Hypersomnia: What It Is and How to Treat It
Excessive daytime sleepiness may seem like something outside of your control. But if you suffer from hypersomnia, there are things that you can do to feel better.
Apr 29th, 2020 •
Expert Insights from Dr. Luis Javier Peña-Hernández, MD, FCCP, a lung health specialist at PCSI, the largest integrated pulmonary and chest specialty group in Palm Beach County.
Do you struggle with excessive sleepiness? Maybe you sleep fine throughout the night, but you still feel like you could fall asleep at any time during the day. Or you might feel incredibly lethargic when you wake in the morning, no matter how much you’ve slept.
Sleep disorders are common. So common, in fact, that many people feel as if their symptoms are a normal part of life. Fatigue, brain fog, sluggishness—we’ve all experienced these symptoms at one time or another. But if you can’t seem to get them to go away, you may have a condition called idiopathic hypersomnia (IH)(meaning that it arises from no known cause), also called hypersomnolence.
What is Hypersomnia?
“Hypersomnia is a neurological disorder characterized by excessive daytime sleepiness, brain fog, inability to sleep well, and excessive sleep period during the day,” explains Dr. Peña-Hernández.
IH, also known as excessive daytime sleepiness, is a neurological disorder. Early symptoms of hypersomnia include:
- Excessively long sleep (over ten hours)
- Difficulties getting out of bed (known as sleep inertia)
- Brain fog or troubles thinking
- Daytime sleepiness or fatigue
- Feeling groggy in the morning, or throughout the day
- Trouble focusing
- An inability to sleep well
- Difficulty waking up to alarms
- Excessive sleep periods each day (usually taken to mean more than 10 hours)
Nearly everyone can relate to the above symptoms at one time or another. Because of this, people will often ignore these symptoms. Instead of seeing whether something is wrong, we’ll assume that it’s our own fault, or that everyone feels this way. This can lead to difficulties with diagnosis, leaving people with IH to suffer needlessly for long periods of time.
Eventually, chronic daytime sleepiness can grow from an inconvenience to a health hazard. As you can imagine, energy and sleep troubles can wreak havoc on your mental and physical health. If left untreated, IH can lead to:
- Weight gain
- Depression or other mood disorders
- Poor performance at work or in school
- Relationship difficulties
- Other health conditions
If you seem to be fighting against daily fatigue, it’s important to learn what’s causing it. Only once you’ve identified the problem can you truly begin to find ways to solve it. Read on to learn more about hypersomnia, from what causes it to how it can be treated.
What Causes Hypersomnia?
“Hypersomnia can be caused by our genetics, environment, or lifestyle,” says Dr. Peña-Hernández.
Hypersomnia, also known as excessive daytime sleepiness, can be a condition in its own right, or it can be caused by another condition. These two varieties are known as primary or secondary hypersomnia.
Primary hypersomnia is believed to be caused by dysfunction of certain brain systems. Our genetics, environment, and lifestyle can all contribute to troubles with the parts of our brains responsible for our sleep/wake cycle.
Research also suggests that some people over-produce a molecule that acts as a sedative. While the composition of this molecule is still unknown, we do know that it can enhance the sleep-promoting effects of the neurotransmitter GABA.
Many times, excessive daytime sleepiness is caused by another condition that contributes to insufficient sleep quality or sleep deprivation. Additionally, these conditions can cause fatigue unrelated to poor sleep. Some conditions known to cause hypersomnia include:
- Multiple sclerosis
- Parkinson’s disease
- Chronic fatigue syndrome
- Obstructive sleep apnea
- Kidney failure
- Chronic pain
- Head injury
- Movement disorders
Hypersomnia may be caused by other disorders such as depression, Celiac disease, mononucleosis or fibromyalgia, or it may arise as a by-product of other sleep disorders. It may also be in some cases an adverse reaction to certain medications, or result from drug or alcohol abuse. A genetic predisposition may also be a factor, as may excess weight. It is thought that the immediate mechanism for hypersomnia may be a particular somnogen (sleep-inducing substance) in the spinal fluid, although the substance’s exact identity and cause have still not been narrowed down.
