Editing Hypersomnia

{{short description|Neurological disorder of excessive time spent sleeping or excessive sleepiness}}
{{distinguish|Narcolepsy}}
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'''Hypersomnia''' is a [[neurological disorder]] of excessive time spent sleeping or [[Excessive daytime sleepiness|excessive sleepiness]]. It can have many possible causes (such as [[seasonal affective disorder]]) and can cause [[Distress (medicine)|distress]] and problems with functioning.<ref name="DSM-sleep">{{cite web|title=Sleep Disorders|url=http://www.dsm5.org/patients-families/sleep-disorders/what-are-sleep-disorders|publisher=American Psychiatric Association|access-date=12 January 2017|date=2015}}</ref> 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 disorder]]s.<ref name="DSM-5 Sleep-Wake">{{cite web |url=http://www.dsm5.org/Pages/RecentUpdates.aspx |title=Recent Updates to Proposed Revisions for DSM-5: Sleep-Wake Disorders |work=DSM-5 Development |publisher= American Psychiatric Association }}</ref>

Hypersomnia is a pathological state characterized by a lack of [[alertness]] during the waking episodes of the day.<ref name="AASM">American Academy of Sleep Medicine. The international classification of sleep disorders: diagnostic & coding manual (2nd ed). Westchester, IL: American Academy of Sleep Medicine, 2005.</ref> It is not to be confused with [[fatigue]], which is a normal physiological state.<ref>Grossman, A., Barenboim, E., Azaria, B., Sherer, Y., & Goldstein, L. (2004). The maintenance of wakefulness test as a predictor of alertness in aircrew members with idiopathic hypersomnia. ''Aviation, space, and environmental medicine, 75''(3), 281–283.</ref> Daytime sleepiness appears most commonly during situations where little interaction is needed.<ref>Wise, M. S., Arand, D. L., Auger, R. R., Brooks, S. N., & Watson, N. F. (2007). Treatment of narcolepsy and other hypersomnias of central origin. ''Sleep, 30''(12), 1712–1727.</ref>

Since hypersomnia impairs patients' attention levels ([[wakefulness]]), quality of life may be impacted as well.<ref name="Morgenthaler">Morgenthaler, T. I., Kapur, V. K., Brown, T. M., Swick, T. J., Alessi, C., Aurora, R. N., … Zak, R. (2007). Practice Parameters for the Treatment of Narcolepsy and other Hypersomnias of Central Origin. ''Sleep, 30''(12), 1705‑1711. https://doi.org/10.1093/sleep/30.12.1705</ref> This is especially true for people whose jobs request high levels of attention, such as in the healthcare field.<ref name="Morgenthaler"/>

This is not to be confused with [[clinophilia]], a sleep disorder where a person intentionally refuses to get out of bed, regardless of a disease or not.

== Symptoms ==
The main symptom of hypersomnia is [[excessive daytime sleepiness]] (EDS), or prolonged nighttime sleep,<ref>{{Cite web |title= NINDS Hypersomnia information page |url= http://www.ninds.nih.gov/disorders/hypersomnia/hypersomnia.htm |access-date= 2009-01-23 |archive-url= https://web.archive.org/web/20090825020421/http://www.ninds.nih.gov/disorders/hypersomnia/hypersomnia.htm |archive-date= 2009-08-25 |url-status= dead }}</ref> which has occurred for at least 3 months prior to diagnosis.<ref name="Dauvilliers">{{cite journal |title=Differential Diagnosis in Hypersomnia |author=Dauvilliers, Yves|journal=Current Neurology and Neuroscience Reports |volume=6 |issue=2 |pages=156–162 |year=2006 |doi=10.1007/s11910-996-0039-2 |pmid=16522270 |s2cid=43410010 |display-authors=etal}}</ref>

Sleep drunkenness is also a symptom found in hypersomniac patients.<ref name="Roth">Roth, B. (1972). Hypersomnia With « Sleep Drunkenness ». ''Archives of General Psychiatry, 26''(5), 456. https://doi.org/10.1001/archpsyc.1972.01750230066013</ref><ref name="Trotti">Trotti, L. M. (2017). Waking up is the hardest thing I do all day: Sleep inertia and sleep drunkenness. ''Sleep medicine reviews, 35'', 76–84.</ref> It is a difficulty transitioning from sleep to wake.<ref name="Trotti"/> Individuals experiencing sleep drunkenness report waking with confusion, disorientation, slowness and repeated returns to sleep.<ref name="Roth"/><ref>Vernet, C., & Arnulf, I. (2009). Idiopathic hypersomnia with and without long sleep time: A controlled series of 75 patients. ''Sleep, 32''(6), 753–759.</ref>

