| Hypersomnia |
| Classification and external resources |
| MeSH |
D006970 |
In the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, published in May 2013, hypersomnia appears under sleep-wake disorders as hypersomnolence, of which there are several subtypes.[1]
Contents
- 1 Symptoms
- 2 Epidemiology
- 3 Diagnosis
- 4 Differential diagnosis
- 4.1 Primary hypersomnias
- 4.2 Primary hypersomnia mimics
- 4.3 Secondary hypersomnias
- 5 Treatment
- 6 See also
- 7 External links
- 8 References
Symptoms
The main symptom of hypersomnia is excessive daytime sleepiness (EDS), or prolonged nighttime sleep,[2] which has occurred for at least 3 months prior to diagnosis.[3]
Epidemiology
Hypersomnia affects approximately 5% of the general population, "with a higher prevalence for men due to the sleep apnea syndromes."[3]
Diagnosis
"The severity of daytime sleepiness needs to be quantified by subjective scales (at least the Epworth Sleepiness Scale) and objective tests such as the multiple sleep latency test (MSLT)."[3] The Stanford sleepiness scale (SSS) is another frequently-used subjective measurement of sleepiness.[4] After it is determined that EDS is present, a complete medical examination and full evaluation of potential disorders in the differential diagnosis (which can be tedious, expensive and time-consuming) should be undertaken.[3]
Differential diagnosis
Hypersomnia can be primary (of central/brain origin), or it can be secondary to any of numerous medical conditions. However, more than one type of hypersomnia can coexist in a single patient. Even in the presence of a known cause of hypersomnia, the contribution of this cause to the complaint of EDS needs to be assessed. When specific treatments of the known condition do not fully suppress EDS, additional causes of hypersomnia should be sought.[5] For example, if a patient with sleep apnea is treated with CPAP (continuous positive airway pressure) which resolves their apneas but not their EDS, it is necessary to seek other causes for the EDS. Obstructive sleep apnea “occurs frequently in narcolepsy and may delay the diagnosis of narcolepsy by several years and interfere with its proper management.”[6]
Primary hypersomnias
The true primary hypersomnias include these: narcolepsy (with and without cataplexy); idiopathic hypersomnia; and recurrent hypersomnias (like Klein-Levin syndrome).[3]
Primary hypersomnia mimics
There are also several genetic disorders that may be associated with primary/central hypersomnia. These include the following: Prader-Willi syndrome; Norrie disease; Niemann–Pick disease, type C; and myotonic dystrophy). However, hypersomnia in these syndromes may also be associated with other secondary causes, so it is important to complete a full evaluation. Interestingly, myotonic dystrophy is often associated with SOREMPs (sleep onset REM periods, such as occur in narcolepsy).[3]
There are many neurological disorders that may mimic the primary hypersomnias narcolepsy and idiopathic hypersomnia: brain tumors; stroke-provoking lesions; and dysfunction in the thalamus, hypothalamus, or brainstem. Also, neurodegenerative conditions such as Alzheimer's disease, Parkinson's disease, or multiple system atrophy are frequently associated with primary hypersomnia. However, in these cases, one must still rule out other secondary causes.[3]
Early hydrocephalus can also cause severe EDS.[7] Additionally, head trauma can be associated with a primary/central hypersomnia, and symptoms similar to those of idiopathic hypersomnia can be seen within 6–18 months following the trauma. However, the associated symptoms of headaches, memory loss, and lack of concentration may be more frequent in head trauma than in idiopathic hypersomnia. "The possibility of secondary narcolepsy following head injury in previously asymptomatic individuals has also been reported."[3]
Secondary hypersomnias
Secondary hypersomnias are extremely numerous.
