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hypersomnia, hypersomnia symptoms
Hypersomnia, or hypersomnolence, is a neurological disorder of excessive time spent sleeping or excessive sleepiness It can have many possible causes1 and can cause distress and problems with functioning2 In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, hypersomnolence, of which there are several subtypes, appears under sleep-wake disorders3


  • 1 Symptoms
  • 2 Epidemiology
  • 3 Diagnosis
  • 4 Differential diagnosis
    • 41 Primary hypersomnias
    • 42 Primary hypersomnia mimics
    • 43 Secondary hypersomnias
  • 5 Treatment
  • 6 See also
  • 7 References
  • 8 External links


The main symptom of hypersomnia is excessive daytime sleepiness EDS, or prolonged nighttime sleep,4 which has occurred for at least 3 months prior to diagnosis 5


Hypersomnia affects approximately 5% of the general population, "with a higher prevalence for men due to the sleep apnea syndromes"5


"The severity of daytime sleepiness needs to be quantified by subjective scales at least the Epworth Sleepiness Scale and objective tests such as the multiple sleep latency test MSLT"5 The Stanford sleepiness scale SSS is another frequently-used subjective measurement of sleepiness6 After it is determined that EDS is present, a complete medical examination and full evaluation of potential disorders in the differential diagnosis which can be tedious, expensive and time-consuming should be undertaken5

Differential diagnosisedit

Hypersomnia can be primary of central/brain origin, or it can be secondary to any of numerous medical conditions More than one type of hypersomnia can coexist in a single patient Even in the presence of a known cause of hypersomnia, the contribution of this cause to the complaint of EDS needs to be assessed When specific treatments of the known condition do not fully suppress EDS, additional causes of hypersomnia should be sought7 For example, if a patient with sleep apnea is treated with CPAP continuous positive airway pressure which resolves their apneas but not their EDS, it is necessary to seek other causes for the EDS Obstructive sleep apnea “occurs frequently in narcolepsy and may delay the diagnosis of narcolepsy by several years and interfere with its proper management”8

Primary hypersomniasedit

The true primary hypersomnias include these: narcolepsy with and without cataplexy; idiopathic hypersomnia; and recurrent hypersomnias like Klein-Levin syndrome5

Primary hypersomnia mimicsedit

There are also several genetic disorders that may be associated with primary/central hypersomnia These include the following: Prader-Willi syndrome; Norrie disease; Niemann–Pick disease, type C; and myotonic dystrophy However, hypersomnia in these syndromes may also be associated with other secondary causes, so it is important to complete a full evaluation Interestingly, myotonic dystrophy is often associated with SOREMPs sleep onset REM periods, such as occur in narcolepsy5

There are many neurological disorders that may mimic the primary hypersomnias, narcolepsy and idiopathic hypersomnia: brain tumors; stroke-provoking lesions; and dysfunction in the thalamus, hypothalamus, or brainstem Also, neurodegenerative conditions such as Alzheimer's disease, Parkinson's disease, or multiple system atrophy are frequently associated with primary hypersomnia However, in these cases, one must still rule out other secondary causes5

Early hydrocephalus can also cause severe EDS9 Additionally, head trauma can be associated with a primary/central hypersomnia, and symptoms similar to those of idiopathic hypersomnia can be seen within 6–18 months following the trauma However, the associated symptoms of headaches, memory loss, and lack of concentration may be more frequent in head trauma than in idiopathic hypersomnia "The possibility of secondary narcolepsy following head injury in previously asymptomatic individuals has also been reported"5

Secondary hypersomniasedit

Secondary hypersomnias are extremely numerous

Hypersomnia can be secondary to disorders such as clinical depression, multiple sclerosis, encephalitis, epilepsy, or obesity10 Hypersomnia can also be a symptom of other sleep disorders, like sleep apnea10 It may occur as an adverse effect of taking certain medications, of withdrawal from some medications, or of drug or alcohol abuse10 A genetic predisposition may also be a factor10 In some cases it results from a physical problem, such as a tumor, head trauma, or dysfunction of the autonomic or central nervous system10

Sleep apnea is the most frequent cause of secondary hypersomnia, affecting up to 4% of middle-aged adults, mostly men Upper airway resistance syndrome UARS is a clinical variant of sleep apnea that can also cause hypersomnia5 Just as other sleep disorders like narcolepsy can coexist with sleep apnea, the same is true for UARS There are many cases of UARS in which EDS persists after CPAP treatment, indicating an additional cause, or causes, of the hypersomnia and requiring further evaluation7