It also appears in non-hypersomniac persons, for example after a night of insufficient sleep.<ref name="Roth"/> Fatigue and consumption of alcohol or hypnotics can cause sleep drunkenness as well.<ref name="Roth"/> It is also associated with irritability: people who get angry shortly before sleeping tend to experience sleep drunkenness.<ref name="Roth"/>

According to the [[American Academy of Sleep Medicine]], hypersomniac patients often take long naps during the day that are mostly unrefreshing.<ref name="AASM" /> Researchers found that naps are usually more frequent and longer in patients than in controls.<ref name="Vernet">Vernet, C., Leu-Semenescu, S., Buzare, M.-A., & Arnulf, I. (2010). Subjective symptoms in idiopathic hypersomnia: Beyond excessive sleepiness. ''Journal of sleep research, 19''(4), 525–534.</ref> Furthermore, 75% of the patients report that short naps are not refreshing either, compared to controls.<ref name="Vernet"/>

== Diagnosis ==
"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)."<ref name="Dauvilliers" /> The [[Stanford Sleepiness Scale|Stanford sleepiness scale]] (SSS) is another frequently-used subjective measurement of sleepiness.<ref name=freedman>{{Cite web|url = http://www.uptodate.com/contents/quantifying-sleepiness| access-date = 2013-07-23|title = Quantifying sleepiness |author = Neil Freedman, MD }}</ref> After it is determined that excessive daytime sleepiness 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 undertaken.<ref name="Dauvilliers" />

=== Differential diagnosis ===
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 excessive daytime sleepiness needs to be assessed. When specific treatments of the known condition do not fully suppress excessive daytime sleepiness, additional causes of hypersomnia should be sought.<ref name="2001 Montplaisir">{{cite journal | title = Idiopathic hypersomnia: a diagnostic dilemma. A commentary of "Idiopathic hypersomnia" (M. Billiard and Y. Dauvilliers) | journal = Sleep Medicine Reviews | year = 2001 | last = Montplaisir | doi=10.1053/smrv.2001.0216 | pmid=12530999 | volume=5 | issue = 5 | pages=361–362}}</ref> For example, if a patient with sleep apnea is treated with CPAP ([[continuous positive airway pressure]]), which resolves their apneas but not their excessive daytime sleepiness, it is necessary to seek other causes for the excessive daytime sleepiness. [[Obstructive sleep apnea]] "occurs frequently in [[narcolepsy]] and may delay the diagnosis of narcolepsy by several years and interfere with its proper management."<ref>{{cite journal | title = Obstructive sleep apnea in narcolepsy | journal = Sleep Med | date = Jan 2010 | first1 = G | last1 = Sansa | doi = 10.1016/j.sleep.2009.02.009 | pmid = 19699146 | last2 = Iranzo | first2 = Alex | last3 = Santamaria | first3 = Joan | volume = 11 | pages = 93–5 | issue = 1}}</ref>

==== Primary hypersomnias ====
The true primary hypersomnias include:<ref name="Dauvilliers" />

* [[Narcolepsy]] (with and without [[cataplexy]])
* [[Idiopathic hypersomnia]]
* Recurrent hypersomnias (like [[Kleine-Levin syndrome]])

==== Primary hypersomnia mimics ====

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. Myotonic dystrophy is often associated with SOREMPs ([[Sleep onset|sleep onset REM periods]], such as occur in narcolepsy).<ref name="Dauvilliers" />

There are many [[neurological disorders]] that may mimic the primary hypersomnias, narcolepsy and idiopathic hypersomnia: [[brain tumors]]; [[Stroke|stroke-provoking lesions]]; [[clinophilia]]; 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 causes.<ref name="Dauvilliers" />

Early [[hydrocephalus]] can also cause severe excessive daytime sleepiness.<ref name="ref-3">{{Cite web | title = International classification of sleep disorders, revised: Diagnostic and coding manual | url = http://www.esst.org/adds/ICSD.pdf | publisher = American Academy of Sleep Medicine | year = 2001 | access-date = 25 January 2013 | url-status = dead | archive-url = https://web.archive.org/web/20110726034931/http://www.esst.org/adds/ICSD.pdf | archive-date = 26 July 2011 }}</ref> 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."<ref name="Dauvilliers" />

==== Secondary hypersomnias ====
Secondary hypersomnias are extremely numerous.