Hypersomnia can be secondary to disorders such as clinical depression, multiple sclerosis, encephalitis, epilepsy, or obesity.[8] Hypersomnia can also be a symptom of other sleep disorders, like sleep apnea.[8] It may also occur as an adverse effect of taking certain medications, of withdrawal from some medications, or of drug or alcohol abuse.[8] A genetic predisposition may also be a factor.[8] In some cases it results from a physical problem, such as a tumor, head trauma, or dysfunction of the autonomic or central nervous system.[8]
Sleep apnea is the most frequent cause of secondary hypersomnia, affecting up to 4% of middle-aged adults, mostly men. Upper airway resistance syndrome is a clinical variant of sleep apnea that can also cause hypersomnia.[3] Just as other sleep disorders (like narcolepsy) can coexist with sleep apnea, the same is true for UARS. There are many cases of UARS in which EDS persists after CPAP treatment, indicating an additional cause, or causes, of the hypersomnia and requiring further evaluation.[5]
Sleep movement disorders, such as restless legs syndrome (RLS) and periodic limb movement disorder (PLMD or PLMS) can also cause secondary hypersomnia. Although RLS does commonly cause EDS, PLMS does not. There is no evidence that PLMS plays “a role in the etiology of daytime sleepiness. In fact, two studies showed no correlation between PLMS and objective measures of EDS. In addition, EDS in these patients is best treated with psychostimulants and not with dopaminergic agents known to suppress PLMS.”[5]
Neuromuscular diseases and spinal cord diseases often lead to sleep disturbances due to respiratory dysfunction causing sleep apnea, and they may also cause insomnia related to pain.[9] “Other sleep alterations, such as periodic limb movement disorders in patients with spinal cord disease, have also been uncovered with the widespread use of polysomnography.”[9]
Primary hypersomnia in diabetes, hepatic encephalopathy, and acromegaly is rarely reported, but these medical conditions may also be associated with the secondary hypersomnias sleep apnea and periodic limb movement disorder (PLMD).[3]
Chronic fatigue syndrome and fibromyalgia can also be associated with hypersomnia. Regarding chronic fatigue syndrome, it is “characterized by persistent or relapsing fatigue that does not resolve with sleep or rest. Polysomnography shows reduced sleep efficiency and may include alpha intrusion into sleep EEG. It is likely that a number of cases labeled as chronic fatigue syndrome are unrecognized cases of upper airway resistance syndrome”[10] or other sleep disorders, such as narcolepsy, sleep apnea, PLMD, etc. ”[11]
Similarly to chronic fatigue syndrome, fibromyalgia also may be associated with anomalous alpha wave activity (typically associated with arousal states) during NREM sleep.[12] Also, researchers have shown that disrupting stage IV sleep consistently in young, healthy subjects causes a significant increase in muscle tenderness similar to that experienced in "neurasthenic musculoskeletal pain syndrome." This pain resolved when the subjects were able to resume their normal sleep patterns.[13]
Hypothyroidism and iron deficiency with or without (iron-deficiency anemia) can also cause secondary hypersomnia. Blood tests for these disorders are done so they can be treated.[14] Hypersomnia can also develop within months after viral infections such as Whipple's disease, mononucleosis, HIV, and Guillain–Barré syndrome.[3]
Chronic kidney disease is commonly associated with sleep symptoms and excessive daytime sleepiness. For those on dialysis, approximately 80% have sleep disturbances. Sleep apnea can occur 10 times as often in uremic patients than in the general population and can affect up to 30-80% of patients on dialysis, though nighttime dialysis can improve this. About 50% of dialysis patients have hypersomnia, as severe kidney disease can cause uremic encephalopathy, increased sleep-inducing cytokines, and impaired sleep efficiency. About 70% of dialysis patients are affected by insomnia, and RLS and PLMD affect 30%, though these may improve after dialysis or kidney transplant.[15]
Most forms of cancer and their therapies can cause fatigue and disturbed sleep, affecting 25-99% of patients and often lasting for years after treatment completion. “Insomnia is common and a predictor of fatigue in cancer patients, and polysomnography demonstrates reduced sleep efficiency, prolonged initial sleep latency, and increased wake time during the night.” Paraneoplastic syndromes can also cause insomnia, hypersomnia, and parasomnias.[15]
Autoimmune diseases, especially lupus and rheumatoid arthritis are often associated with hypersomnia, as well. Morvan's syndrome is an example of a more rare autoimmune illness that can also lead to hypersomnia.[15]
Behaviorally induced insufficient sleep syndrome must also be considered in the differential diagnosis of secondary hypersomnia. This disorder occurs in individuals who fail to get sufficient sleep for at least three months. In this case, the patient has chronic sleep deprivation although he or she is not necessarily aware of it. This situation is becoming more prevalent in western society due to the modern demands and expectations placed upon the individual.[3]
Many medications can also lead to secondary hypersomnia. Therefore, a patient's complete medication list should be carefully reviewed for sleepiness or fatigue as side effects. In these cases, careful withdrawal from the possibly offending medication(s) is needed; then, medication substitution can be undertaken.[3]
Mood disorders, like depression, anxiety disorder and bipolar disorder, can also be associated with hypersomnia. The complaint of EDS in these conditions is often associated with poor sleep at night. "In that sense, insomnia and EDS are frequently associated, especially in cases of depression."[3] Hypersomnia in mood disorders seems to be primarily related to "lack of interest and decreased energy inherent in the depressed condition rather than an increase in sleep or REM sleep propensity." In all cases with these mood disorders, the MSLT is normal (not too short and no SOREMPs).[3]
Treatment
Although “there has been no cure of chronic hypersomnia,” there are several treatments that may improve patients’ quality of life, depending on the specific cause or causes of hypersomnia that are diagnosed.[3]
See also
External links
- Hypersomnia Foundation
- National Sleep Foundation
- Talk About Sleep - Idiopathic Hypersomnia
- Help: I can't stay awake! - Public Radio Interview with Dr. David Rye
- med/3129 at eMedicine - "Primary Hypersomnia"
- -483065848 at GPnotebook
References
- ^ "Recent Updates to Proposed Revisions for DSM-5: Sleep-Wake Disorders". DSM-5 Development. American Psychiatric Association.
