Hypersomnia

Definition and Overview
Hypersomnia is a sleep disorder characterized by excessive daytime sleepiness or prolonged nighttime sleep that interferes with daily functioning. Unlike occasional tiredness, hypersomnia involves persistent difficulty staying awake during the day, even after seemingly adequate or long periods of rest. It may be primary (idiopathic hypersomnia) or secondary to other medical, neurological, or psychiatric conditions.

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Causes

• Primary causes

  • Idiopathic hypersomnia (a neurological disorder without clear external cause).

  • Narcolepsy (with or without cataplexy).

• Secondary causes

  • Sleep apnea (obstructive or central).

  • Restless legs syndrome or periodic limb movement disorder.

  • Neurological diseases (Parkinson’s, multiple sclerosis, brain injury).

  • Psychiatric disorders (depression, bipolar disorder).

  • Chronic fatigue syndrome.

• Lifestyle or substance-related

  • Sedating medications (antihistamines, benzodiazepines, antipsychotics).

  • Alcohol or drug use.

  • Poor sleep hygiene (irregular sleep schedules, excessive screen time).

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Symptoms

• Persistent and overwhelming sleepiness during the day.

• Difficulty waking up in the morning (sleep inertia).

• Long naps that are unrefreshing.

• Prolonged nighttime sleep (sometimes 10–12+ hours).

• Cognitive impairment (poor concentration, memory problems).

• Irritability, anxiety, or depression.

• Impaired performance at work, school, or social activities.

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Diagnosis

• Clinical evaluation: Review of medical, psychiatric, and sleep history.

• Sleep diary and actigraphy: Monitoring sleep-wake patterns over days/weeks.

• Polysomnography (overnight sleep study): To exclude sleep apnea or other sleep disorders.

• Multiple Sleep Latency Test (MSLT): Measures how quickly a person falls asleep during the day.

• Blood tests and imaging: To rule out thyroid disorders, infections, or neurological causes.

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Treatment
Treatment depends on whether hypersomnia is primary or secondary.

• Lifestyle and behavioral strategies

  • Maintain a consistent sleep schedule.

  • Improve sleep hygiene (quiet, dark environment, limit caffeine/alcohol).

  • Scheduled daytime naps if appropriate.

  • Regular exercise.

• Pharmacological treatment

  • Stimulants (e.g., methylphenidate, modafinil, armodafinil) to promote wakefulness.

  • Wake-promoting agents (solriamfetol, pitolisant) used in narcolepsy and idiopathic hypersomnia.

  • Antidepressants may be considered if linked to depression.

  • Adjusting or stopping sedative medications if they are contributing factors.

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Complications if Untreated

• Impaired work or academic performance.

• Increased risk of accidents (e.g., falling asleep while driving).

• Strain on personal and social relationships.

• Increased risk of psychiatric conditions like depression.

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Precautions

• Avoid driving or operating heavy machinery when excessively drowsy.

• Seek medical evaluation for persistent excessive sleepiness lasting more than a few weeks.

• Monitor medication side effects if stimulants or wake-promoting drugs are prescribed.

• Address underlying conditions such as sleep apnea or mood disorders.

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Drug Interactions

• Stimulants (e.g., modafinil, methylphenidate): May interact with antihypertensives, antidepressants, and anticoagulants.

• Sedatives (benzodiazepines, opioids, alcohol): Worsen hypersomnia and should be avoided.

• Antidepressants: Can interact with stimulants and increase the risk of serotonin syndrome.

• Caffeine: May potentiate stimulant effects and cause jitteriness or palpitations.