Recurrent Hypersomnia
Recurrent hypersomnia is an unusual disorder and diagnosed by recurrent episodes of hypersomnia more than 18 hours a day lasting from several days to several weeks.
Hypersomnia refers to a set of related disorders that involve excessive daytime sleepiness.
Types Of Hypersomnia
There are two main types of hypersomnia: primary hypersomnia (sometimes called idiopathic hypersomnia) and recurrent hypersomnia (sometimes called recurrent primary hypersomnia). Both are characterized by the same signs and symptoms and differ only in the frequency and regularity with which the symptoms occur.
Primary hypersomnia is characterized by excessive daytime sleepiness over a long period of time. The symptoms are present all, or nearly all, of the time. Recurring hypersomnia involves periods of excessive daytime sleepiness that can last from one to many days, and happen again over the course of a year or more.
The primary difference between this and primary hypersomnia is that persons experiencing recurring hypersomnia will have extended periods where they do not exhibit any signs of hypersomnia, whereas persons experiencing primary hypersomnia are affected by it nearly all the time.
Kleine-Levin syndrome
One of the best-documented forms of recurrent hypersomnia is Kleine-Levin syndrome, although there are other forms as well. The Kleine-Levin syndrome is a subtype of the recurrent hypersomnia and characterized by excessive eating or hyper sexuality.
There are many different causes for daytime sleepiness that are not considered hypersomnia, and there are many diseases and disorders in which excessive daytime sleepiness is a primary or secondary symptom.
Feelings of daytime sleepiness are frequently associated with the use of common substances such as caffeine, alcohol, and many medications. Other common factors that can lead to excessive daytime sleepiness that is not considered hypersomnia include shift work and insomnia.
Shift work can disrupt the body's natural sleep rhythms. Insomnia can cause excessive daytime sleepiness because of lack of nighttime sleep, and is a separate disorder.
Recurrent Hypersomnia Causes And Symptoms
People experiencing hypersomnia do not get irregular amounts of nighttime sleep. However, they frequently have problems waking up in the morning and staying awake during the day. People with hypersomnia nap frequently, and upon waking from the nap, do not feel refreshed.
Hypersomnia is sometimes misdiagnosed as narcolepsy. In many ways the two are similar. One significant difference is that people with narcolepsy experience a sudden onset of sleepiness, while people with hypersomnia experience increasing sleepiness over time.
Also, people with narcolepsy find daytime sleep refreshing, while people with hypersomnia do not. The causes of hypersomnia remain unclear. There is some speculation that in many cases it can be attributed to problems involving the hypothalamus, but there is little evidence to support that claim.
Recurrent Hypersomnia Diagnosis
Hypersomnia is characterized by excessive daytime sleepiness, and daytime naps that do not result in a more refreshed or attentive feeling. Hypersomnia does not include lack of nighttime sleep.
People experiencing problems with nighttime sleep may have insomnia, a separate sleep disorder. In people with insomnia, excessive daytime sleepiness may be a side effect.
Talk to your doctor, if you consistently feel drowsy during the day. In making a diagnosis of hypersomnia, your doctor will ask you about your sleeping habits; if you wake up at night, how much sleep you get at night, and whether you fall asleep during the day.
Your doctor will also want to know if you are having any emotional problems or are taking any medications that may be interfering with your sleep. The doctor may also order some tests, including blood tests, computed tomography (CT) scans, and a sleep test called Polysomnography.
In some cases, an additional electroencephalogram (EEG), which measures the electrical activity of the brain, is needed.
Recurrent Hypersomnia Treatments
There have been some attempts at using drugs to treat hypersomnia. No substantial body of evidence supports the effectiveness of these treatments. Stimulants are not generally recommended to treat hypersomnia as they treat the symptoms but not the base problem.
Some researchers believe that treatment of the hypothalamus may be a possible treatment for hypersomnia. If you are diagnosed with hypersomnia, your doctor can prescribe various drugs to treat it.
Stimulants, such as amphetamine, methylphenidate, and modafinil, may be prescribed. Other drugs used to treat hypersomnia include clonidine, levodopa, bromocriptine, antidepressants, and monoamine oxidase inhibitors.
Changes in behavior and diet may offer some relief. Patients should avoid alcohol and caffeine. Dosage of stimulants is based on individual need. Modafinil is given as a single morning dose of 200 or 400 mg, Methylphenidate 20 to 60 mg/day, ephedrine 25 mg, amphetamine 10 to 20 mg, dextroamphetamine 5 to 10 mg.
Tricyclic antidepressants (particularly clomipramine, imipramine and protriptyline) and monoamine oxidase inhibitors are useful in treating sleep paralysis, cataplexy and hypnagogic hallucinations.
Imipramine 10-to 75-mg/day po is the drug of choice to treat cataplexy but should be taken only during the day to reduce nocturnal arousal. Patients taking both imipramine and stimulants risk developing hypertension and should be closely monitored.
