What Is Hypersomnia? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Feeling drowsy and sluggish once in a while isn’t unusual, but if these symptoms occur frequently — for example, over a period of several months or more than two days per week — and interfere with your work, school, activities, or relationships, you may be dealing with hypersomnia, the medical term for excessive daytime sleepiness.

“It’s when you can’t pay attention to things, you can’t focus,” says Carl W. Bazil, MD, PhD, a clinical neurophysiologist with Columbia University Irving Medical Center in New York City. “Some people think they’re having memory problems when it’s actually hypersomnia.”

Or it could be the result of a bad night’s sleep. “That's something we run into all the time,” Dr. Bazil says, adding that a lack of sleep can affect your performance on a daily basis. And of course, over time, poor sleep can lead to a host of health problems.

No matter the underlying cause, feeling exhausted during the day is not something you’ll want to brush aside. “No matter how it shows up, it can be a sign of a serious problem, and it needs to be addressed,” says Vishesh Kapur, MD, MPH, a sleep medicine physician and the founder of the UW Medicine Sleep Medicine Clinic in Seattle.

There are two types of hypersomnia: primary hypersomnia and secondary hypersomnia.

You may not hear these terms from your doctor, however, explains Safia Khan, MD, an assistant professor of family medicine and neurology at the UT Southwestern Peter O'Donnell Jr. Brain Institute in Dallas. “Different clinics practice differently, but we don't specifically call it primary or secondary hypersomnia.”

According to both Bazil and Dr. Kapur, the top cause of excessive daytime sleepiness they see in their clinical practice isn’t an underlying disorder or condition but rather lack of adequate sleep duration.

• Sleep disorders, such as obstructive sleep apnea (OSA), narcolepsy, or Kleine-Levin syndrome
• Other medical conditions, including multiple sclerosis, depression, encephalitis, epilepsy, or obesity
• Alcohol and recreational drug use
• Certain medications, such as prescription high blood pressure medications, steroids, decongestants, antidepressants, and diet pills

  

• A genetic predisposition

The National Institute of Neurological Disorders and Stroke (NINDS) points out that this daytime sleepiness is different from when you feel tired after interrupted sleep, as this extreme sleepiness may make you fall asleep at inappropriate times.

Other symptoms of hypersomnia can include (according to Cleveland Clinic, NINDS, and other research):

• Feeling very sleepy during the day
• Difficulty waking up in the morning
• Waking up with sleep inertia, also called “sleep drunkenness,” which refers to a period of sleepiness and confusion
• Restlessness
• Anxiety and irritability
• Headaches, loss of appetite, or hallucinations
• Trouble focusing or concentrating
• Slow thinking
• Decreased energy
• Slow speech
  

If this sounds like something you may be dealing with, you can self-assess your sleep using the Epworth Sleepiness Scale, available on the CDC’s website. The results may suggest you seek medical intervention for a possible sleep disorder, or at least ask your doctor or healthcare provider about symptoms you’re experiencing.

Your first visit should be to your primary care doctor, who will likely start by taking a thorough medical history and then try to rule out obvious reasons for the sleepiness. He or she may refer you to a clinical sleep medicine specialist (doctors who work at sleep medicine clinics or sleep health centers) to properly identify any underlying causes of the hypersomnia and to discuss the best ways to treat it.

There's a simple device you can use at home overnight, or you can do a more involved test in a sleep laboratory, Bazil says.

If you are getting enough sleep and are still experiencing daytime sleepiness, it’s possible you have idiopathic hypersomnia, sometimes referred to as hypersomnolence disorder, according to the NIH’s National Center for Advancing Translational Sciences.

“Idiopathic hypersomnia is really a diagnosis of exclusion,” Bazil says. “If you are still sleepy and there's no other diagnosis, that's idiopathic hypersomnia, though it’s pretty unusual.”

Along with polysomnography, there are additional tests to diagnose idiopathic insomnia, such as the multiple sleep latency test (MSLT), according to Stanford Medicine. (The MSLT measures sleep latency, or how fast a person falls asleep, as well as how quickly they enter REM sleep.)

A Maintenance of Wakefulness Test, which assesses daytime alertness, may also be used, per the Hypersomnia Foundation, though participants may experience side effects from sleep deprivation, such as headaches.