Hypersomnia can be secondary to disorders such as [[clinical depression]], [[multiple sclerosis]], [[encephalitis]], [[epilepsy]], or [[obesity]].<ref name="NINDS"/> Hypersomnia can also be a symptom of other sleep disorders, like [[sleep apnea]].<ref name="NINDS"/> It may occur as an [[adverse effect]] of taking certain medications, of withdrawal from some medications, or of substance use.<ref name="NINDS"/> A genetic predisposition may also be a factor.<ref name="NINDS"/> In some cases it results from a physical problem, such as a tumor, head trauma, or dysfunction of the [[autonomic nervous system|autonomic]] or [[central nervous system]].<ref name="NINDS">{{cite web |url= http://www.ninds.nih.gov/disorders/hypersomnia/hypersomnia.htm |title= NINDS Hypersomnia Information Page |access-date= 2009-01-23 |author= National Institutes of Health |date= June 2008 |archive-url= https://web.archive.org/web/20090825020421/http://www.ninds.nih.gov/disorders/hypersomnia/hypersomnia.htm |archive-date= 2009-08-25 |url-status= dead }}</ref>

Sleep apnea is the second 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 hypersomnia.<ref name="Dauvilliers" /> 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 excessive daytime sleepiness persists after CPAP treatment, indicating an additional cause, or causes, of the hypersomnia and requiring further evaluation.<ref name="2001 Montplaisir" />

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 excessive daytime sleepiness, 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 excessive daytime sleepiness. In addition, EDS in these patients is best treated with psychostimulants—and not with dopaminergic agents known to suppress PLMS."<ref name="2001 Montplaisir" />

[[Neuromuscular disease]]s and [[spinal cord diseases]] often lead to sleep disturbances due to respiratory dysfunction causing sleep apnea, and they may also cause [[insomnia]] related to pain.<ref name="MedLink">{{Cite web | title = MedLink Clinical Summary: Sleep and neuromuscular and spinal cord disorders | url = http://www.medlink.com/web_content/index/MLT002PJ.asp  | publisher = MedLink | access-date = 7 January 2014}}</ref> "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]]."<ref name="MedLink" />

Primary hypersomnia in [[diabetes]], [[hepatic encephalopathy]], and [[acromegaly]] is rarely reported, but these medical conditions may also be associated with hypersomnia secondary to [[sleep apnea]] and [[periodic limb movement disorder]] (PLMD).<ref name="Dauvilliers" />

[[Myalgic encephalomyelitis/chronic fatigue syndrome]] (ME/CFS) and [[fibromyalgia]] can also be associated with hypersomnia. The CDC states that people with ME/CFS experience [[post-exertional malaise]], fatigue, and sleep problems (among other symptoms).<ref>{{Cite web |date=2024-04-23 |title=Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) {{!}} CDC |url=https://www.cdc.gov/me-cfs/index.html |access-date=2024-05-05 |website=www.cdc.gov |language=en-us}}</ref> Polysomnography shows reduced sleep efficiency and may include [[alpha intrusion]] into sleep [[EEG]].  ME/CFS can be comorbid with sleep disorders such as narcolepsy, sleep apnea, PLMD, etc.<ref name="pmid23794547">{{cite journal | vauthors = Gotts ZM, Deary V, Newton J, Van der Dussen D, De Roy P, Ellis JG | title = Are there sleep-specific phenotypes in patients with chronic fatigue syndrome? A cross-sectional polysomnography analysis | journal = BMJ Open | volume = 3 | issue = 6 | pages = e002999 | date = June 2013 | pmid = 23794547 | pmc = 3669720 | doi = 10.1136/bmjopen-2013-002999 }}</ref>

