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Author: Ron Cridland, MD
Hypersomnia has been associated with a variety of medical disorders. These people have daily periods of irrepressible need to sleep or daytime lapses into sleep. Medical conditions that can be associated with hypersomnia include traumatic brain injury, Parkinson’s Disease or other neurodegenerative conditions, stroke, brain tumors, chronic infections, sarcoidosis, hypothyroidism, hepatic or renal failure as well as certain genetic disorders or inherited metabolic diseases. Another more recently recognized condition is residual insomnia in patients with adequately treated Obstructive Sleep Apnea.
Diagnosis
There are daily periods of irrepressible need to sleep or daytime lapses into sleep in association with a specific diagnosed underlying medical disorder. A Nocturnal Polysomnogram does not show any significant sleep disorder that could account for your degree of daytime sleepiness. A Multiple Sleep Latency Test (MSLT) shows an average sleep latency of less than 8 minutes. In people with residual hypersomnia in adequately treated Obstructive Sleep Apnea, the polysomnogram shows the sleep apnea is well controlled and the MSLT may show an average sleep latency of greater than 8 minutes. There is no other medical, psychiatric, sleep disorder or medication effect that explains this degree of sleepiness.
Management
It is important to optimize sleep quality and quantity with good sleep hygiene. It is generally stated that the normal amount of sleep for an adult is 7 – 9 hours per night. If you are tired or sleepy and getting less than 9 hours of sleep per night, you should to try to sleep longer to see if this helps. Some people are unable to sleep longer. However, they can usually train themselves to sleep longer the same way we help insomniacs sleep longer. That is by following the recommendations in the section on Sleep Hygiene.
Some people complain about feeling worse when they sleep longer. They may believe that they have slept “too much” and that is why they think they are tired. This is not true. I personally do not believe there is such a thing as too much sleep. There is research that says those who average more than 9 hours per night sleep have increased mortality just like those who average less than 5 hours sleep per night. However, although these studies have tried to control for health and lifestyle factors, I think the increased mortality for long sleepers is caused by the underlying reason for why they are sleeping long, not because they are sleeping long.
It is important to understand why you might feel more tired after getting more sleep. If you are usually tired or sleepy during the day and you typically get up after only 6 – 7 hours of sleep per night, you are not waking up because you have finished sleeping. You are waking up because of habit or commitment. The “adrenalin” kicks in and you function as best you can. However, the adrenalin also hides your true energy level which is lower than you think. If you happen to sleep-in one day and get 9 or more hours of sleep, you wake up naturally without as much adrenalin and get a chance to feel how tired you really are. However, one night of 9 or more hours of sleep is not enough to pay off your sleep debt. You usually need at least 2 – 3 weeks of getting 9 or more hours of sleep per night to start to pay of your sleep debt before you really notice a significant improvement in your sleepiness and fatigue. After 3 months you can see if you have established a trend of gradually increasing energy levels. Then it can take months and sometimes up to 2 years to feel like your energy is in the normal range.
If you do not notice any improvement in the first few months of getting a minimum of 9 hours of sleep per night, then you may need to look into stimulant medication such as what is used in Narcolepsy or Idiopathic Hypersomnia to control your daytime sleepiness.