• You experience excessive sleepiness with prolonged sleep or daily daytime sleep episodes for at least one month (or you experience excessive sleepiness that lasts at least three days several times a year for at least two years).
• You’re unable to function properly and see the effects mentally, socially, and professionally.
• Your excessive sleepiness isn’t due to another known cause.

Treatment differs depending on whether you’re dealing with primary or secondary hypersomnia. “If you have secondary hypersomnia, you can't treat the hypersomnia without treating the underlying sleep disorder,” Dr. Khan says. If you're diagnosed with an underlying medical condition, treatment may involve making some changes to your daily sleep habits and possibly taking medication.

Treating idiopathic hypersomnia involves two approaches to medication. “There are some medications that can help consolidate sleep at night,” Bazil says. “There are other medicines that are used for wakefulness during the day.”

• Keep a regular sleep schedule. Go to bed at the same time and wake up at the same time, ideally every night of the week.
• Don’t nap. Daytime naps decrease the amount of sleep you need the next night, causing sleep fragmentation and difficulty falling asleep at bedtime.
• Turn off the TV and other electronic devices before you get into bed. The bed is a place for rest, and a computer, cell phone, or laptop screen may overstimulate your brain and keep you awake.
• Avoid caffeinated drinks later in the day. Caffeine’s effects last for several hours, so skip beverages like coffee, tea, and soda after noon.
• Exercise regularly. Exercise promotes continuous sleep, but try to get your workout in earlier in the day. Avoid rigorous exercise before bedtime, as it stimulates the circulation of endorphins in your body, which may keep you awake.
• Maintain a quiet, comfortable bedroom. Set your bedroom thermostat at a comfortable temperature. If your pets keep you awake, keep them out of the bedroom. You should also maintain a peaceful sleeping environment by keeping your bedroom dark and having a comfortable mattress.

You can, however, gain control of your excessive daytime sleepiness by working with your doctor to find the right treatment and making changes, with a goal of better sleep, improved function during the day, and a better-rested, healthier, and safer you.

• Is more common in women than men
• Affects about 5 percent of the population, with primary hypersomnia occurring in only about 1 percent of the population (Primary hypersomnia affects fewer than 200,000 people in the United States, notes the Genetic and Rare Diseases Information Center.)
• Is usually diagnosed when a patient is between ages 17 and 24

Sodium oxybate, a prescription drug that induces a very deep sleep, is a relatively new treatment for idiopathic hypersomnia, Bazil says.

Khan says a possible future area of research could be how diet affects hypersomnia. “Anecdotally, I’ve had patients report improved symptoms when they avoid processed food and improve their diet,” Khan says.

• Epilepsy
• Hypothyroidism
• Encephalitis
• Multiple sclerosis
• Parkinson’s disease
• Obesity
• Obstructive sleep apnea
• Delayed sleep phase syndrome
• Multiple systems atrophy
• Myotonic dystrophy
• Mood disorders, including depression, bipolar disorder, seasonal depression
• Diseases related to the central nervous system
• Head trauma
• Tumors

The Hypersomnia Foundation

The Hypersomnia Foundation is a nonprofit organization dedicated to advocating for the unmet needs of people with hypersomnia and other sleep disorders. The website has information about various sleep disorders, treatment options, current research, and a directory of providers who can help. Their page for the “newly diagnosed” is particularly helpful for anyone who’s learning to deal with hypersomnia. The organization also has a guide for parents of children with idiopathic hypersomnia. Here, you’ll find guides on how to ask for special accommodations, useful technology, and how to help your child navigate higher education.

The National Sleep Foundation (NSF)

NSF has been around for more than three decades and serves as a go-to resource for sleep science and sleep health. The website has articles on how to get a good night’s sleep, how to know if your sleep habits are normal, and when it’s time to see a doctor for sleep issues.

The Hypersomnia Alliance

The Hypersomnia Alliance is a group that helps people connect via online support groups and retreats for people with hypersomnia and central disorders of hypersomnolence, such as narcolepsy. Their website has a list of Facebook support groups that could be helpful for those looking to connect with others in similar situations.

National Institute of Neurological Disorders and Stroke

This NIH site can help you learn what sleep is and why it matters. It covers what’s happening within the brain while sleep occurs, how technology can be used to track your sleep, and more.