Hypersomnolence Disorder

For a person to be diagnosed with hypersomnolence according to the criteria of the DSM-5, they must experience at least one of the following symptoms: 

• Recurrent periods of sleep or lapses into sleep within the same day.
• A prolonged primary sleep episode of more than nine hours per day that is nonrestorative (i.e., unrefreshing).
• Difficulty being fully awake after abrupt awakening.

The following are other specific symptoms that a person with hypersomnolence may experience: 

• Excessive sleepiness, even after getting seven or more hours of sleep per night.
• Sleep that is nonrestorative.
• A tendency to fall asleep during the day.
• Increased time sleeping, up to 18 hours per day for some.
• Recurrent naps during the day that do not restore alertness.
• Difficulty waking, confusion, combativeness, or disorientation that can last for hours after waking.
• Impairment of function and distress caused by excessive sleep.
• Memory problems.
• Anxiety and irritability.
• Headaches.
• Hallucinations.
• Loss of appetite.

These symptoms must have occurred at least three times per week for at least three months. Those who have trouble remaining alert for one or two days a week might be considered to have a mild case of hypersomnolence, for more than three days per week a moderate case, and for five to seven days a severe case.

Hypersomnolence is often comorbid¹ with other mental health conditions,² such as depressive disorders and substance use disorders.³ In the case of depression, the symptoms of one disorder can exacerbate the symptoms of the other. Substance use disorders may occur if an individual attempts to manage their somnolence with stimulants.

Categories

Hypersomnolence disorder is categorized in the following three ways: 

• Acute: Lasting one month or less
• Subacute: Lasting one to three months
• Persistent: Lasting more than three months

The cause of hypersomnolence is unknown, although researchers believe that there may be a genetic link. Cerebrospinal fluid and neurotransmitters in the brain, such as dopamine, GABA, histamine, and serotonin, may also play a role. 

Other medical and mental disorders can cause symptoms of hypersomnolence, including conditions like sleep apnea, multiple sclerosis, obesity, head trauma, viral infections, and depression. Some prescription medications, or withdrawal from these medications, can cause hypersomnolence, as well. To diagnose hypersomnolence disorder, other medical conditions may need to be ruled out. Testing may include the multiple sleep latency test, in which an individual is asked to take several short naps at predetermined intervals throughout the day in a sleep laboratory or clinic setting.

Under the primary diagnosis of hypersomnolence, there are four central disorders of hypersomnolence that should be ruled out by a doctor. These include:

• Narcolepsy type one: This type is also known as narcolepsy with cataplexy (cataplexy is a sudden muscle weakness that is caused by emotional events). 
• Narcolepsy type two: This type of narcolepsy presents without cataplexy. 
• Klein-Levin Syndrome: This disorder presents with recurring episodes of extreme hypersomnia, often with accompanying behavioral, mental, or psychiatric disturbances. Episodes may last from around ten days to a few weeks, with asymptomatic periods in between. 
• Idiopathic hypersomnia: This condition is hypersomnia with no known cause.

Risk factors

Those who have a family member with hypersomnolence disorder may be at greater risk of experiencing the condition themselves. Hypersomnolence typically shows up in adolescence to early adulthood and often occurs evenly between people of different genders. An exception is when hypersomnolence is comorbid with depression. In this case, it tends to occur slightly more frequently in women.

Common comorbid conditions like obstructive sleep apnea can also contribute to the onset of hypersomnolence disorder.

Treatment for hypersomnolence may include a combination of medication and lifestyle changes. Therapy might be a helpful supplement to manage stress or negative emotions that the disorder may create. 

Medication

Calcium, magnesium, potassium, sodium oxybate, and sodium pitolisant are FDA-approved medications for treatment of adults with idiopathic hypersomnia and excessive daytime sleepiness. Lower-sodium oxybate is approved to treat those aged seven and older with narcolepsy and adults with idiopathic hypersomnia. 

New research shows that a combination therapy using stimulants and wakefulness-promoting agents might be effective in reducing symptoms. However, more research is needed to understand this connection. 

Some of the medications used to treat this condition may cause addiction in some individuals, which could lead to misuse and harmful side effects. Do not start, change, or stop a medication without consulting your doctor. Continue to follow up with your doctor when taking any medication prescribed to promote wakefulness.

Other treatments 

Implementing healthy sleeping habits to get the most effective rest possible can be critical when managing hypersomnia. A healthy sleep routine may involve sleep hygiene strategies like the following: 

• Keeping your room dark or cool and using it for sleep or sex only
• Limiting caffeine and avoiding consuming caffeine after noon
• Avoiding exercising in the late afternoon or evening hours
• Keeping your sleep schedule consistent and waking and sleeping at the same time, even on weekends
• Investing in the most comfortable mattress, pillows, and bedclothes you can afford
• Using earplugs if you are sensitive to noise

Therapy can be a useful tool in managing some of the psychological symptoms of hypersomnolence. Stress is not a direct cause of this disorder, but high stress can exacerbate symptoms, so stress management and relaxation techniques may be effective. Excessive sleepiness can also incite anxiety or depression. A therapist may help you address these feelings and offer coping mechanisms to manage them healthily. Cognitive-behavioral therapy (CBT),⁴ in particular, is designed to shift negative thought and behavior patterns into more positive channels.

Someone experiencing the symptoms of hypersomnolence may find it more difficult to get to a therapist’s office to attend in-person sessions. Online therapy offers an alternative, with platforms like BetterHelp that match you to a licensed therapist. Therapy sessions are held online via audio, video, or live chat, giving clients control over the form of support they receive. 

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

A feasibility study conducted in 2020 found that a novel CBT therapy for hypersomnia (CBT-H) may reduce symptoms of depression while improving self-efficacy in individuals who experience hypersomnolence disorders. They also concluded that a telehealth model is promising as a format to increase engagement for participants. 

A 2021 systematic review of hypersomnolence disorders concluded that certain medications are effective at managing symptoms, with new medications on the horizon. However, researchers also state that there is a need for further study into non pharmacological symptom management to help patients manage chronic symptoms. This study calls for the cooperation of health care providers, patient groups, government agencies, and other industries to spur further research into improved treatment and testing methods. 

A study from 2018 looked at the sleep patterns of adolescents in the United States. Researchers found that even in adolescents getting adequate sleep for their age group, 11.7% still reported symptoms of hypersomnolence. Based on this study, researchers suspect that sleep disorders in teens may fluctuate between oversleeping and under-sleeping. They recommend that the strong correlation between sleep disturbance and mental health conditions be studied further.

Below are several statistics on hypersomnolence disorder:

• One study published in Nature found that 33% of participants experienced excessive daytime sleepiness at baseline. 
• A study of people with idiopathic hypersomnia found “substantial impairments in absenteeism, presenteeism, overall work productivity, and overall regular daily activity (mean percent [SD]: 12.3 [23.6], 47.6 [22.7], 51.4 [24.7], and 64.0 [21.9], respectively).” This result was based on scores from the Work Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI:SHP), version 2.0, Clinical Practice Version.
• One study on teens found that adolescent girls had a higher prevalence of hypersomnia than boys. 
• According to the National Organization for Rare Disorders, the “incidence of narcolepsy is approximately one in 2,000, and most researchers believe that the disorder remains undiagnosed or misdiagnosed in many affected individuals.”