As with chronic fatigue syndrome, [[fibromyalgia]] may be associated with anomalous alpha wave activity (typically associated with arousal states) during [[NREM]] sleep.<ref name="pmid169541">{{cite journal | vauthors = Moldofsky H, Scarisbrick P, England R, Smythe H | title = Musculosketal symptoms and non-REM sleep disturbance in patients with "fibrositis syndrome" and healthy subjects | journal = Psychosom Med | volume = 37 | issue = 4 | pages = 341–51 | date = 1975 | pmid = 169541 | doi = 10.1097/00006842-197507000-00008| s2cid = 34100321 }}</ref> 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 patterns.<ref name="pmid176677">{{cite journal | vauthors = Moldofsky H, Scarisbrick P | title = Induction of neurasthenic musculoskeletal pain syndrome by selective sleep stage deprivation | journal = Psychosom Med | volume = 38 | issue = 1 | pages = 35–44 | date = 1976 | pmid = 176677 | doi = 10.1097/00006842-197601000-00006 | s2cid = 27588469 }}</ref>
[[Chronic kidney disease]] is commonly associated with sleep symptoms and excessive daytime sleepiness. 80% of those on [[Kidney dialysis|dialysis]] have sleep disturbances. Sleep apnea can occur 10 times as often in [[uremia|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 transplant.<ref name="Lewis Book">{{Cite book  | last1 = Lewis | first1 = Steven L. | title = Neurological disorders due to systemic disease | year = 2013 | publisher = Wiley-Blackwell | location = Chichester, West Sussex | isbn = 978-1-4443-3557-6 | pages = 261–282 }}</ref>

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 [[parasomnia]]s.<ref name="Lewis Book" />

[[Autoimmune disease]]s, especially [[lupus]] and [[rheumatoid arthritis]], are often associated with hypersomnia. [[Morvan's syndrome]] is an example of a rarer autoimmune illness that can also lead to hypersomnia.<ref name="Lewis Book" /> [[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."<ref name="ZingoneSiniscalchi2010">{{cite journal | vauthors = Zingone F, Siniscalchi M, Capone P, Tortora R, Andreozzi P, Capone E, Ciacci C | title = The quality of sleep in patients with coeliac disease | journal = Aliment. Pharmacol. Ther. | volume = 32 | issue = 8 | pages = 1031–6 | date = October 2010 | pmid = 20937049 |issn = 0269-2813| doi = 10.1111/j.1365-2036.2010.04432.x | url = https://hal.archives-ouvertes.fr/hal-00566325/file/PEER_stage2_10.1111%252Fj.1365-2036.2010.04432.x.pdf | doi-access = free }}</ref> There are also some case reports of central hypersomnia in celiac disease.<ref name="celiac hypersomnia abstract">{{cite web |url=http://registration.akm.ch/einsicht.php?XNABSTRACT_ID=111706&XNSPRACHE_ID=2&XNKONGRESS_ID=118&XNMASKEN_ID=900 |title=Abstractverwaltung Congrex |access-date=Aug 10, 2014 |archive-url=https://web.archive.org/web/20140812211503/http://registration.akm.ch/einsicht.php?XNABSTRACT_ID=111706&XNSPRACHE_ID=2&XNKONGRESS_ID=118&XNMASKEN_ID=900 |archive-date=August 12, 2014 |url-status=dead }}</ref> And RLS "has been shown to be frequent in celiac disease," presumably due to its associated iron deficiency.<ref name="ZingoneSiniscalchi2010"/><ref name="celiac hypersomnia abstract"/>

[[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 treated. Hypersomnia can also develop within months after viral infections such as [[Whipple's disease]], [[mononucleosis]], [[HIV]], and [[Guillain–Barré syndrome]].<ref name="Dauvilliers" />

Behaviorally induced insufficient sleep syndrome must 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 they may not necessarily be aware of it. This situation is becoming more prevalent in western society due to the modern demands and expectations placed upon the individual.<ref name="Dauvilliers" />

Many [[medication]]s can 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 medication(s) is needed; then, medication substitution can be undertaken.<ref name="Dauvilliers" />

[[Mood disorders]], like depression, [[anxiety disorder]] and [[bipolar disorder]], can also be associated with hypersomnia. The complaint of excessive daytime sleepiness 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."<ref name="Dauvilliers" /> 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 SOREMPs).<ref name="Dauvilliers" />

