PRIMARY HYPERSOMNIA

HYPERSOMINIA AND PRIMARY HYPERSOMNIA: A DEFINITION

Hypersomnia inherently means excessive sleepiness. It is a neurological or a sleep-wake disorder that is characterized by excessive day time sleepiness (EDS) or prolonged night time sleep that occurs continuously for a period of three months or more.

Primary hypersomnia is a sleep disorder with excessive sleepiness when there are no other medical conditions present.

SYMPTOMS, ONSET AND PREVALENCE

According to the DSM-5 the symptoms of the disorder include: excessive sleepiness during the day or prolonged night time sleep for at least three months, functional impairment and significant distress due to the fatigue and drowsiness. However, these symptoms cannot be attributed to any other previously existing mental disorders, medical conditions, substance abuse or simply lack of sleep. The individual may also have trouble adjusting to wakefulness after being awoken. It may occur as frequently as 3 times a week.

Other symptoms of the disorder include: low energy, irritability, anxiety, loss of appetite, slow thinking or speech, difficulty remembering, and restlessness.  This disorder affects a growing proportion of the 15% to 30% of people suffering from sleep problems, however, its prevalence is much greater in men compared to women. Its typical onset is between ages 15 and 30 and its believed to be a lifelong disorder.

CLASSIFICATION AND CAUSE

Primary Hypersomnia is classified by duration into acute when it occurs for less than a month, subacute when it occurs for a duration of 1 to 3 months and persistent when it persists for more than 3 months. It is classified by the severity based on degree of difficulty maintaining daytime alertness into mild (1–2 days a week), moderate (3–4 days a week) and severe (5–7 days a week). Primary hypersomnia is a bracket term for disorders like narcolepsy type 1 (NT1), narcolepsy type 2 (NT2), idiopathic hypersomnia (IH), and Kline-Levin syndrome (KLS).

Primary hypersomnia is caused by issues in the brain regions that control sleep and wakefulness. Studies suggest that Primary hypersomnia also has a genetic component.

TREATMENT

Modafinil, armodafinil, sodium oxybate, amphetamine, methamphetamine, dextroamphetamine, methylphenidate, and selegiline are a few drugs that are used for the treatment of the disorder. Behavioural approaches and sleep hygiene techniques are recommended, although they have little overall positive impact on this disease. However, treatment also requires significant amount of lifestyle change. The patients are advised to maintain a strict and regular sleep schedule, take scheduled naps to combat sleepiness or drowsiness, practice good sleep hygiene, avoid substances like alcohol, nicotine, caffeine etc before bed, etc.

This disorder is a disabling problem and may often lead to permanent unemployment. It significantly affects an individual’s functionality in everyday life. Due to this, early diagnosis and symptom identification is of the essence. The patient and their family must be properly educated and included in the process of making decisions. It is also essential to have a comprehensive management plan for each and every patient.

References:

World Health Organization. (1992). The ICD–10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines.

Adrian Pedra (2018) Primary Hypersomnia; Medscape