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Hypersomnia





























Hypersomnia

Hypersomnia or narcolepsy is a sleep disorder in which the hypersomniac is excessively drowsy during the day. Usually, such a person encounters great difficulty to stay awake from sleep.


Depending on deficiency levels of hypocretin in a person facing hypersomnia, narcolepsy is classified into Type 1 and Type 2.

Besides medication, methods for treating narcolepsy includes Cognitive Behavioral Therapy (CBT), sleep hygiene, and lifestyle changes.


The prognosis for hypersomnia depends on the actual cause of the disorder.


Definition

Hypersomnia is a sleep disorder characterized by excessive daytime sleepiness or sudden attacks of Rapid Eye Movement (REM) sleep while awake. Moreover, it produces hypnagogic and hypnopompic hallucinations and disturbance of sleep architecture. A limited number of people may get unconscious dream behavior in a few cases.


Classification

A. Type 1 narcolepsy

Type 1 narcolepsy may cause other symptoms, including cataplexy (sudden muscle weakness) that occurs when the hypersomniac are awake. Furthermore, sleep paralysis is a temporary inability to speak or move while falling asleep or waking up. Similarly, hallucinations develop in the form of vivid images or other sensory experiences occurring when the hypersomniac fall asleep or wake up.


Insomnia is a condition characterized by difficulty falling or staying asleep at night. The presence of cataplexy is one of the key attributes of Type 1 narcolepsy. This symptom does not usually occur in Type 2 narcolepsy.

B. Type 2 narcolepsy

The symptoms of Type 2 narcolepsy is are less severe than Type 1 narcolepsy. Besides EDS, Type 2 narcolepsy may cause sleep paralysis, hallucinations, and insomnia. Moreover, Type 2 narcolepsy does not usually cause cataplexy.


Epidemiology

The prevalence of narcolepsy is about 0.02%-0.18%, and it occurs slightly higher in men than in women. Past literature reports two peak incidences of narcolepsy--around 15 and 35 years of age. Moreover, it can seriously impact hypersomniacs' quality of life and cognitive functions, even resulting in life-threatening accidents.


Causes

Narcolepsy is a chronic sleep disorder due to unknown origins. It implies that the root cause of narcolepsy is not clear yet. According to various research studies, the following factors may cause this sleep disorder:


Another sleep disorder (such as narcolepsy or sleep apnea) may cause hypersomnia. Excessive use of drugs or alcohol abuse can cause autonomic nervous system dysfunction.

In some cases, it results from some physical issues like tumors, head trauma, and injury to the central nervous system.

Certain medications (or medicine withdrawal) may also trigger hypersomnia. Medical conditions —e.g., multiple sclerosis, depression, encephalitis, epilepsy, or obesity—may contribute to the disorder.

Some hypersomniac may have a genetic predisposition to hypersomnia. However, it typically appears in adolescence or young adulthood.


Symptoms

Some typical symptoms of hypersomnia are recurrent episodes of excessive daytime sleepiness or prolonged night sleep. Unlike feeling drowsy due to less or interrupted sleep at night, hypersomniacs with Hypersomnia nap repeatedly during the day. They often sleep at inappropriate times, such as at work, during a meal, or in a conversation. These naps may last only a few minutes or up to tens of minutes and occur several times daily. Moreover, any length of sleep during the night does not affect these naps. During the sleep attacks, hypersomniacs may have difficulty in concentrating. Nonetheless, these recurrent daytime naps usually offer no relief from symptoms. Hypersomniacs have sudden cataplexy attacks and difficulty waking from a long sleep. Consequently, they may feel disoriented. Other symptoms of hypersomnia include anxiety, irritation, low energy, restlessness, sluggish thinking and speaking, loss of appetite, hallucinations, and memory loss. In addition, Some hypersomniac lose the ability to interact properly in family functions, social gatherings, and occupational activities.

Diagnosis

A. Diagnostic Basis

According to the International Classification of Sleep Disorders, 3rd Edition (ICSD-3) issued by the American Academy of Sleep Medicine (AASM) in 2014, there are two types of narcolepsy, namely, narcolepsy Type 1 and Type 2.

B. Clinical features

Cataplexy is one of the attributes of narcolepsy and an indicator that helps diagnose narcolepsy. It is the most obvious symptom of hypocretin deficiency.

Hypersomniacs has had poor sleep quality at night for a long time.

Hypersomniacs always need to sleep during the day, even after getting enough sleep at night. This scenario affects his/her daily life activities and routines.

Hypnagogic and hypnopompic hallucinations, as well as sleep paralysis, occur frequently during narcolepsy.

Hypersomniacs can be easily awakened with excessive dreaming, dream enactment behaviors. They may face challenges in falling back to sleep after waking up.

C. Sleep History

The usual approach to treat this disorder is to consider sleep history and other possible causes of excessive daytime drowsiness.

Various sleep disorders (Hypersomnia or Narcolepsy) may cause daytime sleepiness.

Different causes for excessive sleepiness include depression, certain medicines, drug and alcohol use, low thyroid function, and past head injury.

D. Hypersomnia Tests

These tests include the following:


A sleep latency test determines how long it takes to fall asleep during a daytime nap.

A polysomnography is a sleep study to detect various sleep disorders.

A mental health evaluation test analyzes any depression or anxiety-causing sleep disorder.

E. Differential Diagnosis

Differential diagnosis includes cataplexy, Hypersomnia, Kleine-Levin syndrome, etc.


