Most people have some experience of sleepless nights due to insomnia. Of these we remember the unpleasant sensations of tossing and turning in bed tormented by an alarm clock that is getting closer and closer. But what impact can the opposite condition have on daily life? What happens in our lives when we feel an unstoppable and relentless desire to sleep? What is hypersomnia, how does it manifest itself, what symptoms distinguish it? We will try to answer these questions by also focusing on therapies and strategies for living with drooping eyelids.
What is hypersomnia? Definition and causes.
The Higher Institute of Health in the ISSalute index provides the following definition:
“The term hypersomnia refers to an excessive need for sleep or a continuous state of drowsiness that interferes with everyday life.”.
Again according to what is reported in the corresponding entry in the Index of the Istituto Superiore di Sanità, the main causes may concern (Galimberti, 2018):
- Narcolepsy (the subject goes from wakefulness to REM sleep in response to brief, but insurmountable attacks of sleep during the day);
- sleep apnea (subjects frequently wake up at night due to breathing difficulties caused, for example, by obesity, then experiencing daytime drowsiness);
- restless legs syndrome;
- severe sleep deprivation;
- depression (hypersomnia is one of the symptoms classified by the DSM-5);
- the use of drugs (for example tranquilizers);
- The abuse of drugs and alcohol.
If the causes are not known and sleep is regular, it is called idiopathic hypersomnia.
Symptoms of idiopathic hypersomnia
People who suffer from idiopathic hypersomnia struggle to stay awake during the day. They are forced to take frequent naps, often involuntary, which are not effective in combating drowsiness and have a significant impact on daily life, interfering with relationships, work and conversations. Also due to this negative influence on social life people can experience:
- anxious symptoms and low mood;
- low vital energy;
- restlessness and agitation;
- Slowing of thought and speech;
- Memory difficulties and attention problems;
The onset of these symptoms usually occurs in adolescence, but can also concern adulthood or advanced age (ISS, 2018). It is therefore not simple tiredness and may need to be addressed from a medical and psychological point of view.
The diagnosis of hypersomnia
If you experience constant drowsiness during the day, with a significant impact on daily activities, it may be useful to contact your doctor. During the interview, sleep habits will be explored, any nocturnal awakenings will be investigated, and the possible presence of mood disorders (for example depression) or current pharmacotherapies (for example anxiolytics) will be explored. If necessary, the general practitioner may request a specialist visit to a neurologist.
Tests for the diagnosis of Hypersomnia
Among the tests that may be prescribed to diagnose hypersomnia we find:
- Polysomnography: the test involves the application, during sleep and wakefulness, of electrodes on the body, head and face to record brain waves, muscle activity, eye movement, breathing, snoring in order to exclude narcolepsy and sleep apnea;
- Multiple latency tests: normally the day after the polysomnography you are asked to take several naps so as to be able to record the time needed to fall asleep (in case of hypersomnia the latency should not exceed 8 minutes).
If the need to take naps and excessive sleepiness cannot be explained by proven causes, a picture of idiopathic hypersomnia can be hypothesized.
Differences between narcolepsy and hypersomnia.
The two conditions differ based on the following characteristics:
- in narcolepsy strong emotions can cause loss of muscle control (catalepsy) unlike what happens in hypersomnia;
- in narcolepsy, vivid dreams and hallucinations may be present;
- in narcolepsy, nocturnal sleep is fragmented and of poor quality, while it is continuous in hypersomnia;
- in narcolepsy, daytime naps are restorative unlike what happens in hypersomnia;
- in narcolepsy you quickly fall into the deep sleep phase (REM) unlike what happens in hypersomnia.
Differences between hypersomnia and common tiredness
Work overloads, stress and physical fatigue can lead to a common condition of tiredness. An adequate period of relaxation or restful sleep can resolve the condition of tiredness. In hypersomnia, however, tiredness is continuous and constant and is not restored even in the presence of prolonged sleep or frequent naps.
Hypersomnia treatments
Hypersomnia can be treated in the following ways:
- pharmacological treatment: although there are no specific drugs, stimulant-based treatment can be useful to help maintain wakefulness;
- lifestyle changes: the alternative to pharmacological treatment includes strategies for sleep hygiene to be applied to the daily routine: avoidance of alcohol, caffeine and drugs that inhibit sleep, taking care of sleeping routines and habits.
Hypersomnia and daily life: a difficult coexistence?
Hypersomnia can have a significant impact on daily life, limiting social and working life and compromising, for example, the ability to drive vehicles or hold conversations. For this reason it may be useful to develop strategies that allow us to contain the influence that hypersomnia can have on everyday life. Promoting activities that promote wakefulness, such as reading and walking, and organizing routines that include naps can be useful in combating hypersomnia. In some cases it may be useful to keep a sleep diary in which to note the characteristics of night sleep and episodes of drowsiness.
Sweet sleep?
The causes of hypersomnia can be multiple. Neurophysiological aspects, behavioral aspects linked to personal and work habits, mood disorders, sleep apnea or narcolepsy (Bollu et al., 2018). If you recognize that drowsiness is continuous and significantly impacts your daily routine, it may be useful to consult your doctor to consider a specialist visit. A psychological intervention can be useful to modify behaviors and sleep routines and to manage any discomfort resulting from hypersomnia conditions.