“If you think you may be experiencing hypersomnia, you should speak with your doctor to discuss your symptoms,” says Dr. Peña-Hernández. “They will likely refer you to a sleep specialist or recommend that you undergo a sleep study.”
With 40% of us experiencing symptoms of hypersomnia at one time or another, it’s only natural to wonder if you have IH. Rather than comb the internet and try to self-diagnose (WebMD, anyone?), it’s best to contact your primary care physician to discuss your symptoms.
If your PCP determines that you do suffer from a sleep disorder, you’ll be referred to a sleep specialist for further evaluation. These visits can include questions to evaluate your symptoms, habits, other medical conditions, and drugs (like sleep medicines) that could cause IH.
For those who meet certain criteria, a sleep study might be scheduled. These include things like:
- Six months or more of hypersomnia symptoms
- A lack of underlying medical condition that might be causing IH
- A Multiple Sleep Latency Test of fewer than ten minutes
In recurrent hypersomnia, the symptoms recur several times during the year, in between periods of relatively normal sleep-wake cycles, and may also be accompanied by other psychological disorders such as hypersexuality or compulsive eating.
Additionally, if an underlying condition is suspected to be the cause of your hypersomnia, further tests may be ordered to identify and help treat the condition.
“Hypersomnia can be treated with prescription medications or lifestyle changes like exercising, reducing alcohol and caffeine consumption, and other sleep hygiene practices,” says Dr. Peña-Hernández.
There is no single universal treatment for people with idiopathic hypersomnia. Treatments for IH vary widely depending on the root cause. A combination of prescription drugs and lifestyle changes are often recommended.
Prescription Drugs Used for IH
Prescription drugs used to treat primary hypersomnia often address daytime sleepiness. Drugs for narcolepsy, a separate sleep disorder, are frequently prescribed to IH patients. According to the Hypersomnia Foundation, the narcolepsy medication modafinil has demonstrated efficacy at helping control IH symptoms in human clinical trials.
Unfortunately, modafinil, stimulants, and other narcolepsy drugs don’t work for everyone with hypersomnia. Additionally, they often come with side effects, and their efficacy can fade over time.
For secondary hypersomnia, drugs and other treatments are used that address the underlying cause. For example, those with daytime sleepiness caused by sleep apnea may be prescribed continuous positive airway pressure machines that can help you sleep through the night.
Lifestyle Changes for Excessive Daytime Sleepiness
Lifestyle changes are often recommended to help normalize the sleep/wake cycle. These can be aimed at improving sleep quality, reducing time to fall asleep, and enhance overall health. Some lifestyle changes that may help include:
- Controlling alcohol and caffeine intake (particularly in the evenings)
- Implementing a sleep schedule
- Eating a healthy diet high in vitamins and minerals
- Quitting smoking
- Not eating or drinking before bedtime
- Practicing relaxation techniques
- Limiting blue light exposure at night
Additionally, the National Sleep Foundation recommends for those with hypersomnia to discuss their condition with those close to them. By helping your coworkers, friends, and family understand what to expect, you can build a support system to help you through the tough times.
Because the causes for hypersomnia vary from one person to the next, the best form of treatment also differs. Working with sleep specialists can help you determine the best course of action for you.
If you feel excessively sleepy no matter how long you sleep at night, you might be suffering from idiopathic hypersomnia. While obtaining a diagnosis for a sleep disorder might seem daunting, it’s the first step towards feeling like yourself again. Do yourself a favor and reach out to your primary care physician or a sleep specialist today.
Once you have a diagnosis, you can start an individualized treatment program to help regain your energy and quality of life. Remember, feeling fatigued and groggy throughout the day is not normal. You deserve to lead a life without excessive daytime sleepiness.
Dr. Luis Javier Peña-Hernández, MD, FCCP, is a lung health specialist at PCSI, the largest integrated pulmonary and chest specialty group in Palm Beach County. His areas of expertise include asthma and immunotherapy, COPD, lung cancer, and invasive diagnostic techniques in pulmonary medicine including endo-bronchial ultrasound and diagnostic bronchoscopy. He is also one of the few experts in cardiopulmonary exercise testing and exercise physiology in Palm Beach County.
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