- ^ "NINDS Hypersomnia information page"
- ^ a b c d e f g h i j k l m n o p Dauvilliers, Yves et al (2006). "Differential Diagnosis in Hypersomnia". Current Neurology and Neuroscience Reports 6 (2): 156–162. doi:10.1007/s11910-996-0039-2. PMID 16522270.
- ^ Neil Freedman, MD. "Quantifying sleepiness". Retrieved 2013-07-23.
- ^ a b c Montplaisir (2001). "Idiopathic hypersomnia: a diagnostic dilemma. A commentary of "Idiopathic hypersomnia" (M. Billiard and Y. Dauvilliers)". Sleep Medicine Reviews.
- ^ Sansa, G; Iranzo, Alex; Santamaria, Joan (Jan 2010). "Obstructive sleep apnea in narcolepsy". Sleep Med 11 (1): 93–5. doi:10.1016/j.sleep.2009.02.009. PMID 19699146.
- ^ "International classification of sleep disorders, revised: Diagnostic and coding manual". American Academy of Sleep Medicine. 2001. Retrieved 25 January 2013.
- ^ a b c d e National Institutes of Health (June 2008). "NINDS Hypersomnia Information Page". Retrieved 2009-01-23.
- ^ a b "MedLink Clinical Summary: Sleep and neuromuscular and spinal cord disorders". MedLink. Retrieved 7 January 2014.
- ^ Billiard, M.; Dauvilliers, Y. (Oct 2001). "Idiopathic Hypersomnia". Sleep Med Rev 5 (5): 349–358. doi:10.1053/smrv.2001.0168. PMID 12530998.
- ^ Gotts, Zoe; Deary, V.; Newton, J.; Van Der Dussen, D.; De Roy, P.; Ellis, J. G. (Apr 2013). "Are there sleep-specific phenotypes in patients with chronic fatigue syndrome? A cross-sectional polysomnography analysis". BMJ Open 3 (6): e002999. doi:10.1136/bmjopen-2013-002999. PMC 3669720. PMID 23794547.
- ^ Moldofsky H, Scarisbrick P, England R, Smythe H (1 July–August 1975). "Musculosketal symptoms and non-REM sleep disturbance in patients with "fibrositis syndrome" and healthy subjects". Psychosom Med 37 (4): 341–51. PMID 169541.
- ^ Moldofsky H, Scarisbrick P (1 January–February 1976). "Induction of neurasthenic musculoskeletal pain syndrome by selective sleep stage deprivation". Psychosom Med 38 (1): 35–44. PMID 176677.
- ^ "About Hypersomnia". Hypersomnia Foundation. Retrieved 8 February 2013.
- ^ a b c Lewis, Steven L. (2013). Neurological disorders due to systemic disease. Chichester, West Sussex: Wiley-Blackwell. pp. 261–282. ISBN 978-1-4443-3557-6.
|
Mental and behavioral disorders (F 290–319)
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Neurological/symptomatic
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Eating disorder
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- Anorexia nervosa
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Nonorganic
sleep disorders
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- (Nonorganic hypersomnia
- Nonorganic insomnia)
- Parasomnia
- (REM behavior disorder
- Night terror
- Nightmare)
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Sexual
dysfunction
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- sexual desire
- (Hypoactive sexual desire disorder
- Hypersexuality)
- sexual arousal
- (Female sexual arousal disorder)
- Erectile dysfunction
- orgasm
- (Anorgasmia
- Delayed ejaculation
- Premature ejaculation
- Sexual anhedonia)
- pain
- (Vaginismus
- Dyspareunia)
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Postnatal
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- Postpartum depression
- Postnatal psychosis
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Adult personality and behavior
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Sexual and
gender identity
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- Sexual maturation disorder
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- (Voyeurism
- Fetishism)
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Other
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- Personality disorder
- Impulse control disorder
- (Kleptomania
- Trichotillomania
- Pyromania
- Dermatillomania)
- Body-focused repetitive behavior
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- (Münchausen syndrome)
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Mental disorders diagnosed in childhood
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Intellectual disability
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- X-linked intellectual disability
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Psychological development
(developmental disorder)
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Emotional and behavioral
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- (ODD)
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- DAD)
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- (Tourette syndrome)
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- (Stuttering
- Cluttering)
- Movement disorder
- (Stereotypic)
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Symptoms and uncategorized
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- Catatonia
- False pregnancy
- Intermittent explosive disorder
- Psychomotor agitation
- Sexual addiction
- Stereotypy
- Psychogenic non-epileptic seizures
- Klüver-Bucy syndrome
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dsrd (o, p, m, p, a, d, s), sysi/epon, spvo