==== Posttraumatic hypersomnias ====
In some cases, hypersomnia can be caused by a brain injury.<ref>Guilleminault, C., Faull, K. F., Miles, L., & Van den Hoed, J. (1983). Posttraumatic excessive daytime sleepiness: A review of 20 patients. ''Neurology, 33''(12), 1584–1584.</ref> Researchers found that the level of sleepiness is correlated with the severity of the injury.<ref name="Watson">Watson, N. F., Dikmen, S., Machamer, J., Doherty, M., & Temkin, N. (2007). Hypersomnia following traumatic brain injury. ''Journal of Clinical Sleep Medicine, 3''(04), 363–368.</ref> Even if patients reported an improvement, sleepiness remained present for a year in about a quarter of patients with traumatic brain injury.<ref name="Watson" />

====Recurrent hypersomnias====
Recurrent hypersomnias are defined by several episodes of hypersomnia persisting from a few days to weeks.<ref name="Dauvilliers2">Dauvilliers, Y., & Buguet, A. (2005). Hypersomnia. ''Dialogues in clinical neuroscience, 7''(4), 347.</ref> These episodes can occur weeks or months apart from each other.<ref name="Dauvilliers2" /> There are 2 subtypes of recurrent hypersomnias: Kleine-Levin syndrome and menstrual-related hypersomnia.<ref name="Billiard">Billiard, M., & Podesta, C. (2013). Recurrent hypersomnia following traumatic brain injury. ''Sleep Medicine, 14''(5), 462‑465. https://doi.org/10.1016/j.sleep.2013.01.009</ref>

Kleine-Levin syndrome is characterized by the association of episodes of hypersomnias with behavioral, cognitive and mood abnormalities.<ref name="Billiard" /><ref>Arnulf, I., Zeitzer, J. M., File, J., Farber, N., & Mignot, E. (2005). Kleine–Levin syndrome: A systematic review of 186 cases in the literature. ''Brain, 128''(12), 2763–2776</ref> The behavioral disturbances can be composed of [[hyperphagia]], [[irritability]], or sexual disinhibition.<ref name="AASM" /> The cognitive disorders consist of confusion, hallucinations or delusions. Mood symptoms are characterized by anxiety or depression.<ref name="AASM"/>

Menstrual-related hypersomnia is characterized by episodes of excessive sleepiness associated with the menstrual cycle.<ref name="AASM" /> Researchers found that the degree of premenstrual symptoms were correlated with daytime sleepiness.<ref>Manber, R., & Bootzin, R. R. (1997). Sleep and the menstrual cycle. ''Health Psychology, 16''(3), 209.</ref> Unlike Kleine-Levin syndrome, [[hyperphagia]] and [[hypersexuality]] are not reported in people with menstrual-related hypersomnia, but [[hypophagia]] could be present.<ref>Rocamora, R., Gil-Nagel, A., Franch, O., & Vela-Bueno, A. (2010). Familial Recurrent Hypersomnia: Two Siblings with Kleine-Levin Syndrome and Menstrual-Related Hypersomnia. ''Journal of Child Neurology, 25''(11), 1408‑1410. https://doi.org/10.1177/0883073810366599</ref><ref name="blabla">Harris, S. F., Monderer, R. S., & Thorpy, M. (2012). Hypersomnias of Central Origin. Neurologic Clinics, 30(4), 1027‑1044. https://doi.org/10.1016/j.ncl.2012.08.002</ref> Ordinarily, these episodes appear 2 weeks before menstruation.<ref name="blabla" /> A few studies have attested that some hormones as [[prolactin]] and [[progesterone]] could be responsible for Menstrual-Related Hypersomnia.<ref name="blabla" /> Therefore, different contraceptive pills could improve the symptoms.<ref name="blabla" /> The sleep architecture changes.<ref name="blabla" /> There is a decrease of [[slow-wave sleep]] and an increase of slow-Theta-wave activity.<ref name="blabla" />

