Under hypersomnia, the medical profession understands the sleep addiction. The sleep addiction manifests itself in an excessive need for daytime sleep, which can manifest itself quite differently. Affected persons are mainly middle-aged men. Most often, hypersomnia occurs in conjunction with other, usually mental illnesses or with pronounced sleep apnea.
What is hypersomnia?
Hypersomnia is manifested by an increased need for sleep during the day without frequent or prolonged periods of conscious wakefulness during nighttime sleep. Daytime sleep can manifest itself in very different ways, ranging from brief attacks of sleep that strike the affected person abruptly to persistent fatigue throughout the day. Those affected suffer greatly from the clinical picture, as their performance is impaired. Participation in road traffic, for example, is usually no longer possible. Hypersomnia is classified according to its severity into mild, moderate and severe hypersomnia. In mild hypersomnia, involuntary sleep does not occur every day; in moderate hypersomnia, it occurs daily; and in severe hypersomnia, it occurs several times a day.
Causes
The causes of insomnia are not yet clearly known. However, the frequent co-occurrence of other diseases, such as depression, schizophrenia, cancer, Parkinson’s disease, or multiple sclerosis, is striking. In addition, a connection between drug and alcohol abuse and sleep addiction has been observed. The most common cause – as various records in sleep laboratories have shown – is sleep apnea. If a patient suffers from sleep apnea, breathing frequently stops during night sleep. This can occur several times an hour and last for minutes at a time. The suspension of breathing leads to a lack of oxygen in the body. Night sleep is then, without the sufferer noticing, not very restful. The continuous waking situation also causes enormous stress.
Symptoms, complaints and signs
The central symptom of hypersomnia is daytime sleepiness. Daytime sleepiness is very pronounced in this case and does not occur once, but regularly or permanently. Affected persons often cannot or only with difficulty keep awake. In addition, concentration problems can be an indication of hypersomnia. As a result, work performance may decrease and the likelihood of making mistakes increases. The lack of concentration and fatigue may also be expressed in motor unsteadiness. Another possible symptom of hypersomnia is memory problems. These are partly related to the concentration difficulties. Depending on the underlying disease of hypersomnia, sleep may be perceived as restful or non-restful. Narcoleptics typically feel refreshed during the day after a short sleep, while this may not be the case with other forms of hypersomnia. Daytime sleepiness often affects driving ability in drivers. Depending on the type of hypersomnia, the spectrum ranges from general inattentiveness and lack of concentration to narcoleptic attacks of falling asleep. Drivers with hypersomnias other than narcolepsy can also fall into microsleep. In this case, they fall asleep at the wheel for a few seconds, sometimes without realizing it. Furthermore, psychological symptoms such as [depressed mood|depressive moods]] may occur. Conversely, hypersomnia can also result from depression, schizophrenia, or other mental illness.
Diagnosis and course
To make a definite diagnosis, a visit to a sleep laboratory is advised. In a sleep laboratory, the patient’s night sleep is monitored. To do this, he or she is connected to an EEG and ECG, which allows monitoring of brain waves as well as cardiac activity. In addition, movement activity and respiratory flow are recorded. The patient also receives some questionnaires and is subjected to various tests – for example, the pupil width is measured during the night or the ability to concentrate during monotonous activities – which also provide information about his night and daytime sleep. If all the results are available, an experienced sleep physician can make a diagnosis of “hypersomnia.” If an organic cause is a possibility, the tests in the sleep laboratory are followed by internal medicine or psychiatric diagnostics. The course of hypersomnia varies greatly.In the case of mild hypersomnia, the patient usually does not suffer from the insomnia, and often does not even perceive it as an illness. Only when the individual daily rhythm of the affected person is disturbed or secondary diseases – such as cardiovascular problems – have occurred due to disturbed night sleep, the affected person will perceive the disease.
Complications
In most cases, hypersomnia occurs in middle-aged men. In this case, the affected person suffers from a real sleep addiction. If a high requirement for sleep is not met on a daily basis, the patient feels ill or becomes more irritable. Hypersomnia also has a negative effect on the patient’s psyche and is usually associated with other psychological complaints. The patient’s sleep is very deep and lasts for a long time. It is often difficult to get up. It is not uncommon for those affected to also suffer from sleep disorders and therefore require sleep at other irregular times. Everyday life is disrupted by hypersomnia and made more difficult for the patient. In many cases, it is no longer possible to perform a job or a normal activity. Furthermore, the patient may experience heart or circulatory problems, and in the worst case, death may result. Treatment of hypersomnia is usually causal and does not lead to particular complications. However, it cannot be predicted how easily the underlying disease can be treated. In most cases, however, life expectancy is not reduced.
When should you see a doctor?