Sleep movement disorders, such as restless legs syndrome RLS and periodic limb movement disorder PLMD or PLMS can also cause secondary hypersomnia Although RLS does commonly cause EDS, PLMS does not There is no evidence that PLMS plays "a role in the etiology of daytime sleepiness In fact, two studies showed no correlation between PLMS and objective measures of EDS In addition, EDS in these patients is best treated with psychostimulants and not with dopaminergic agents known to suppress PLMS"7

Neuromuscular diseases and spinal cord diseases often lead to sleep disturbances due to respiratory dysfunction causing sleep apnea, and they may also cause insomnia related to pain11 "Other sleep alterations, such as periodic limb movement disorders in patients with spinal cord disease, have also been uncovered with the widespread use of polysomnography"11

Primary hypersomnia in diabetes, hepatic encephalopathy, and acromegaly is rarely reported, but these medical conditions may also be associated with the secondary hypersomnias sleep apnea and periodic limb movement disorder PLMD5

Chronic fatigue syndrome and fibromyalgia can also be associated with hypersomnia Regarding chronic fatigue syndrome, it is "characterized by persistent or relapsing fatigue that does not resolve with sleep or rest Polysomnography shows reduced sleep efficiency and may include alpha intrusion into sleep EEG It is likely that a number of cases labeled as chronic fatigue syndrome are unrecognized cases of upper airway resistance syndrome"12 or other sleep disorders, such as narcolepsy, sleep apnea, PLMD, etc13

Similarly to chronic fatigue syndrome, fibromyalgia also may be associated with anomalous alpha wave activity typically associated with arousal states during NREM sleep14 Also, researchers have shown that disrupting stage IV sleep consistently in young, healthy subjects causes a significant increase in muscle tenderness similar to that experienced in "neurasthenic musculoskeletal pain syndrome" This pain resolved when the subjects were able to resume their normal sleep patterns15

Chronic kidney disease is commonly associated with sleep symptoms and excessive daytime sleepiness For those on dialysis, approximately 80% have sleep disturbances Sleep apnea can occur 10 times as often in uremic patients than in the general population and can affect up to 30-80% of patients on dialysis, though nighttime dialysis can improve this About 50% of dialysis patients have hypersomnia, as severe kidney disease can cause uremic encephalopathy, increased sleep-inducing cytokines, and impaired sleep efficiency About 70% of dialysis patients are affected by insomnia, and RLS and PLMD affect 30%, though these may improve after dialysis or kidney transplant16

Most forms of cancer and their therapies can cause fatigue and disturbed sleep, affecting 25-99% of patients and often lasting for years after treatment completion "Insomnia is common and a predictor of fatigue in cancer patients, and polysomnography demonstrates reduced sleep efficiency, prolonged initial sleep latency, and increased wake time during the night" Paraneoplastic syndromes can also cause insomnia, hypersomnia, and parasomnias16

Autoimmune diseases, especially lupus and rheumatoid arthritis are often associated with hypersomnia, as well Morvan's syndrome is an example of a more rare autoimmune illness that can also lead to hypersomnia16 Celiac disease is another autoimmune disease associated with poor sleep quality which may lead to hypersomnia, "not only at diagnosis but also during treatment with a gluten-free diet"17 There are also some case reports of central hypersomnia in celiac disease18 And RLS "has been shown to be frequent in celiac disease," presumably due to its associated iron deficiency1718

Hypothyroidism and iron deficiency with or without iron-deficiency anemia can also cause secondary hypersomnia Various tests for these disorders are done so they can be treated19 Hypersomnia can also develop within months after viral infections such as Whipple's disease, mononucleosis, HIV, and Guillain–Barré syndrome5

Behaviorally induced insufficient sleep syndrome must also be considered in the differential diagnosis of secondary hypersomnia This disorder occurs in individuals who fail to get sufficient sleep for at least three months In this case, the patient has chronic sleep deprivation although he or she is not necessarily aware of it This situation is becoming more prevalent in western society due to the modern demands and expectations placed upon the individual5

Many medications can also lead to secondary hypersomnia Therefore, a patient's complete medication list should be carefully reviewed for sleepiness or fatigue as side effects In these cases, careful withdrawal from the possibly offending medications is needed; then, medication substitution can be undertaken5

Mood disorders, like depression, anxiety disorder and bipolar disorder, can also be associated with hypersomnia The complaint of EDS in these conditions is often associated with poor sleep at night "In that sense, insomnia and EDS are frequently associated, especially in cases of depression"5 Hypersomnia in mood disorders seems to be primarily related to "lack of interest and decreased energy inherent in the depressed condition rather than an increase in sleep or REM sleep propensity" In all cases with these mood disorders, the MSLT is normal not too short and no SOREMPs5