== Assessment tools ==

=== Polysomnography ===
Polysomnography is an objective sleep assessment method.<ref>Ibáñez, V., Silva, J., & Cauli, O. (2018). A survey on sleep assessment methods. ''PeerJ, 6'', e4849. https://doi.org/10.7717/peerj.4849</ref> It comprises a lot of electrodes which measure physiological variables related to sleep.<ref name="Marino">Marino, M., Li, Y., Rueschman, M. N., Winkelman, J. W., Ellenbogen, J. M., Solet, J. M., … Buxton, O. M. (2013). Measuring sleep: Accuracy, sensitivity, and specificity of wrist actigraphy compared to polysomnography. ''Sleep, 36''(11), 1747–1755.</ref> Polysomnography often includes [[electroencephalography]], [[electromyography]], [[electrocardiography]], muscle activity and respiratory function.<ref name="Marino"/><ref>Chesson Jr, A. L., Ferber, R. A., Fry, J. M., Grigg-Damberger, M., Hartse, K. M., Hurwitz, T. D., … Rosen, G. (1997). The indications for polysomnography and related procedures. ''Sleep, 20''(6), 423–487.</ref>

Polysomnography is helpful to identify the very short sleep onset latency period, the very efficient sleep (more than 90%), the increased slow wave sleep, and sometimes an elevated amount of sleep spindles in idiopathic hypersomnia patients.<ref name="Bassetti 2011 969–979">{{Citation|last1=Bassetti|first1=Claudio L.|title=Idiopathic Hypersomnia|date=2011|work=Principles and Practice of Sleep Medicine|pages=969–979|publisher=Elsevier|isbn=9781416066453|last2=Dauvilliers|first2=Yves|doi=10.1016/b978-1-4160-6645-3.00086-4}}</ref>

=== Multiple sleep latency test (MSLT) ===
The 'multiple sleep latency test' (MSLT) is an objective tool which indicates the degree of sleepiness by measuring the sleep latency (i.e. the speed of falling asleep).<ref name="Carskadon">Carskadon, M. A. (1986). Guidelines for the multiple sleep latency test (MSLT): A standard measure of sleepiness. ''Sleep, 9''(4), 519–524.</ref><ref name="Littner">Littner, M. R., Kushida, C., Wise, M., G. Davila, D., Morgenthaler, T., Lee-Chiong, T., … Berry, R. B. (2005). Practice parameters for clinical use of the multiple sleep latency test and the maintenance of wakefulness test. ''Sleep, 28''(1), 113–121.</ref> It also gives information regarding the presence of abnormal REM sleep onset episodes.<ref name="Carskadon"/> During that test, patients have a series of opportunities to sleep at 2-h intervals across the day in a darkened room and with no external alerting influences.<ref name="Littner" /><ref>{{cite journal |last1=Thorpy |first1=MJ |title=The clinical use of the Multiple Sleep Latency Test. The Standards of Practice Committee of the American Sleep Disorders Association |journal=Sleep |date=June 1992 |volume=15 |issue=3 |pages=268–76 |doi=10.1093/sleep/15.3.268 |pmid=1621030|doi-access=free }}</ref>

The MSLT is often administered the day after recording the polysomnography, and the mean sleep latency score is often found to be around (or less than) 8 minutes in idiopathic hypersomnia patients.<ref name="Bassetti 2011 969–979"/> Some patients might even have a sleep onset latency of 5 minutes or less. These patients are often even more aware of sleeping during naps than narcolepsy patients.

=== Actigraphy ===
[[Actigraphy]], which operates by analyzing the patient's limb movements, is used to record the sleep and wake cycles.<ref name="Ancoli">Ancoli-Israel, S., Cole, R., Alessi, C., Chambers, M., Moorcroft, W., & Pollak, C. P. (2003). The role of actigraphy in the study of sleep and circadian rhythms. ''Sleep, 26''(3), 342–392.</ref> In order to report them, the patient has to wear continuously a device on his or her wrist, which looks like a watch and does not contain any electrodes.<ref name="Ancoli"/><ref name="Lichstein">Lichstein, K. L., Stone, K. C., Donaldson, J., Nau, S. D., Soeffing, J. P., Murray, D., … Aguillard, R. N. (2006). Actigraphy validation with insomnia. ''Sleep, 29''(2), 232–239.</ref><ref>Sadeh, A., & Acebo, C. (2002). The role of actigraphy in sleep medicine. ''Sleep medicine reviews, 6''(2), 113–124.</ref>
The advantage actigraphy shows over polysomnography is that it is possible to record for 24-hours a day for weeks.<ref name="Ancoli"/> Furthermore, unlike the polysomnography, it is less expensive and non-invasive.<ref name="Ancoli"/>

An actigraphy over several days can show longer sleep periods, which are characteristic for idiopathic hypersomnia.<ref name="Bassetti, Claudio L. Billiard, M. Michel Mignot, Emmanuel. 2007">{{Cite book|title=Narcolepsy and hypersomnia|last=Bassetti, Claudio L. Billiard, M. (Michel) Mignot, Emmanuel.|date=2007|publisher=Informa Healthcare|isbn=978-0849337154|oclc=74460642}}</ref> Actigraphy is also helpful in ruling out other sleep disorders, especially circadian disorders, leading to an excess of sleepiness during the day, too.

