Is Hypersomnolence a Mental Disorder?

Hypersomnolence is a condition characterized by excessive daytime sleepiness or prolonged nighttime sleep. People with hypersomnolence may have difficulty staying awake during the day and may fall asleep at inappropriate times, such as while driving or at work. They may also sleep for longer periods at night and still feel tired upon waking.

Treatment for hypersomnolence may involve identifying and addressing the underlying cause, improving sleep hygiene, and in some cases, using medications to promote wakefulness during the day. Individuals with hypersomnolence should seek medical attention immediately as untreated hypersomnolence can have serious consequences, including an increased risk of accidents and a lower quality of life.

Hypersomnolence is classified into several types proposed by various sleep and psychiatric organizations, but the most accepted classification includes primary and secondary hypersomnolence.

Primary hypersomnolence is not caused by another medical condition or medication. It is classified into four types:

Narcolepsy type I:

• A chronic sleep disorder characterized by excessive daytime sleepiness and sudden episodes of sleep during the day.
• Caused by the brain's inability to regulate sleep-wake cycles.
• Also known as narcolepsy with cataplexy (sudden muscle weakness triggered by emotions).
• Caused by a low level of a neurotransmitter, hypocretin, in the brain and cerebrospinal fluid.

Narcolepsy type II

• Less severe type of narcolepsy without cataplexy.

Kleine-Levin syndrome

• Characterized by recurrent episodes of extreme hypersomnia lasting several weeks to months.

Idiopathic hypersomnia

• A type of hypersomnolence that does not have a known cause.

Secondary hypersomnolence is caused by some known medical issues or medications, and can be of the following three types:

• Hypersomnolence caused by medical conditions, such as
  • Head injury
  • Parkinson’s disease
  • Myotonic dystrophy
  • Obesity
  • Obstructive sleep apnea
  • Depression
  • Bipolar disorder
  • Multiple sclerosis
  • Encephalitis
  • Epilepsy
  • Hypothyroidism
• Hypersomnia due to medications or substances, such as
  • Antidepressants
  • Antihypertensive drugs
  • Antiepileptic drugs
  • Anti-parkinsonian agents
  • Antipsychotics
  • Opiates
  • Cannabis
  • Alcohol
• Insufficient sleep syndrome
  • Not sleeping enough hours per night regularly (adults regularly need seven to nine hours of sleep)
  • Not having good quality sleep

There can be several causes of hypersomnolence, including medical conditions, medications, lifestyle factors, and sleep disorders. Moreover, it is believed that demyelination of neurons and accumulation of chemicals in the brain can cause hypersomnolence.

Six causes of hypersomnolence include

1. Medical conditions

• Obstructive sleep apnea
• Restless leg syndrome
• Chronic pain or discomfort
• Anemia
• Hypothyroidism
• Hormonal imbalances

2. Mental health conditions

• Depression
• Anxiety

3. Medications: have the potential to cause drowsiness, which can lead to hypersomnolence

• Sedatives
• Antidepressants
• Blood pressure medications
• Antihistamines

4. Lifestyle factors

• Poor sleep hygiene, such as irregular sleep schedules or an uncomfortable sleep environment
• Lack of physical activity

5. Sleep disorders

• Insomnia
• Narcolepsy

6. Substance abuse

• Alcohol use
• Drug use

Three risk factors for hypersomnolence include

1. Genetic predisposition

• Some people with idiopathic hypersomnolence have been noted to have the condition run in the family.

2. Age

• It is commonly diagnosed in young adults ages 17 to 24 years. 
• However, it is also seen in older adults as they are more likely to experience sleep problems, which lead to hypersomnolence.

3. Gender

• Women are more likely to have hypersomnolence than men.

The symptoms of hypersomnolence are presented in many ways during the day and during sleep.

Symptoms during the day

• Excessive fatigue and drowsiness 
• Restlessness
• Headache
• Difficulty staying awake or concentrating
• The need for extended periods of sleep or napping (10 hours or more)
• Irritability
• Mood changes
• Hallucinations
• Difficulty waking up in the morning or feeling unrefreshed after sleep

Symptoms during sleep

• Snoring or other loud noises during sleep
• Sleepwalking or other abnormal behaviors during sleep

To diagnose hypersomnolence, your doctor takes down your complete medical history, family history and conducts a physical examination. You will be inquired about your sleeping habits, including the quality and duration of your sleep along with any medications or substances you may be taking that may interfere with your sleep.

The following three tests may be recommended by your doctor to help diagnose hypersomnolence:

1. Sleep study

• Also known as a polysomnogram, it is a test that measures brain activity, eye movement, heart rate and other physiological functions while you sleep.
• This test can help identify any sleep disorders that may be causing your symptoms.

2. Multiple sleep latency test (MSLT)

• The MSLT measures how quickly you fall asleep during the day.
• It can help determine if you have a condition such as narcolepsy, characterized by excessive daytime sleepiness.

3. Actigraphy

• A noninvasive test that uses a wearable device to track your sleep-wake patterns over a period of several days or weeks. 
• This can help a healthcare professional determine if you have a sleep disorder or other underlying condition that may be causing your symptoms.

The treatment of hypersomnolence may vary depending on the underlying cause of the condition. It is important to address any underlying mental health issues that may be contributing to hypersomnolence to manage the condition effectively. In some cases, a combination of lifestyle changes and medications may be necessary to manage the condition.

Three treatment options for hypersomnolence include:

1. Lifestyle changes

• Making changes to your sleep habits, such as establishing a regular sleep schedule and practicing good sleep hygiene, can help improve sleep quality and reduce daytime sleepiness.
• Engaging in regular physical activity and keeping your weight under control.
• Avoiding caffeine and alcohol before bedtime.

2. Medications

• Depending on the underlying cause of your hypersomnolence, a healthcare professional may recommend medications to help improve sleep quality and reduce daytime sleepiness.
• These may include stimulants, such as modafinil, armodafinil, or sedatives, such as benzodiazepines.

3. Continuous positive airway pressure (CPAP) therapy

• If sleep apnea is causing your hypersomnolence, your doctor may recommend using a CPAP machine during sleep.
• This device delivers a continuous flow of air through a mask to help keep the airway open and improve sleep quality.

Working with your healthcare professional is crucial to determine the best treatment options for your specific needs and goals.

If you experience hypersomnolence, there are several things you can try to help manage the condition and improve your sleep quality. The following four measures might be helpful:

1. Practice good sleep hygiene

• Establish a regular sleep schedule and stick to it as closely as possible.
• Make sure your sleep environment is good, with a comfortable bed, a cool and dark room and minimal noise and distractions.
• Avoid caffeine and alcohol close to bedtime and try to relax before going to sleep.

2. Exercise regularly

• Regular physical activity can help improve sleep quality and reduce daytime sleepiness. 
• Aim for at least 30 minutes of moderate to intense exercise most days of the week.

3. Avoid napping

• Although napping can help improve alertness in some people, it can also disrupt your sleep-wake cycle and make it hard to fall asleep at night.
• If you need to nap, limit it to 20 to 30 minutes and avoid napping in the afternoon.

4. Take short breaks

• If you find it difficult to stay awake during the day, try taking short breaks every hour or so to stretch and move around. 
• This can help increase your alertness and reduce fatigue.

It is important to remember that the treatment of hypersomnolence may require a combination of lifestyle changes and medications.