Hypersomnia is excessive sleepiness and it happens in different forms. Some people may
be sleepy throughout the day, or may become very sleepy at certain points during the day,
and other people may have sleep attacks where they may be reasonably well between these
attacks, but get sudden overwhelming sleepiness, often in socially awkward or inconvenient
circumstances, such as during a meal or even in conversations with people. When people
actually have these hypersomnias they will often doze or fall asleep and they may sleep
for anything from a few seconds, minutes, up to hours depending on the cause of the
hypersomnance. The other form of hypersomnance that we often see is where people will have
microsleeps during the day, and then they may carry out automatic actions such as sticking
their socks in the fridge, or writing nonsense or typing nonsense, and without actually being
aware of what they're doing because their brain is partially asleep.
The commonest cause of hypersomnia is getting inadequate amounts of sleep at night. We all
need different lengths of sleep at night and some people will restrict their sleep unnecessarily
leaving them to be sleepy during the day. The other commonest cause of excessive sleepiness
during the day is not getting adequate sleep at night because the sleep is disturbed, and
there may be a range of conditions that do that. The branch of hypersomnia that interests
me most is narcolepsy, and narcolepsy is a very specific condition in which the hypersomnia
is caused by a disregulation of sleep, so that people will get sleep attacks during
the day but will also have disturbed and disrupted sleep at night. The understanding of what
causes that is something that I find particularly fascinating - recently it's been discovered
that there are brain cells that specifically regulate our sleep, and that it may be damage
to those brain cells that causes the condition. Because of that, and because those brain cells
never grow again, narcolepsy is a condition that is a lifelong condition, and so can have
a devastating effect on people's lives if left untreated.
Hypersomnia can have a devastating effect on people's lives - being excessively sleepy
means that people cannot drive, it may affect their work because they may be falling asleep
at work, but also it can affect everyday aspects - it can affect relationships, it can affect
the ability to do things around the house. So it can actually affect all aspects of a
person's life. The other aspect that it affects is that it can make people quite down and
depressed. People who are hypersomnant will often find that because of their inability
to do things, their inability to socialise, they become socially isolated. Lastly, and
importantly, sleep has a very critical role in memory and memory formation and concentration,
and both memory and concentration can suffer due to hypersomnance. The important thing
is that if we are able to treat the hypersomnance successfully, then we can reverse nearly all
of these problems.
The most important thing in treating hypersomnia is making an accurate diagnosis, because people
are getting inadequate sleep and obviously increasing the amount of sleep that they have
would be the way to treat that, or if people are getting disturbed sleep, treating whatever
is disturbing their sleep will obviously treat the hypersomnia. We all have a clock in our
brain that tells us when we should go to sleep and when we should get up, and when we should
eat. The important thing about that is that the brain likes to have a routine - a regular
bedtime, a regular get up time - and if we tend to disturb that routine, or tend to sleep
irregular hours, then that can often disrupt or disturb our sleep overnight so we may get
inadequate sleep during the week. Then people try to catch up at the weekends by lying in,
which is not a great habit. The thing that is most challenging are those people who have
hypersomnia for other causes such as narcolepsy, and those people really need stimulants during
the day to try to keep them awake. Interestingly, because people with narcolepsy have disregulated
sleep, sometimes giving them a hypnotic at night, something to help them sleep at night,
may improve their sleepiness during the day. So it's often a combination of using something
at night to help them sleep, and something during the day to keep them awake. In addition,
we have to try and cope with the disregulation of the dream sleep, and we use certain drugs
for that as well - mainly anti-depressant type drugs that tend to affect our dream sleep,
to decrease the amount of dream sleep we have and prevent those dream sleep attacks that
people may have during the day, in particular things like cataplexy.