Although "there has been no cure of chronic hypersomnia", there are several treatments that may improve patients' quality of life, depending on the specific cause or causes of hypersomnia that are diagnosed5

See alsoedit

  • Reticular formation
  • Sleep medicine
  • Encephalitis lethargica


  1. ^ Reynolds, Charles F; O’Hara, Ruth 2013 "DSM-5 Sleep-Wake Disorders Classification: Overview for Use in Clinical Practice" The American Journal of Psychiatry 170 10: 1099–1101 Retrieved 12 January 2017 The aim is simply to acknowledge the bidirectional and interactive effects between sleep disorders and coexisting medical and psychiatric illnesses 
  2. ^ "Sleep Disorders" American Psychiatric Association 2015 Retrieved 12 January 2017 
  3. ^ "Recent Updates to Proposed Revisions for DSM-5: Sleep-Wake Disorders" DSM-5 Development American Psychiatric Association 
  4. ^ "NINDS Hypersomnia information page" 
  5. ^ a b c d e f g h i j k l m n o p Dauvilliers, Yves; et al 2006 "Differential Diagnosis in Hypersomnia" Current Neurology and Neuroscience Reports 6 2: 156–162 doi:101007/s11910-996-0039-2 PMID 16522270 
  6. ^ Neil Freedman, MD "Quantifying sleepiness" Retrieved 2013-07-23 
  7. ^ a b c Montplaisir 2001 "Idiopathic hypersomnia: a diagnostic dilemma A commentary of "Idiopathic hypersomnia" M Billiard and Y Dauvilliers" Sleep Medicine Reviews 5: 361–362 doi:101053/smrv20010216 PMID 12530999 
  8. ^ Sansa, G; Iranzo, Alex; Santamaria, Joan Jan 2010 "Obstructive sleep apnea in narcolepsy" Sleep Med 11 1: 93–5 doi:101016/jsleep200902009 PMID 19699146 
  9. ^ "International classification of sleep disorders, revised: Diagnostic and coding manual" PDF American Academy of Sleep Medicine 2001 Retrieved 25 January 2013 
  10. ^ a b c d e National Institutes of Health June 2008 "NINDS Hypersomnia Information Page" Retrieved 2009-01-23 
  11. ^ Billiard, M; Dauvilliers, Y Oct 2001 "Idiopathic Hypersomnia" Sleep Med Rev 5 5: 349–358 doi:101053/smrv20010168 PMID 12530998 
  12. ^ Gotts, Zoe; Deary, V; Newton, J; Van Der Dussen, D; De Roy, P; Ellis, J G Apr 2013 "Are there sleep-specific phenotypes in patients with chronic fatigue syndrome A cross-sectional polysomnography analysis" BMJ Open 3 6: e002999 doi:101136/bmjopen-2013-002999 PMC 3669720  PMID 23794547 
  13. ^ Moldofsky H, Scarisbrick P, England R, Smythe H 1 July–August 1975 "Musculosketal symptoms and non-REM sleep disturbance in patients with "fibrositis syndrome" and healthy subjects" Psychosom Med 37 4: 341–51 doi:101097/00006842-197507000-00008 PMID 169541  Check date values in: |date= help
  14. ^ Moldofsky, H; Scarisbrick, P 1 January–February 1976 "Induction of neurasthenic musculoskeletal pain syndrome by selective sleep stage deprivation" Psychosom Med 38 1: 35–44 doi:101097/00006842-197601000-00006 PMID 176677  Check date values in: |date= help
  15. ^ a b c Lewis, Steven L 2013 Neurological disorders due to systemic disease Chichester, West Sussex: Wiley-Blackwell pp 261–282 ISBN 978-1-4443-3557-6 
  16. ^ a b Zingone, F; Siniscalchi, M; Capone, P; Tortora, R; Andreozzi, P; Capone, E; Ciacci, C 2010 "The quality of sleep in patients with coeliac disease" Alimentary Pharmacology & Therapeutics 32 8: 1031–1036 doi:101111/j1365-2036201004432x ISSN 0269-2813 
  17. ^ a b "Abstractverwaltung Congrex" Retrieved Aug 10, 2014 
  18. ^ "About Idiopathic Hypersomnia" Hypersomnia Foundation 2015 Retrieved 30 January 2017 

External linksedit

  • Hypersomnia Foundation
  • National Sleep Foundation
  • Talk About Sleep - Idiopathic Hypersomnia
  • Help: I can't stay awake! - Public Radio Interview with Dr David Rye
  • med/3129 at eMedicine - "Primary Hypersomnia"

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