Hypersomnia
Hypersomnia is excessive daytime sleepiness. Excessive daytime sleepiness is difficulty staying awake or alert. Sleepiness may be confused with fatigue since a lack of energy characterizes both conditions. Further complicating matters, it is possible to experience fatigue and sleepiness.
Hypersomnia can be dangerous. Consequences include risk of car accidents, decreased work productivity, mood lability, and relationship issues. In children, sleepiness can impair school performance and social development. In the elderly, sleepiness can increase the risk of falls and cognitive impairment. Long-term sleep deprivation might contribute to diabetes, obesity, and heart disease. There is considerable overlap between hypersomnia in children and adults, but there are substantial differences. Sleepiness is more likely to appear as restlessness or irritability in children, leading to a behavior problem's misdiagnosis.
What we can offer at Sleep and Brain
Our diagnostic process starts learning your sleep habits and the nature of your daytime sleepiness. In many cases, especially with children, we involve family members to provide more context about their symptoms. Surprisingly, you may lack insight into your level of sleepiness. Even if you do not feel sleepy, you may be suffering from excessive sleepiness. Our detailed clinical history unearths the subtle signs of sleep deprivation, such as:
Feelings of irritation
Memory problems
Trouble focusing
Difficulty retaining new concepts
Difficulty making decisions
Slower reaction times
Risk-taking behaviors
Our careful clinical history coupled with a specialized physical examination elucidates the complex and multi-factorial causes of excessive daytime sleepiness as exampled below:
Sleep Disorders
Sleep-disordered breathing and periodic limb movement disorder cause sleepiness by fragmenting sleep. Restless legs syndrome causes sleepiness by impairing sleep onset. Narcolepsy and idiopathic hypersomnia act through the brain to cause sleepiness. Circadian dysrhythmias cause sleepiness through misalignment of the sleep-wake cycle with the night-day cycle.
Medical Conditions
Cancer, lupus, hypothyroidism, obesity, et cetera
Psychological Conditions
Depression, anxiety, schizophrenia, Parkinson's disease, multiple sclerosis, chronic pain, et cetera
Genetics
An individual may have an innate propensity toward sleepiness.
Drugs
Alcohol, narcotics, prescription medications, and illicit medications
We pay special attention to narcolepsy, a specific form of hypersomnia. Unfortunately, narcolepsy diagnosis is often delayed by a decade or longer because subtle signs, such as the ones listed below, are missed:
Automatic behaviors
Avoid sleepiness can trigger automatic behaviors. For example, a student in the class may continue writing but is just scrawling gibberish lines on paper.
Disrupted nighttime sleep
Individuals with narcolepsy may awaken multiple times during the night.
Sleep paralysis
Individuals with narcolepsy have a higher rate of being unable to move, which occurs while falling asleep or waking up.
Sleep-related hallucinations
Individuals with narcolepsy have a higher rate of vivid imagery while falling asleep or awakening. The hallucinations are particularly frightening if they accompany sleep paralysis.
Cataplexy
A sudden, brief loss of muscle control in response to strong emotions like laughter or anger is unique mainly to narcolepsy. The severity of muscle tone loss can range from collapsing to the floor to dropping a pen held in hand. Cataplexy is often more subtle in children. It commonly involves the face rather than the body and may be perceived as a facial tic. A clear link between cataplexy and emotion in children may not be discernible.
In addition to what you or your family members tell us, we utilize questionnaires such as the Epworth Sleepiness Scale to document your subjective sense of sleepiness symptoms.
Hypersomnia is often due to an underlying sleep disorder. Following our discussion with you and reviewing the questionnaires, we may recommend sensitive home sleep testing with peripheral arterial tonometry to quantify your sleep patterns and evaluate sleep-disordered breathing and sympathetic arousal frequency.
Laboratory sleep testing, performed in your home, may be necessary to assess other sleep disorders. Additionally, the day after your polysomnogram, a multiple sleep latency test (MSLT) may be necessary to evaluate narcolepsy and idiopathic hypersomnia. The MSLT measures the time it takes for you to fall asleep and enter rapid eye movement sleep at five separate intervals. People with narcolepsy fall asleep quickly and enter rapid eye movement sleep during the MSLT.
We offer sophisticated testing to elucidate areas of brain imbalance. A brain map can pinpoint which brain areas are hyperactive and hypoactive. We can also assess which networks between brain areas are improperly functioning. Together, the data allows us to determine if a brain health condition is contributing to sleepiness.
Understanding the cause of your sleepiness is essential to customize a treatment regimen. Treating sleep problems may improve daytime alertness and vitality. We direct treatment toward the sleep disorder as exampled below:
Removing the tonsils, expanding the palate, and starting CPAP can help anxiety and disordered sleep symptoms.
Iron and dopamine deficiencies can cause RLS, PLMD, and, in part, ADHD. We treat RLS with iron supplements, medication, and non-medication therapies.
Identifying and eliminating the cause of awakenings from sleep
Utilizing light therapy to advance or delay your sleep cycle
In addition to treating an underlying sleep disorder, we institute robust behavioral interventions. Examples of non-medical forms of therapy that we may incorporate into your daily routine are as follow:
Short naps
Naps are typically refreshing. However, accommodations at school or work may be necessary to make time for naps.
Sleep hygiene
Establishing a consistent sleep schedule and bedroom environment free of distractions and disruptions
Diet and Exercise
Certain foods and exercise promote alertness. Conversely, avoiding alcohol, sedatives, and a sedentary lifestyle.
Although behavioral approaches are frequently helpful, some people with hypersomnia, especially those with narcolepsy, also receive treatment with medications. Some of the medicines we commonly prescribe for narcolepsy include:
Modafinil and Armodafinil
These two FDA-approved wakefulness-promoting drugs are chemically similar and are typically the first therapy for excessive daytime sleepiness.
Methylphenidate
This is an amphetamine that can reduce daytime sleepiness. Although commonly used, the medicine is not FDA approved for narcolepsy.
Solriamfetol
The FDA-approved this drug approved in 2019 and has shown comparable or better effects than modafinil.
Sodium oxybate
This FDA-approved medication treats all aspects of narcolepsy: cataplexy, EDS, and nighttime sleep disturbances.
Lower-sodium oxybate
Similar to sodium oxybate but with 92% less sodium
Pitolisant
Pitolisant is an FDA-approved wake-promoting agent that has also shown a positive effect on cataplexy.
Not all medicines work for all people, and you may experience more bothersome side effects with some versus others. We can help identify the medication and dosage with the best balance of benefits and downsides. Pregnancy poses an additional challenge, and due to limited drug safety data, we often recommend stopping narcolepsy medications when trying to conceive and when pregnant and breastfeeding. We may institute behavioral interventions and other accommodations to cope with symptoms without medication. For children, we may recommend a cardiovascular examination before beginning stimulants.
