What are hypersomnia (excessive daytime sleepiness)?
Hypersomnia are disorders that are characterized by excessive daytime sleepiness not attributable to medical causes, medication or other sleep disorders (for example, sleep apnea or restless legs syndrome).
There are generally two disorders characterized by excessive sleepiness: idiopathic hypersomnia and narcolepsy.
How does hypersomnia (excessive daytime sleepiness) manifest?
Idiopathic hypersomnia may present with a prolonged increase in the duration of nocturnal sleep (even beyond 10 hours), daytime sleepiness, and / or involuntary daytime naps.
Those suffering from this disorder, despite the large amount of sleep, do not feel rested upon awakening and struggle to get up in the morning.
The diagnosis is quite complex, as it requires that all other possible causes of drowsiness be excluded, such as, for example, a fragmented night’s sleep, breathing disorders in sleep, taking medications, mood disorders, etc …
Narcolepsy is a serious, disabling, but above all chronic, disorder that persists throughout life. It is characterized by the presence of four key symptoms:
- excessive daytime sleepiness: irrepressible urge to fall asleep, sudden sleep attacks during the day, especially while engaging in monotonous activities (e.g. in front of the television, or at school)
- in the presence of strong emotions (positive or negative), there is a loss of strength and sometimes even falling to the ground (cataplexy)
- daydreams, visual hallucinations (hypnagogic hallucinations) even during the day
- despite being conscious, the patient experiences, upon falling asleep and / or awakening, inability to move, as if paralyzed (paralysis in sleep).
How common are hypersomnia (excessive daytime sleepiness)?
In the case of idiopathic hypersomnia, the onset of the disease usually occurs before the age of 25 (usually between 15 and 30 years) and shows a prevalence of 4-15 in 10,000 individuals. Narcolepsy has a prevalence of approximately 1 -2 cases per 1000 people. Due to the poor knowledge of this disorder, it can go unnoticed for a long time or, especially in Italy compared to other European countries, it can be diagnosed late. In any case, with respect to the age of onset, a peak is observed between 15 and 25 years.
What are the causes of hypersomnia (excessive daytime sleepiness)?
For both disorders the etiology is still unknown. In the case of Narcolepsy, the symptoms suggest that REM sleep dysregulation may be present, and recent research has shown, in patients suffering from this pathology, a reduction in the spinal fluid of a neuromediator called hypocretic / orexin.
Finally, at the genetic level, those who suffer from this disease present common leukocyte antigens (HLA).
How does hypersomnia (excessive daytime sleepiness) present in children?
Unlike insomnia, daytime sleepiness can remain unrecognized and ignored even by parents for a long time. Disorders related to sleepiness are in fact frequently attributed to other factors (behavioral problems, laziness, etc.) and often the diagnosis occurs only after entering school, for learning disabilities or because the child falls asleep in class.
Excessive daytime sleepiness also occurs very differently in children than in adults. In fact, among the most common symptoms we find: hyperactivity, irritability, attention problems, aggression, learning disabilities, sudden sleep attacks, frequent naps, drops in concentration, distractibility, slowed speech and growth retardation. In the case of Narcolepsy, what most leads parents to ask for a medical consultation are, more than drowsiness, episodes of decreased muscle tone (cataplexy). An interesting relationship has been observed between the onset of Narcolepsy in school age and precocious puberty in the developmental age.
How is hypersomnia (excessive daytime sleepiness) diagnosed?
Diagnosis is mainly made through the use of instrumental techniques such as nocturnal polysomnography and a daytime test which consists of naps scheduled at regular intervals every two hours (multiple latency tests in sleep).
What is the treatment of hypersomnia (excessive daytime sleepiness)?
As it was said initially, compared to Narcolepsy, there is currently no treatment that is able to resolve the disorder, but there are a whole series of behavioral measures and drugs that help keep the symptoms under control.
For sleepiness, the most commonly used drugs are methylphenidate and modafinil, which help keep alertness high. For the other symptoms (cataplexy, hypnagogic hallucinations and sleep paralysis), tricyclic antidepressants are used and, recently, the use of viloxazine is proving effective, which among other things, in addition to helping to control cataplexy, increases the level of alertness.
However, pharmacological treatment alone does not lead to a remission of symptoms, but it is advisable to associate a behavioral approach.
In fact, it is necessary to instruct the patient (in the case of children the parent) on some precautions to be taken to counter the problem. Among the most effective are:
- Take 15-20 minute rests about every two hours
- Take stimulant substances such as coffee, tea and cola
- Before carrying out potentially “dangerous” activities, such as, for example, driving a car, remember to take a nap, even if only for 15 minutes.
It is also very important to make the patient aware of the chronic and disabling nature of the disorder, in order to highlight the importance of pharmacological / behavioral treatment.
Another fundamental aspect is given by psychological support to patients affected by this disease. In fact, the symptoms themselves, in adults as well as children, lead to a reduction in self-esteem, to a social closure (the fear of falling asleep in public determines the tendency to be isolated), with the consequent possibility of developing mood disorders.
Therefore it is essential, also in order to make the chosen pharmacological therapy more effective, to associate psychological / psychotherapeutic support.
