Idiopathic hypersomnia (IH) is a rare condition characterized by excessive daytime sleepiness which is not relieved even after long naps and a good night’s sleep.
A state of sleep drunkenness is often experienced by sufferers of IH, making waking up and “getting going” difficult.
This condition can be very dangerous obviously, and spontaneously improves in just up to one fourth of patients.
Do you suffer from idiopathic hypersomnia?
You may be suffering from idiopathic hypersomnia if:
Idiopathic hypersomnia usually begins in young adulthood, often between the ages of 15 and 25 years. It may run in the family.
If you’re tired because you don’t normally get enough sleep or if you’re getting lots of poor quality sleep, then you’re not suffering from idiopathic hypersomnia – doesn’t matter how tired you are. When people with IH go through a sleep study, they exhibit normal, healthy sleep patterns. They fall asleep easily though and can sleep for long hours (sometimes more than 10-11 hours).
Other symptoms may include:
Other less common symptoms:
What is idiopathic hypersomnia?
Sleep scientists have limited understanding of this condition. One theory which attempts to explain it is known as the Two-Factor Model, proposed by Bonnet and Arand in 1997. The two factors are:
Arising from different combinations of these factors are 4 distinct conditions:
Long story short, according to the Two-Factor Theory, idiopathic hypersomnia characterizes people who require a relatively long sleep duration, while having a low basal arousal level. The low basal arousal level makes them constantly tired, yet are getting plenty of sleep. Indeed, people suffering from idiopathic hypersomnia often experience an irresistible need to sleep or even daytime sleep episodes. At night, it often takes them no more than 8 minutes to fall asleep and they can sleep 12-14 hours per day.
In the Epworth Sleepiness Scale, sufferers of IH score higher (sleepier) than even people who suffer from narcolepsy. Distinguishing idiopathic hypersomnia from narcolepsy without cataplexy may require going through a sleep study.
Excessive daytime sleepiness can result from other conditions, such as:
Why does idiopathic hypersomnia happen?
Science doesn’t currently know what causes this condition, which may be more common in women. 1-2 thirds of cases appear to be familial. Idiopathic hypersomnia usually begins insidiously over several weeks or months between ages 10 and 30 years.
Occasionally, idiopathic hypersomnia have been reported to follow acute insomnia, abrupt changes in sleep-wake habits, overexertion, mood change, general anesthesia, viral illness, or mild head trauma.
There may be an association between IH and diabetes, obesity, and an increased body mass index.
The condition may involve a delayed start (and decline) of melatonin and cortisol secretion.
Treatment of idiopathic hypersomnia
First, don’t fight the sleepiness, especially when you’re about to drive, operate heavy machinery, or do anything that can be dangerous when overly tired. If you need a nap, take one to avoid dangerous episodes of severe drowsiness and automatic behavior. It may be wise though to plan naps in advance and make them short.
Behavioral approaches and sleep hygiene are recommended to prevent insufficient sleep and may include restriction of time in bed as well as avoiding alcohol, exercise, heavy meals, and warm environments.
Caffeine is a widely available alerting agent, effective when used intermittently at doses of 200 mg or more. Sources include coffee (Coffea arabica), tea (Camellia sinensis), cocoa (Theobroma cacao), Yerba mate (Ilex paraguayensis), Guarana (Paullinia cupana), and Cola acuminata. Tolerance develops with chronic use.
Other natural nervous system stimulants include:
Another herbal approach to treat IH is to stimulate the body’s innate vitality by using herbs such as:
Because the underlying causes of IH are unknown, the medical treatment is symptomatic and involves ingesting stimulant drugs and awake-enhancing medications, such as modafinil (first-line treatment), armodafinil, methylphenidate, pitolisant, mazindol, and dextroamphetamine. Also sometimes used are tricyclic antidepressants, MAOIs, SSRIs, clonidine, levodopa, bromocriptine, selegiline, and amantadine. Atomoxetine and reboxetine (in Europe) are slightly wake promoting and reduce REM sleep.
If sleep apnea may underlie the symptoms, try using CPAP and see if it improves the daytime sleepiness.
Hoffmann, David. Medical Herbalism: The Science and Practice of Herbal Medicine. Healing Arts Press.
Kryger, Meir H.; Roth, Thomas; Dement, William C.. Principles and Practice of Sleep Medicine E-Book. Elsevier Health Sciences. Kindle Edition.
Westerman, David, E., The Concise Sleep Medicine Handbook: Essential Knowledge for the Boards & Beyond. (5th ed.) GSSD Publishers, LLC.
This content was originally published here.