Hypersomnolence disorder is part of a cluster of diagnoses called the sleep-wake disorders. Sleep-wake disorders are a group of psychiatric conditions that include:
These disorders are broadly characterized by disruptions in sleep and wakefulness. Individuals with insomnia disorder have frequent difficulty falling asleep or staying asleep. Individuals with hypersomnolence disorder feel excessively sleepy during the day, despite obtaining what for most people would be a full night of sleep. Individuals with parasomnias such as non-rapid eye movement sleep arousal disorder and nightmare disorder experience unusual behaviors while sleeping, such as sleep walking, or vivid and disturbing dreams or night terrors.
Some sleep-wake disorders, including insomnia disorder and hypersomnolence disorder, are associated with disturbances in the amount of time the individual spends asleep (too much or too little) or the times at which the individual sleeps (often outside of the desired sleeping window). Other disorders, such as the parasomnias, are not associated with disturbances in the quantity or timing of sleep per se, but are instead associated with behavioral disturbances during sleep or frequent highly distressing dreams.
Hypersomnolence disorder usually has an onset in young adulthood; pediatric cases are rare. Nevertheless, 6 - 20% of children report daytime sleepiness. Hypersomnolence disorder is characterized by excessive daytime sleepiness, despite a main sleep period that is sufficiently long for most children at the same developmental stage.
This excessive sleepiness is accompanied by at least one of the following symptoms:
Sleep inertia, sometimes called sleep drunkenness, is not required for a diagnosis of hypersomnolence, but is relatively specific to the disorder. Sleep inertia is characterized by disorientation or impaired alertness during the sleep-wake transition. During this time, which may last several minutes to several hours, the individual appears awake but exhibits impaired motor dexterity, memory deficits, inappropriate behavior, or disorientation.
Occasional sleep difficulties are fairly common in children and adolescents. Therefore, hypersomnolence disorder is diagnosed only when the sleep difficulty occurs at least three times per week for a period of three months or longer. Hypersomnolence disorder is diagnosed only if the individual is significantly distressed or impaired by the hypersomnolence or accompanying symptoms.
Hypersomnolence disorder severity can range from mild to severe. In severe cases, hypersomnolence disorder can lead to impaired school or work performance or impaired social relationships due to falling asleep at inappropriate times or to associated daytime symptoms, such as impaired efficiency, concentration, and memory.
Little is known about the neurobiology of hypersomnolence disorder. Some studies have linked hypersomnolence to alterations in the histaminergic or dopaminergic signaling systems. Viral infections such as HIV pneumonia or infectious mononucleosis precede or accompany hypersomnolence in approximately 10% of cases. In these cases, hypersomnolence disorder should be diagnosed only when the medical comorbidity ceases to fully account for the hypersomnolence. The disorder appears to run in families and may have a genetic component, although having a genetic predisposition to hypersomnia disorder does not necessarily mean that someone will develop hypersomnia disorder.
Currently there is little research on the treatment of hypersomnolence outside the context of narcolepsy. Published treatment guidelines for hypersomnolence of varying origins are available from the American Academy of Sleep Medicine.
Clinical research and practice guidelines suggest that the following treatments may be effective for improving hypersomnolence and reducing daytime sleepiness in pediatric samples:
Additional Treatments to Consider
Preliminary evidence suggests that the following strategies, while not a substitute for the more well-validated treatments described above, might be considered.
Clinical research and practice guidelines suggest that the following treatments may be effective for improving hypersomnolence and reducing daytime sleepiness in pediatric samples:
Additional Treatments to Consider
Preliminary evidence suggests that the following strategies, while not a substitute for the more well-validated treatments described above, might be considered.