Treatment

Physicians usually prescribe medications for excessive daytime sleepiness, cataplexy with hallucinations, sleep paralysis, and disorders. Due to hypersomniac differences in various medicines, there is no absolute best, fastest, and most effective medication. While selecting medications, both physicians and hypersomniacs must consider the possible side effects. As narcolepsy is a lifelong disease, the patient people with narcolepsy may have to receive long-term medication treatment. Certain drugs may develop tolerance or addiction. Therefore, physicians and hypersomniacs must communicate adequately at the start and during medication to ascertain the pros and cons. They should keep a balance between effective treatment and an active lifestyle and evade any side effects and drug tolerance. Scheduled daytime naps may help hypersomniacs improve wakefulness and reduce the dose of excitatory drugs and antidepressants.


In general, the relevant medicines fall into the following three categories:


Stimulants: These wake-promoting drugs include derivatives of amphetamines. They are effective but can have side effects, including dependence, heart issues and getting hooked on them.

Non-stimulant wake-promoting medications: These medicines affect the brain's chemical dopamine to keep the awake.

Sodium oxybate: This medication—taken at night—promotes deep sleep. Consequently, it reduces daytime drowsiness for those with narcolepsy and can help people with IH.


Additionally, the physician may prescribe other medicines to treat Attention Deficit Hyperactivity Disorder (ADHD), antidepressants, and sedatives.


Intervention

Treatment of people with narcolepsy requires Cognitive Behavioral Therapy (CBT) to develop good sleep hygiene and lifestyles. Here are some intervention options:

Apply Cognitive and Behavioral Therapy (CBT)

Young narcoleptics are especially prone to reactive depressive symptoms. Therefore, physicians should provide the necessary guidance to help them comprehend the disease scientifically to establish correct coping strategies. For instance, narcoleptics should avoid certain types of jobs. They may include shift work, on-call duties, driving and transportation jobs, security guard positions, and any tedious job requiring long, uninterrupted, and continued attention. Moreover, narcoleptics might change their lifestyle, such as avoiding night diets and party.

Develop Good Sleep Hygiene

Maintaining a regular sleep-wake rhythm can relieve the symptoms of daytime drowsiness. As a result, it should enhance the efficacy of the medication and reduce the occurrence of concomitant diseases. The physicians can remind narcoleptics to take naps regularly. Moreover, their colleagues or family can wake them up when sleep time is up. Other vital behavioral treatments include a regular sleep schedule, avoidance of frequent time-zone variations, and overall good sleep hygiene.

Lifestyle Changes

Lifestyle changes that can help ease symptoms and prevent injuries. These changes include:


Avoid alcohol, caffeine, and medicines that can make the condition worse.

Avoid operating motor vehicles or using hazardous equipment.

Evading night work or social activities that may delay bedtime.

Social Support

Drowsiness and cataplexy can seriously affect the narcoleptic's life, as people with narcolepsy are prone to anxiety and self-doubt. People around them can misconstrue them. Thus, they can develop psychological disorders like depression, low self-esteem, withdrawal, and social phobia. Therefore, narcoleptics' family members and friends should offer more social support and help, including:


Showing more compassion;

Encouraging and supporting narcoleptics psychologically;

Helping narcoleptics to face the disease positively and optimistically;

Interacting with narcoleptics in interesting ways;

Encouraging narcoleptics to exercise regularly;

Helping narcoleptics enrich their lives through healthy activities.

Behavior Management

Behavior management in the case of hypersomnia including:


Sleep. Narcoleptics should maintain a regular life schedule. Narcoleptics should maintain a regular life schedule, sleeping habits with regular daily naps, and should not stay awake till late. A quiet and comfortable sleeping atmosphere is imperative for such narcoleptics.

Diet. Narcoleptics should maintain a healthy and nutritional diet and avoid foods affecting sleep, such as coffee, cigarettes, and alcohol. They should control weight, evade overeating, and avoid excessive consumption of highly carbonated foods. Moreover, they should eat more whole grains and vegetables.

Exercise. Narcoleptics should maintain a regular and moderate exercise routine. This exercise lasts approximately 4 to 5 hours before bedtime to help stay awake during the day and promote night sleep.

Mental State. Take care of narcoleptics' psychological health, help them relieve emotional stress, and promote the education of narcolepsy.

Monitoring Diary

The efficacy evaluation is usually carried out once a month to ascertain whether the hypersomnia symptoms have improved or disappeared. This way, the hypersomniac can determine whether his/her daily life has returned to normal.

Prevention

Changing lifestyle is vital for the routine management of narcolepsy. The Narcoleptics should maintain a regular schedule and good sleep habits. They should avoid smoking and drinking, exercise regularly to sleep better at night and reduce daytime drowsiness. Furthermore, people with severe narcolepsy should avoid jobs with higher risk, such as driving, working at heights or underwater, etc. They should minimize the possibility of traveling alone or engaging in dangerous activities, such as hiking, swimming, driving, and high-risk jobs. These activities may create life-threatening accidents. Finally, a regular life schedule and a balanced diet are positive factors for preventing narcolepsy.


Prognosis

Narcolepsy is a lifelong sleep disorder, although it is not life-threatening. The attacks usually continue indefinitely, which can have serious consequences, such as automobile accidents due to falling asleep while driving. Similarly, a burn injury can follow if a sudden attack of drowsiness occurs while cooking. Currently, there is no cure for narcolepsy. However, medications and behavioral-psychological interventions may help relieve symptoms. Narcolepsy can seriously impact the narcoleptic 's life quality.


Complications

Long-term chronic hypersomnia may lead to physical diseases like precocious puberty before age 8 for girls and 9 for boys. Obstructive Sleep Apnea is the primary symptom of hypersomnia, include daytime drowsiness. Finally, peolple with narcolepsy are more likely to have excessive weight due to their low metabolism.

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