful for regularizing sleep cycles for individuals of all ages.
- Refrain from late naps. We know how difficult it can be to stay awake on a slow day. Be it at office or school. We like to sneak in a little naptime in the break room or at the back of the class during the late hours. However, napping for even 20 minutes can recharge you for a considerable period. Unless you want to stay awake counting stars at night once again, you should not give in. Try indulging in exciting activities, drink more water, send some electrolytes to your system and at all costs avoid caffeine.
- Wait until you are sleepy. Going to bed tired and going to bed sleepy are two very different feelings. You can be tired but not sleepy. You may have already experienced this, your feet hurt, your eyes hurt and your thoughts are scattered, but there is no sleep. Feeling sleepy is very different, your eyes droop, and you feel drowsy. Most often people also doze off in case they do not make it to their beds on time. Always remember to go to bed when you are sleepy!
- Develop a bedtime ritual. People find it easier to separate their day’s grind with their night’s rest. Some find taking a warm bath in relaxing essential oils helpful, while others find listening to calming music more helpful. Your pre-sleep ritual should be personal, but it should set your day apart from your night. Chamomile tea and warm milk also help but avoid them if you have bladder problems.
- Do not drink alcohol. Even today, several people believe that a “nightcap” will help them nod off quicker. Studies show that alcohol prevents your brain from going into non-REM to REM sleep. So when that alcohol wears off, you will again be awake at night and probably with a hangover!
- Check with a specialist. Daytime sleepiness sounds trivial and somewhat jocular, but it is a severe disorder that can affect anyone. Since there are primary, secondary and primary mimicking physiological challenges that can potentially cause EDS in patients, doctors always insist on thorough sleep analysis, actigraphy, and polysomnography. If you have been suffering from any symptom of hypersomnia in the last three months, you need to check with an expert immediately.
To wake up on time for work or school, you can try one of the new alarm clocks that take the words “you snooze, you lose” quite literally. Snoozing the alarm will either cost you money, or you need indulge in physical exercise to shut the notification off successfully. The new generation of creative wake-up calls on smartphones has these features. They are useful in preventing people from oversleeping each day.
How do Experts Treat Chronic Hypersomnia?
Hypersomnia does not have one cause. Therefore, the treatment is not as simple as most would like it to be. In most cases, the remedies are multifarious and can be highly personalized too, depending on the different necessities of people.
The treatment of any sleep-deprivation disorder resulting in excessive sleepiness should begin with non-pharmacological steps. People should start by working on their sleep hygiene. Those, who find it impossible to fall asleep within 20 or 30 minutes of going to bed should leave the bed and engage in calming activities.
Listening to soulful music, reading, gardening, or practicing an art form can help them fall asleep much quicker. Leaving bed after 30 mins of waiting will prevent you from using your mobile phone in bed or using your laptop. You should return to bed only when you are sleepy once again.
Pharmacologic approaches can help treat cases of chronic hypersomnia more effectively. However, there can be multiple side effects that experts should always discuss with their patients before prescribing them the drugs. Modafinil, amphetamine, and caffeine are useful stimulants that can prevent daytime sleepiness in patients.
Most experts usually prescribe new anti-depressants that do not exacerbate EDS or night-time sleep deprivation. Modern medicine has made it possible for people to opt for REM-suppressing antidepressants that work marvelously for those suffering from Narcolepsy Type 1, Cataplexy and sleep paralysis due to EDS.
Since somnolence syndrome is a form of hypersomnia that occurs only in people undergoing cancer treatment, people with somnolence syndrome need different kinds of treatment for their condition. They require psychological counseling, antidepressants, multi-vitamins and replacement of several medications they are on to reduce the effects of hypersomnolence.
Conclusion: What is the Present and future of Hypersomnia Treatment?
Excessive sleepiness can be a symptom of several common diseases as well as grievous disorders. It is a universal complaint of people with psychiatric illnesses. Accurate diagnosis of hypersomnia depends on detailed analysis and dialogue with the patient. Experts have to be extra careful while dealing with secondary hypersomnia. Cases of EDS along with several comorbidities can make the situation more complicated. It often results in misdiagnosis, mistreatment, and severe side effects. It can contribute to compromising personal and public safety.
While treating someone for any hypersomnia, experts usually start with non-pharmacologic treatment processes. That includes the improvement of sleep hygiene and introduction of biphasic or polyphasic nap systems. There are several medicines now available in the market that can address issues of excessive drowsiness. However, to proceed to the pharmacologic treatment steps, doctors must always perform sleep studies on the patient. There are morning medications that increase alertness, boost wakefulness, and cut down the drowsiness.
Some of these medicines modify melatonin secretion and free melatonin levels in the system. They can improve cognition and mental performance in patients. Patients with narcolepsy find modafinil treatment more useful. It is a powerful CNS stimulant that can boost wakefulness. It is also beneficial for people with other sleep complications and disorders, who always have residual sleepiness in spite of non-medicine mediated treatment procedures.
Those with hypersomnia often find it difficult to cope with the socioeconomic implications of the disease. It impedes people’s social lives, carriers, and personal finances to a great extent. Sadly, hypersomnia is a lifelong disorder that affects over 5% of the people in the US. Although most organizations, educational institutions, and corporations do not regard hypersomnolence as a disorder, it can be disabling for a person on many levels. It can prevent an adult from driving themselves or their children, it can hinder a person’s use of heavy machinery at work, and it can be difficult for them to complete complex cognitive tasks as well as any other individual.
Most people have to deal with EDS throughout their lives, but thanks to advancements in medical technology, people can now manage their sleepiness better than before. No current case study yet suggests that there is a thriving and permanent treatment for hypersomnia.
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Co-founder of Counting Sheep and Sleepaholic