Hypersomnia: How to Manage Excessive Daytime Sleepiness

Hypersomnia is a sleep disorder characterized by excessive daytime sleepiness, even with adequate nighttime sleep. The condition can significantly impact daily functioning and overall well-being.

As the disorder has various potential underlying causes, it’s crucial to understand them to identify the kind of problem you are dealing with and find the right treatment methods.

In this article, we will learn about hypersomnia, its symptoms, potential causes, methods of diagnosis, and available treatment options.

What is hypersomnia?

The definition of hypersomnia is excessive daytime sleepiness (EDS), often referred to as hypersomnolence or hypersomnolence disorder.

One thing to understand is that hypersomnia is not just simple tiredness or sleepiness. The effects of hypersomnia are usually much more apparent and harder to deal with. Another distinction is that hypersomnia will not go away even with adequate rest, unlike regular sleepiness.

Hypersomnolence is often only a symptom of some other neurological condition or underlying disorder like narcolepsy or Kleine-Levin syndrome, both of which can be categorized as hypersomnias. Hypersomnia can also be a standalone condition with no identifiable underlying cause, in which case, we call it idiopathic hypersomnia. In this article, we will focus on this type.

At first glance, the symptoms might be similar to narcolepsy or other sleep disorders, but the underlying causes and treatment options might vary.

Accurate diagnosis and appropriate treatment are crucial for managing hypersomnia and similar conditions.

Hypersomnia symptoms

The symptoms of hypersomnia might vary slightly depending on the underlying causes. However, excessive daytime sleepiness (EDS) is the hallmark sign of hypersomnia, which is apparent in all forms of the condition.

Other symptoms might include:

• Episodes of excessive sleepiness during daytime, called sleep attacks
• Difficulty remaining awake
• Sleep drunkness after waking up
• Naps are not refreshing
• Need to sleep longer than 10 hours a day
• Low energy levels
• Anxiety, depression, increased stress
• Decreased mental capacity, slow thinking, speaking slowly, problems with memory and concentration
• Headaches
• Hallucinations

It’s important to note that regular tiredness might cause similar symptoms. However, hypersomnia produces the same symptoms even when you get an adequate amount of rest, and the symptoms are usually more apparent and harder to deal with.

Hypersomnia causes

Hypersomnia can be the result of various underlying causes.

We can distinguish between primary and secondary hypersomnias based on what causes them.

Primary hypersomnias are standalone medical conditions, while secondary ones are usually the results of some other underlying disease or disorder.

Primary hypersomnias

There are four conditions that fall into this category.

• Narcolepsy type 1 – Caused by low hypocretin levels, this disorder leads to sudden and intense sleep attacks accompanied by the loss of muscle tone and control, called cataplexy.
• Narcolepsy type 2 – Produces similar symptoms to narcolepsy type 1 but without cataplexy. It occurs with normal hypocretin levels, and the causes behind it are not entirely clear yet.
• Klein-Levin syndrome – A rare, long-standing medical condition that leads to episodes of extreme sleepiness and tiredness, each of them lasting for weeks or even months. The causes behind it are unknown, but doctors suspect the malfunction or damage of the hypothalamus.
• Idiopathic hypersomnia – Hypersomnia is the main symptom of the above disorders, so they are all categorized as hypersomnias. But hypersomnia can appear even on its own, without additional symptoms associated with the conditions above. In these cases, the underlying cause is not clear. This is called idiopathic hypersomnia.

Secondary hypersomnia

Hypersomnia can be categorized as secondary when it is a result of some other underlying issue.

Some medications, excessive alcohol consumption, and long-term lack of proper sleep can all lead to developing secondary hypersomnia.

Several diseases and disorders may also have hypersomnia as a symptom. Some of these are:

• Sleep apnea
• Delayed sleep phase syndrome
• Restless leg syndrome 
• Bruxism
• Depression
• Bipolar disorder
• Epilepsy
• Multiple sclerosis
• Tumors
• Central nervous system dysfunctions
• Parkinson’s disease
• Hypothyroidism

Diagnosing hypersomnia

When diagnosing hypersomnia or other sleep-related issues, doctors will ask questions about your sleep quality, sleep schedule, and sleeping habits. They might also ask you to keep a sleep diary for a while to help with the diagnosis process.

Various diagnostic tests can help doctors rule out other conditions and underlying issues that might lead to hypersomnia. They might run blood tests for anemia or thyroid problems. CT and MRI scans can help uncover neurological issues, and they might use electroencephalogram (EEG) tests to measure electrical brain activity. Polysomnography is a complex sleep test that could help diagnose or rule out many sleep disorders.

If doctors can’t find any underlying causes behind your hypersomnia symptoms, that might lead them to a diagnosis of idiopathic hypersomnia.

Hypersomnia treatments

In the case of secondary hypersomnia, when the underlying cause of your hypersomnia is clear, doctors usually focus on fixing that first, which, in turn, should ease the symptoms of hypersomnia as well.

This might include medical treatment for some other disease or disorder, a change of medications if hypersomnia occurs as a side effect of those, reducing alcohol and caffeine consumption, or some other lifestyle changes.

Idiopathic hypersomnia treatment is a bit less straightforward. Since the cause is unknown, there is no clear-cut cure for it. Treatment focuses on easing the symptoms and restoring your ability to function during the day.

Medications

Doctors might recommend medications to help you stay awake and focused during the day.

• Non-stimulant wake-promoting drugs – modafinil, armodafinil, pitolisant, solriamfetol
• Psychostimulants – amphetamine, methylphenidate, dextroamphetamine
• Other options – sodium oxybate, flumazenil, clarithromycin

These medications might have some unwanted side effects, though. And some of them can be highly addictive.

Other treatment methods

In some cases, doctors might advise different approaches or combine them with medications.

Cognitive behavior therapy can be helpful in dealing with the stress and anxiety caused by hypersomnia, and it might also help you get better sleep by reducing stress levels.

Changing your diet might also alleviate the symptoms of hypersomnia to some degree. Reducing caffeine and alcohol intake could be beneficial, and maintaining a healthy and balanced diet can also improve your overall well-being.

Taking measures to improve your sleep quality might also be a good idea. These things might help you get better rest during the night:

• Maintain a steady sleep schedule
• Avoid night-shift work
• Keep your room dark during the night
• Use white noise to improve your sleep
• Try sleep patches
• Stay active physically
• Avoid stimulating activities before bedtime
• Make sure you address any other sleep disorders that you might have
• Try sleep-promoting herbal teas, like chamomile