=== The maintenance of wakefulness test (MWT) ===
The 'maintenance of wakefulness test' (MWT) is a test that measures the ability to stay awake.<ref name="Mitler">{{cite journal |last1=Mitler |first1=MM |last2=Carskadon |first2=MA |last3=Czeisler |first3=CA |last4=Dement |first4=WC |last5=Dinges |first5=DF |last6=Graeber |first6=RC |title=Catastrophes, Sleep, and Public Policy: Consensus Report |journal=Sleep |date=February 1988 |volume=11 |issue=1 |pages=100–9 |doi=10.1093/sleep/11.1.100 |pmid=3283909 |pmc=2517096}}</ref> It is used to diagnose disorders of excessive somnolence, such as hypersomnia, narcolepsy or obstructive sleep apnea.<ref name="Mitler" /><ref>{{cite journal |last1=Sangal |first1=RB |last2=Thomas |first2=L |last3=Mitler |first3=MM |title=Maintenance of Wakefulness Test and Multiple Sleep Latency Test. Measurement of Different Abilities in Patients With Sleep Disorders. |journal=Chest |date=April 1992 |volume=101 |issue=4 |pages=898–902 |doi=10.1378/chest.101.4.898 |pmid=1555459}}</ref> During that test, patients sit comfortably and are instructed to try to stay awake.<ref name="Mitler" />

===The Stanford sleepiness scale (SSS)===
The [[Stanford Sleepiness Scale|Stanford sleepiness scale]] (SSS) is a self-report scale that measures the different steps of sleepiness.<ref name="Hoddes">Hoddes, E., Zarcone, V., Smythe, H., Phillips, R., & Dement, W. C. (1973). Quantification of Sleepiness: A New Approach. ''Psychophysiology, 10''(4), 431‑436. https://doi.org/10.1111/j.1469-8986.1973.tb00801.x</ref> For each statement, patients report their level of sleepiness using a 7-point scale, going from very alert to excessively sleepy.<ref>Herscovitch, J., & Broughton, R. (1981). Sensitivity of the Stanford sleepiness scale to the effects of cumulative partial sleep deprivation and recovery oversleeping. ''Sleep, 4''(1), 83–92.</ref> Researchers found that the SSS was highly correlated with performances to monotonous and boring tasks, which are found to be very sensitive to sleepiness.<ref name="Hoddes" /> These results suggest that the SSS is a good tool to assess sleepiness in patients.<ref name="Hoddes" />

===The Epworth sleepiness scale (ESS)===
The 'Epworth sleepiness scale' (ESS) is also a self-reported questionnaire that measures the general level of sleepiness in a day <ref name="Johns">Johns, Murray W. (1991). A new method for measuring daytime sleepiness: The Epworth sleepiness scale. ''Sleep, 14''(6), 540–545.</ref><ref>Johns, Murray W. (1993). Daytime sleepiness, snoring, and obstructive sleep apnea: The Epworth Sleepiness Scale. ''Chest, 103''(1), 30–36.</ref> The patients have to rate specific daily situations by means of a scale going from 0 (would never doze) to 3 (high chance of dozing).<ref>Johns, Murray W. (1992). Reliability and factor analysis of the Epworth Sleepiness Scale. ''Sleep, 15''(4), 376–381.</ref> The results found in the ESS correlate with the sleep latency indicated by the Multiple Sleep Latency Test.<ref name="Johns" /><ref>{{Cite journal|last1=Chervin|first1=R. D.|last2=Aldrich|first2=M. S.|last3=Pickett|first3=R.|last4=Guilleminault|first4=C.|date=February 1997|title=Comparison of the results of the Epworth Sleepiness Scale and the Multiple Sleep Latency Test|url=https://pubmed.ncbi.nlm.nih.gov/9076642/|journal=Journal of Psychosomatic Research|volume=42|issue=2|pages=145–155|doi=10.1016/s0022-3999(96)00239-5|issn=0022-3999|pmid=9076642}}</ref>

