Primary hypersomnia is a sleep disorder which causes the victim to sleep an excessive number of hours each night and still wake up the next day feeling tired and in need of more rest.
The condition is generally accompanied also by extreme sleepiness or drowsiness during the daytime, with reactions being similar to someone who might have had no sleep at all the previous night. People afflicted by hypersomnia generally sleep 10 hours or more each night, accumulating in excess of 70 sleep hours per week.
The hypersomnia condition is classified as either primary hypersomnia or secondary hypersomnia, with the distinction between the two based on clusters of symptoms and test results which point to a specific underlying cause.
Secondary hypersomnia is caused by an inability to get sufficient sleep at night, often because of some medical condition, such as obstructive sleep apnea. Victims of obstructive sleep apnea have difficulty breathing at night, and as a result are frequently very drowsy during the daytime. Secondary hypersomnia can also be triggered by infections, chronic fatigue syndrome, depression, kidney failure, myotonic dystrophy, and Parkinson’s disease.
Primary hypersomnia, on the other hand, is not characterized by any medical cause, and even though the sufferer always gets plenty of sleep during the night (usually much more than needed), he/she is still excessively drowsy during the daytime. Causes for primary hypersomnia are not associated with any kind of medical condition at all but are thought to be triggered by abnormalities in the sections of the brain which manage sleeping and waking behavior.
According to the National Sleep Foundation, as many as 40% of all Americans exhibit some of the symptoms of hypersomnia at various points in their lives. Fortunately, only between 1% and 2% of all Americans will ever be afflicted by primary hypersomnia, which is a fairly extreme case of excessive daytime sleeping.
It’s normal for most people to get a little tired or sleepy during the daytime, especially after a big meal, but hypersomnia is much different than this. This affliction is a debilitating sleepiness which people experience routinely during the daytime, even after getting a very good night’s sleep, and it compels them to take naps during the day time. Hypersomnia differs from narcolepsy in that patients afflicted with narcolepsy have no ability whatsoever to resist the urge to fall asleep during the daytime, whereas hypersomniacs can resist the napping urge, although it will cause them to sleep more later.
One of the most obvious symptoms of primary hypersomnia is that the afflicted person is frequently obliged to take naps during the day, even when it is highly inappropriate to do so. For instance, it may be while a sufferer is at work that he/she is overcome by the urge to take a nap, or it could be in the middle of a meal at a fine dining restaurant, or it could even be while the person is engaged in a conversational exchange.
There is no social component to this urge to nap, and it has nothing to do with the person’s social graces or personality – it’s simply a compulsion that is almost impossible to deny. Making matters worse, daytime naps do not generally fulfill the need for sleep, and they do not generally offer any relief from the symptoms of hypersomnia. When a hypersomnia patient does wake up for the day, he/she often finds it extremely difficult to achieve full consciousness and shake off the effects of even a very long sleep.
As a result, it can leave the sufferer feeling somewhat disoriented and confused, and these conditions can persist throughout the day. With this background of interrupted sleep or unfulfilled sleeping patterns, a whole catalog of other symptoms may be observed in the patient, many of which stem from the same basic problem with sleeping.
It’s very common to see people with primary hypersomnia have excessive anxiety or irritation, and they are frequently restless and unable to sit quietly for any length of time. Disorientation and confusion can bring on what appears to be slow thinking and slow speech, as well as moderate to severe difficulties with remembering things. It’s also fairly common to observe low energy levels in afflicted persons, as well as a loss of appetite over extended periods of time. Some hypersomnia patients have even exhibited symptoms which make it clear that they are undergoing hallucinations, or have a distorted perspective on reality.
Some of the symptoms exhibited by a person afflicted with primary hypersomnia can be confused with other kinds of medical disorders, even other sleep disorders like narcolepsy. For an accurate diagnosis of hypersomnia, it is often necessary to undergo polysomnogram tests and sleep latency tests for definitive diagnosis of the disorder. Sleep latency tests measure how quickly a person enters a deep sleep state over a number of two-hour intervals. Persons having hypersomnia have a tendency to quickly enter this deep sleep state, often beginning within 10 minutes or less. Polysomnogram testing will measure a person’s brain waves and their corresponding body motions during various phases of sleep. When the results of the two types of testing are combined, it is generally fairly easy to diagnose hypersomnia.