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proc (eval/thrp), drug (N5A/5B/5C/6A/6B/6D)
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Psychophysiology: Sleep and sleep disorders (F51 and G47 / 307.4 and 327)
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| Sleep stages |
- Rapid eye movement (REM)
- Non-rapid eye movement
- Slow-wave
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| Brain waves |
- Alpha wave
- Beta wave
- Gamma wave
- Delta wave
- Theta rhythm
- K-complex
- Sleep spindle
- Sensorimotor rhythm
- Mu rhythm
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| Sleep disorders |
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Dyssomnia
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- Insomnia
- Narcolepsy
- Sleep apnea
- Obesity hypoventilation syndrome
- Ondine's curse
- Hypersomnia
- Kleine–Levin syndrome
- Sleep state misperception
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Circadian rhythm
disorder
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- Advanced sleep phase disorder
- Delayed sleep phase disorder
- Irregular sleep–wake rhythm
- Jet lag
- Non-24-hour sleep–wake disorder
- Shift work sleep disorder
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Parasomnia
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- Catathrenia
- Night terror
- Rapid eye movement behavior disorder
- Sleepwalking
- Somniloquy
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Other
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- Night eating syndrome
- Nocturia
- Nocturnal myoclonus
- Bruxism
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| Benign phenomena |
- Dream
- Exploding head syndrome
- False awakening
- Hypnagogia / Sleep onset
- Hypnic jerk
- Lucid dream
- Nightmare
- Nocturnal clitoral tumescence
- Nocturnal emission
- Nocturnal penile tumescence
- Sleep paralysis
- Somnolence
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| Related topics |
- Somnology
- Bed
- Bunk bed
- Four-poster bed
- Futon
- Daybed
- Hammock
- Mattress
- Sleeping bag
- Bed bug
- Bedding
- Bedroom
- Bedtime
- Bedtime toy
- Bedtime story
- Caffeine nap
- Chronotype
- Dream journal
- Excessive daytime sleepiness
- Hypnopompic state
- Lullaby
- Sleep induction
- Microsleep
- Nap
- Nightwear
- Polyphasic sleep
- Polysomnography
- Power nap
- Second wind
- Siesta
- Sleep and creativity
- Sleep and learning
- Sleep debt
- Sleep deprivation
- Sleep diary
- Sleep hygiene
- Sleep inertia
- Sleep medicine
- Sleeping while on duty
- Sleepover
- Snoring
- "Sleeping sickness"1
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1 Not a sleep disorder.
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dsrd (o, p, m, p, a, d, s), sysi/epon, spvo
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proc (eval/thrp), drug (N5A/5B/5C/6A/6B/6D)
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anat (n/s/m/p/4/e/b/d/c/a/f/l/g)/phys/devp
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noco (m/d/e/h/v/s)/cong/tumr, sysi/epon, injr
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proc, drug (N1A/2AB/C/3/4/7A/B/C/D)
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Mood disorder (F30–F39, 296)
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| History |
- Emil Kraepelin
- Karl Leonhard
- John Cade
- Mogens Schou
- Frederick K. Goodwin
- Kay Redfield Jamison
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| Symptoms |
- Hallucination
- Delusion
- Emotional dysregulation
- Anhedonia
- Dysphoria
- Suicidal ideation
- sleep disorder
- Psychosis
- Racing thoughts
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| Spectrum |
- Bipolar disorder
- Bipolar I
- Bipolar II
- Cyclothymia
- Bipolar NOS
- Depression
- (Major depressive disorder
- Dysthymia
- Seasonal affective disorder
- Atypical depression
- Melancholic depression)
- Schizoaffective disorder
- Mania
- Mixed state
- Hypomania
- Major depressive episode
- Rapid cycling
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| Treatment |
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Anticonvulsants
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- Carbamazepine
- Lamotrigine
- Oxcarbazepine
- Valproic acid
- Sodium valproate
- Valproate semisodium
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Other mood stabilizers
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- Lithium
- Lithium carbonate
- Lithium citrate
- Lithium sulfate
- Atypical antipsychotics
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Non-pharmaceutical
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- Clinical psychology
- Electroconvulsive therapy
- Involuntary commitment
- Light therapy
- Psychotherapy
- Transcranial magnetic stimulation
- Cognitive behavioral therapy
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dsrd (o, p, m, p, a, d, s), sysi/epon, spvo
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proc (eval/thrp), drug (N5A/5B/5C/6A/6B/6D)
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