What causes hypersomnia and how to treat it

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Hypersomnia is excessive sleepiness during the day.

People with hypersomnia may feel unrefreshed on waking, even after a long sleep. They may feel a compulsion to sleep at any point in the day, including at work or during a meal.

People with a disorder called idiopathic hypersomnia typically sleep for more than 11 hours a day and may also struggle to wake up. This type of sleep behavior often has a significant effect on social, family, or work life.

Depending on the type of hypersomnia, it may first present during adolescence and early adulthood, and it could require lifelong management.

Hypersomnia can be either primary or secondary.

Primary hypersomnia presents with conditions that affect the central nervous system and directly affect sleep itself. Some examples are narcolepsy, idiopathic hypersomnia, and Kleine-Levin syndrome.

Secondary hypersomnia is when excessive sleepiness is due to another condition or issue. Examples include:

• not getting enough sleep
• a sleep disorder that fragments sleep, such as sleep apnea
• a head injury or another neurologic disorder, such as Parkinson’s disease
• a medical disorder
• certain medications or other drugs, including opiates, benzodiazepines, antipsychotics, and antihistamines, among many others

Experts know little about the cause of idiopathic hypersomnia, but they think that multiple factors play a role in its development. In some cases, the cause may be an overproduction of a molecule that increases sleepiness.

Secondary hypersomnia has many possible causes, which include head trauma and multiple sclerosis (MS).

Specific risk factors for hypersomnia are unclear, but some people may have a genetic predisposition to the condition.

Hypersomnia causes excessive sleepiness. People may sleep during the day and for long periods at night. They may also have difficulty waking up, even to an alarm.

Complications of hypersomnia include:

• anxiety
• irritation
• restlessness
• fatigue
• difficulty thinking or concentrating
• slow speech
• hallucinations
• reduced appetite and weight loss
• memory problems

Over time, people may also struggle to maintain a social and work life.

Depression is a common mood disorder that causes both emotional and physical symptoms.

Sleep problems are a symptom of depression, which can cause difficulty sleeping or oversleeping in some people.

Hypersomnia commonly occurs with depression. However, the relationship between the two conditions is complex, and it is unclear which one causes the other.

Learn more about depression and fatigue here.

According to Stanford Health Care, people must have had hypersomnia symptoms for at least 3 months before doctors can consider a diagnosis of primary hypersomnia.

As part of the diagnosis, doctors will likely use a multiple sleep latency test. This test measures how quickly someone falls asleep in a quiet environment during the day.

Diagnosing the cause of secondary hypersomnia may involve checking a person’s current medications and ruling out other health conditions or sleep disorders that could cause the tiredness. The doctor will also ask the person about their sleep habits.

Treatments for hypersomnia will vary depending on any accompanying symptoms and the type of hypersomnia.

A person’s treatment plan could include behavioral therapy, medication, or both.

Behavioral therapy

Doctors may refer an individual with insomnia for cognitive behavioral therapy (CBT). This behavioral intervention aims to strengthen cues for going to bed and weaken cues for wakefulness.

Learn more about CBT here.

The goals of the therapy are to improve sleep quality and quantity, as well as to reduce thoughts that interfere with normal sleep patterns.

Doctors may also recommend lifestyle changes, such as avoiding nighttime work and refraining from socializing late into the evening.

It remains unclear whether behavioral treatments effectively treat hypersomnia.

Medications

People with primary hypersomnia often use stimulants to prevent excessive sleepiness. These could include amphetamine (Evekeo) or methylphenidate (Ritalin). Other options are nonstimulants that promote wakefulness, such as modafinil (Provigil).

Doctors might prescribe treatments for other conditions, such as antidepressants for those with depression. Sodium oxybate (Xyrem) is another option to reduce daytime sleepiness in those with narcolepsy.

The type of drug that a doctor recommends will also depend on what medications a person is already taking.

The outlook of a person with hypersomnia could depend on its cause.

Primary hypersomnia is manageable through treatment, but the condition can be lifelong and have serious consequences. For example, a person may have to give up driving if there is a risk that they could fall asleep at the wheel.

People with secondary hypersomnia may receive different forms of treatment for other conditions. When a doctor is successful in treating the underlying condition, hypersomnia symptoms may disappear.

Feeling tired or napping during the day occasionally is not always a cause for concern. Some people will experience sleepiness from disrupted sleep patterns or staying up too late.

However, those who experience excessive sleepiness regularly without a clear cause should speak with a doctor. This consultation is particularly important if the symptoms are disrupting social, work, or family life.

Hypersomnia causes excessive sleepiness in the daytime. In primary hypersomnia, the symptoms occur regardless of the quality or quantity of the person’s sleep.

Hypersomnia may have several causes, and idiopathic hypersomnia is especially difficult to diagnose.

Other causes of hypersomnia include sleep disorders, insufficient sleep, certain medications, and underlying health conditions, such as MS.

People with hypersomnia may require behavioral therapy and medications to help keep them awake. Without proper treatment, the condition can severely disrupt daily life and lead to further problems.