Sleep is an essential process for our survival and the maintenance of our capabilities. When we are tired or sleepy, our energy level and motivation suffer and we lose the desire to do things. We cannot concentrate and our judgment and analytical skills decrease, as does our performance.

Fortunately, after sleeping an adequate number of hours we regain our energy and maintain a state of regulatory awareness and attention. However, there are people whose sleep periods are altered in time and quality of sleep. This is the case of insomnia or its opposite, hypersomnia .

Hypersomnia

Hypersomnia is a sleep disorder characterized by the presence of excessive sleepiness despite having maintained a previous sleep period of at least seven hours. It is a dyssomnia, a type of sleep disorder that affects the timing, quantity and quality of sleep.

In hypersomnia, the subject in question remains sleepy for a large part of the day and usually finds it difficult to wake up after a period of normative sleep or which may even last nine or more hours, and this sleep may not be restorative and does not allow for real rest. It can involve falling asleep in a similar way to narcolepsy. Thus, someone with hypersomnia may both sleep for long periods of time and be sleepy during the day.

To be considered, episodes of sleepiness must occur at least three times a week (although it may occur almost every day) for at least a month. Hypersomnia usually entails a great deal of dysfunction for those who suffer from it, diminishing their capacities and performance on a work, personal and social level. In fact, the person may fall asleep in high-risk situations, such as when driving a vehicle.

Apart from the lack of energy, this disorder can cause emotional disorders such as anxiety and irritability problems, demotivation and apathy. They also often have memory problems and a certain mental and physical slowing down. On an organic level it can generate changes and weakening of the immune system.

Types of hypersomnia

Depending on whether or not there is a known cause, we can establish different types of hypersomnia . It is important to bear in mind that although narcolepsy also involves episodes of sudden sleep, this is another pathology with its own differentiated characteristics, so we would not be talking about a type of hypersomnia.

Primary or idiopathic hypersomnia

It is known as hypersomnia disorder. In this case the causes that produce this alteration are not known, there being a normative rest period and without the excess of sleep due to organic causes being explained . The symptoms are those described above.

Primary hypersomnias may also include what is known as Kleine-Levine syndrome, which acts in a recurrent and persistent manner causing periods of several days or weeks of intense sleep.

It is common that those who suffer from it can sleep up to 20 hours in a row and remain tired the rest of the time , with a high instability, irritability and disinhibition of impulses that leads to hyperphagia and hypersexuality. It is not uncommon for hallucinations and speech and memory problems to appear. These episodes will occur repeatedly, but the periods of time between sleep and behavior are normative.

Secondary hypersomnia

The presence of persistent daytime sleepiness or difficulty waking up may also have a specific, concrete cause.

Within the secondary hypersomnias we can find those due to sleep deprivation either for not having slept enough or because sleep is frequently interrupted, the effect of different drugs or medications or the existence of some medical or psychiatric disorder that explains it. In these cases, hypersomnia would not be a disorder but a symptom of such an alteration.

Causes of this problem

The causes of hypersomnia are largely unknown at present. The diagnosis of hypersomnia as a primary disorder requires that the symptoms are not better explained by the presence of another pathology or as a result of substance use or sleep deprivation, or that although they may occur together they do not justify hypersomnia.

In this way, although it is possible to have sleep problems due to the persistent absence of sleep, the consumption of substances or certain problems of medical origin, in this case we would be talking about a hypersomnia secondary to these and not about hypersomnia as a disorder in itself.

Even if the cause is not completely known, the possibility of the presence of alterations in the limbic system that may explain the presence of behavioural alterations in cases of Kleine-Levine syndrome is raised. A deficit in the synthesis and transmission of noradrenaline could also be an element to take into account when trying to explain this disorder. A possible lesion in the brain areas responsible for the regulation of sleep could also generate this problem.

What to do? Treatment

Hypersomnia is an annoying and disabling problem for those who suffer from it and can greatly limit their lives and even precipitate accidents dangerous to their own survival. Its treatment is essential.

In this sense, it is recommended that at the behavioral level, one should try to avoid driving heavy machinery or vehicles, as well as try to maintain a sleep hygiene as correct as possible. Sport is also a great help to stay active and reduce the feeling of sleep in the moments after exercise. In sleep hygiene it is recommended to establish specific schedules for sleeping and waking up , as well as to facilitate the entry into sleep at normative moments such as the avoidance of elements that require attention or noise.

At the psychological level, cognitive-behavioral techniques are also used that can be used to address problems arising from the disorder and to increase and help focus attention. The subject is also trained to detect the first signs of sleep, and to apply various exercises at both the physical and mental levels to increase the level of awareness and physiological activity .

It is very useful to avoid the consumption of depressing substances such as alcohol and other drugs with the same effects. The use of drugs and excitatory substances may be prescribed. Some antidepressants such as imipramine or MAOIs have also been used as treatment, although caution should be taken with other health issues such as blood pressure.

Bibliographic references:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.
  • Bassetti, C.L. & Dauvilliers, Y. (2011). Idiopathic hypersomnia. In: Kryger MH, Roth T, Dement WC, eds. Principles and Practice of Sleep Medicine. 5th ed. Philadelphia, PA: Elsevier Saunders.
  • Erro, M.E. and Zandio, B. (2007). Hypersomnias: diagnosis, classification and treatment. Anales del Sistema Sanitario de Navarra; 30. Hospital de Navarra. Pamplona.
  • Guilleminault, C. & Brooks, S.N. (2001). Excessive daytime sleepiness. A challenge for the practising neurologist. Brain; 124: 1482-1491.