== Treatment ==
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 diagnosed.<ref name="Dauvilliers"/>

Because the causes of hypersomnia are unknown, it is only possible to treat symptoms and not directly the cause of this disorder.<ref>{{Citation|last1=Bassetti|first1=C.L.|title=Types of Hypersomnia|date=2013|encyclopedia=Encyclopedia of Sleep|pages=413–417|publisher=Elsevier|isbn=9780123786111|last2=Fulda|first2=S.|doi=10.1016/b978-0-12-378610-4.00223-0}}</ref> Behavioral treatments, as well as sleep hygiene, have to be discussed with the patient and are recommended.

There are several pharmacological agents that have been prescribed to patients with hypersomnia, but few have been found to be efficient.<ref name="Bassetti, Claudio L. Billiard, M. Michel Mignot, Emmanuel. 2007" /> [[Modafinil]] has been found to be the most effective drug against the excessive sleepiness, and has even been shown to be helpful in children with hypersomnia.<ref>{{Cite journal|last1=Anderson|first1=Kirstie N.|last2=Pilsworth|first2=Samantha|last3=Sharples|first3=Linda D.|last4=Smith|first4=Ian E.|last5=Shneerson|first5=John M.|date=October 2007|title=Idiopathic Hypersomnia: A Study of 77 Cases|journal=Sleep|volume=30|issue=10|pages=1274–1281|doi=10.1093/sleep/30.10.1274|pmid=17969461|issn=1550-9109|pmc=2266276}}</ref> The dosage is started at 100&nbsp;mg per day, and then slowly increased to 400&nbsp;mg per day.<ref>{{Cite journal|last1=Ivanenko|first1=Anna|last2=Tauman|first2=Riva|last3=Gozal|first3=David|date=November 2003|title=Modafinil in the treatment of excessive daytime sleepiness in children|journal=Sleep Medicine|volume=4|issue=6|pages=579–582|doi=10.1016/s1389-9457(03)00162-x|pmid=14607353|issn=1389-9457}}</ref>

In general, patients with hypersomnia or excessive sleepiness should only go to bed to sleep or for sexual activity.<ref name="McWhirter">McWhirter, D., Bae, C., & Budur, K. (2007). The Assessment, Diagnosis, and Treatment of Excessive Sleepiness. ''Psychiatry (Edgmont), 4''(9), 26‑35.</ref> All other activities, such as eating or watching television, should be done elsewhere.<ref name="McWhirter" /> For those patients, it is also important to go to bed only when they feel tired, rather than trying to fall asleep for hours.<ref name="McWhirter" /> In that case, they probably should get out of bed and read or watch television until they get sleepy.<ref name="McWhirter" />

== Epidemiology ==
Hypersomnia affects approximately 5% to 10% of the general population,<ref>
Geddes, J., Gelder, M., Price, J., Mayou, R., McKnight, R. ''Psychiatry''. 4th ed. Oxford University Press; 2012. p365. {{ISBN|978-0199233960}}</ref><ref>{{Cite book|title=Diagnostic and Statistical Manual of Mental Disorders|last=American Psychiatric Association|date=2013-05-22|publisher=American Psychiatric Association|isbn=978-0890425558|doi=10.1176/appi.books.9780890425596|url-access=registration|url=https://archive.org/details/diagnosticstatis0005unse}}</ref> "with a higher prevalence for men due to the [[sleep apnea]] syndromes".<ref name="Dauvilliers" />

== See also ==
* [[Encephalitis lethargica]]
*[[Reticular formation]]
* [[Sleep medicine]]
* [[Somnolence]]

== References ==
{{Reflist}}

== External links ==
* [http://wabe.org/post/help-i-cant-stay-awake-emory-researcher-finds-hope-hypersomnia/ Help: I can't stay awake!] {{Webarchive|url=https://web.archive.org/web/20140808053745/http://wabe.org/post/help-i-cant-stay-awake-emory-researcher-finds-hope-hypersomnia |date=2014-08-08 }} - Public Radio Interview with Dr. David Rye
* {{eMedicine|med|3129}} - "Primary Hypersomnia"

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[[Category:Sleep disorders]]