During periods of higher physical or emotional demands, an increased need for sleep is natural. A visit to the doctor is not necessary in these cases, because normally a normal sleep pattern is automatically established after the situation has been successfully managed. Provided the need for sleep does not exceed nine to ten hours a day, there is no cause for concern. A visit to the doctor is necessary if the need for sleep increases or if it occurs without a comprehensible reason. If, despite sufficient night sleep, the person concerned feels tired and fatigued even by performing light tasks, a doctor should be consulted. If the sleep complaints persist for several months, a visit to the doctor is also recommended. If a sudden sleep attack occurs, this is considered unusual. If the performance of everyday or professional tasks is interrupted by an unexpected fall asleep, the affected person needs help. If the affected person is dazed, shows a depressed mood, suffers from persistent attention deficits or is only vaguely aware of environmental influences, a visit to the doctor must be made. If breathing disorders occur, sleep interruptions are more frequent or the person concerned never really feels fit despite good sleep hygiene, check-ups are advisable. In addition to a nutrient deficiency, results from a sleep laboratory can help to find the cause.
Treatment and therapy
Since sleep addiction is usually the result of another condition, it is important to treat the cause. Sleep apnea, one of the most common causes of hypersomnia, is usually triggered by obesity or narrowed airways. If this is the cause of sleep apnea, it usually helps to lose weight or to surgically correct or widen the airways. In addition, it may help the affected person to wear a breathing mask during night sleep, which supports breathing and thus prevents cessation of breathing. In extremely rare cases when severe hypersomnia is present, medications may be administered. The medications – all amphetamines – may overcome the sleep addiction, but they have an extremely high addictive potential. Self-medication is strongly discouraged.
Outlook and prognosis
The prognosis of hypersomnia is tied to the present cause as well as overall diagnosis of the patient. If the affected person suffers from a mental disorder such as anxiety, obsessive-compulsive disorder, depression, or an addictive disorder, there is a risk of chronic disease progression. Relief from the symptoms usually does not occur until the mental illness is treated and an improvement in emotional stability occurs. In the case of cancer, healing of the triggering tumor is necessary for the hypersomnia to be reduced or to remit completely.Recovery often occurs only after several years of therapy and is accompanied by periods of relapse. If the patient suffers from a chronic or progressive disease such as Parkinson’s disease or multiple sclerosis, the prospect of recovery from hypersomnia is low. As the underlying disease progresses, the existing concomitant symptoms manifest. In severe cases, the patient is at risk of an increase in symptoms. If hypersomnia is triggered due to existing life and accompanying circumstances, a change in everyday processes or environmental influences can lead to freedom from complaints in the patient. Sleep hygiene must be revised and optimized in these situations. Often, an adjustment of the daily routine to human needs, as well as a change in mental attitude toward everyday challenges, is necessary for relief of sleep complaints to occur.
Prevention
Hypersomnia itself cannot be prevented. Since it is usually a consequence of another condition – often sleep apnea due to obesity – it is advisable to pay attention to a low body weight. Refraining from excessive alcohol consumption is helpful, as is consistent abstention from drugs and a healthy diet.
Aftercare
For patients with hypersomnia, special care must be taken during follow-up to ensure that sleep hygiene rules are followed. This includes, above all, a controlled progression of the day-night rhythm in conjunction with adherence to the sleep-wake rhythm. Sleep deprivation and sleep deprivation are to be avoided. The sleep-wake rhythm must be individually adjusted and aligned to the respective patient. In this way, optimal sleep and wake phases can be firmly established in the 24-hour daily routine. Sleep phases during the daytime phase should be exceptions and should also be coordinated with the patient’s behavior and habits. A sleep-wake or fatigue-wake diary is recommended. This will make it easier for the patient to accommodate his or her activities in the daily routines in a meaningful and effective way. Activities and tasks that are part of the routine can then, for example, be moved to the phases of daytime sleepiness. In addition, a healthy lifestyle is extremely important for patients with hypersomnia. Alcohol should be absolutely avoided because of its fatiguing effects. A rather light, low-carbohydrate diet spread over several small meals during the course of the day is advisable. Aftercare also includes informing immediate family members and the social environment. The patient’s further life planning, for example, with regard to education, retraining or profession, also plays a decisive role in living with hypersomnia.
What you can do yourself
When there is a strong need for sleep, the affected person should take various precautions to avoid complications or an increased risk of accidents. The need for sleep reduces habitual performance and leads to a reduction in participation in social life. To reduce conflicts in professional and social life, people from the close environment should be informed of the problems. The symptomatology of the disease is often due to increased stress and dissatisfaction. The general lifestyle should be reviewed and optimized. Food intake should be improved and should be rich in vitamins as well as fiber. Overweight should be avoided and sufficient exercise or sports activities promote general well-being. The consumption of alcohol or nicotine should be avoided. Stimulants in the form of drugs or excessive use of medication should also be avoided. Sleep hygiene is to be modified according to the needs of the affected person. A visit to the sleep laboratory is helpful and very informative. Sources of disturbance during rest and recovery phases should be eliminated. The daily routine should be well structured and regular if possible. If sudden sleep attacks occur, sources of danger must be eliminated. Participation in road traffic should not take place without an accompanying person. Activities that pose a high risk of injury should also not be performed without supervision as well as protective clothing.