Thus far, the causes of primary hypersomnia have eluded scientists and doctors researching the subject, although it must be remembered that the disorder itself was only classified within the past decade, so research has been limited. Much more is known about the causes of secondary hypersomnia, because the disorder itself can actually be traced to an existing medical condition, e.g. sleep apnea, which the patient already has.
Since it is thought that the cause of primary hypersomnia lies somewhere in the dysfunction of brain centers controlling sleep, that has been the area most often studied in research up to the present time.
It has been somewhat fruitful for work in this area to rule out potential causes so that it is understood to some degree what does not cause primary hypersomnia. It has been confirmed, for instance, that there is no verifiable association between the disorder and genetics, i.e. people with primary hypersomnia do not inherit it from parents or grandparents.
Environmental factors likewise appear to play no role in developing primary hypersomnia.
Treatment of hypersomnia can take on enormous significance for some people who are afflicted by it because there are many cases where the affliction is completely disabling and can lead to either prolonged or permanent unemployment. Few workplaces can tolerate the kinds of symptoms routinely demonstrated by victims of hypersomnia, i.e. falling asleep at work, poor focus or concentration, low energy levels, and a tendency to nap during tasks, meetings, or conversations. The least invasive forms of treatment begin with behavioral approaches and recommendations for sleep therapy, but these generally have very limited results and rarely achieve any lasting breakthroughs for patients.
Since the symptoms associated with primary hypersomnia revolve around excessive and inappropriate sleepiness, it’s not surprising that one of the most common treatments for the condition involved providing the patient with stimulants. These medicinal energy boosters include dextroamphetamine and methylphenidate, although their usage must be carefully monitored for the effects they produce in individuals, since some of the side effects can lead to aggressive behavior, heart problems, and possibly even dependence on the medication.
Some non-stimulant types of medication are also used, such as modafinil and armodafinil. While these have nothing to do with stimulating the patient, they do seem to have a desirable effect on brain chemistry which increases wakefulness in the person. These two must also be carefully monitored for their effects since they have known side-effects like severe rashes and strong headaches. In some cases, sodium oxybate is recommended for hypersomnia patients, because it promotes a deep sleep at bedtime as well as increased wakefulness during the daytime.
Research is ongoing at this time to learn more about primary hypersomnia in terms of how specific centers of the brain regulate wakefulness and sleepiness. When these processes are better understood, it is likely that some kinds of effective medication will be developed to offset whatever imbalance might exist in the brains of afflicted persons.
For example, histamine is known to have a strong effect on wakefulness, so it may be that some form of medication which counteracts histamines in the body can help to manage or eliminate the symptoms associated with primary hypersomnia. For those cases of primary hypersomnia which are attributable to the excess activity of the GABA system, medications such as flumazenil have been shown to have promising results, which improve sleepiness and allow the patient to enjoy a good night’s sleep.
There is no known way to completely prevent hypersomnia at this time, although it is possible that some form of prevention will be developed in the future, once it is better understood how the brain regulates sleepiness and wakefulness. The best that can be done at present is to lower the risk of contracting primary hypersomnia by removing those risk factors thought to contribute to the onset of the affliction.
One of these is drinking excessive alcohol, which has long been known to interfere with normal sleep patterns. People who are alcoholics, or who have a history of excessive alcohol consumption over a long period of time, can also expect to have a corresponding history of sleep disruption. This has in fact led to the development of primary hypersomnia in some people already, so removal of the alcohol risk factor is one very good step toward prevention.
It’s also a good idea to avoid taking medications that trigger drowsiness because they also disrupt the body’s normal regulatory efforts at sleepiness and wakefulness. Any factor which does this over a prolonged period of time has the potential to permanently interfere with normal operation of those brain centers managing sleep.
A significant number of people afflicted with primary hypersomnia report having worked late at night for extended periods of time, often involving years. Third shift workers, for instance, are fighting their body’s natural tendency to sleep during the dark hours of the night and be wakeful through daylight hours.
Creating an environment conducive to good sleep can be very helpful as a means of warding off the symptoms associated with primary hypersomnia. This involves removing sources of loud noises (although some people prefer background noise or ‘white noise’ to help them sleep), sleeping in a darkened room with drawn curtains, keeping your bedroom a comfortable temperature for sleeping, and exerting sufficient amounts of energy during the daytime to trigger natural, healthy fatigue, and a readiness for sleep.