We all feel sluggish at some point during the day. Imagine feeling tired all day and falling asleep even when you are with your loved ones playing an interesting card game. It is often depressing when the other person on the opposite end doesn’t seem to give you the attention or doesn’t seem to be awake and alert when you are having a conversation. Have you ever heard of the condition of hypersomnia? Around fifteen to thirty percent of the population suffer from hypersomnia.

What is Hypersomnia?

Hypersomnia is a disorder where, during the day, you experience constant sleepiness. Even after long periods of sleep, it can happen. Excessive daytime sleepiness is another term for hypersomnia (EDS). For example, at work or while driving, people who have hypersomnia may fall asleep at any time. They may have other concerns linked to sleep, as well. People with hypersomnia have problems working during the day because they are always exhausted, impairing concentration and energy levels. Having a rare sleep disorder and handling its care is a problem for both males and females. But it can be extremely difficult for women. They must also take into consideration how the effects of their sleep disorder and the drugs they take for it could influence these decisions when they make choices about abortion, pregnancy, breastfeeding, and other issues specific to women.

The types of Hypersomnia

Hypersomnia is of two types:

1) Primary hypersomnia and
2) Secondary hypersomnia

Primary hypersomnia occurs with no associated medical conditions. The only symptom is excessive fatigue. Problems in the brain structures that regulate sleep and waking functions
are assumed to be triggered by it.
On the other hand, secondary hypersomnia mainly occurs due to other medical complications. Parkinson’s disease, sleep apnea, kidney failure, and chronic fatigue syndrome are some of the associated medical conditions. These factors cause a weak nights sleep, causing you to feel exhausted in the daytime. It is the product of conditions that cause tiredness or inadequate sleep. For example, sleep apnea can induce hypersomnia and cause difficulty breathing at night, causing individuals to wake up many times during the night.

What causes of Hypersomnia?

Hypersomnia has many possible causes, including:

• Narcolepsy (daytime sleepiness) and sleep apnea sleep disorders (interruptions of breathing during sleep)
• Not having much sleep at night (sleep deprivation)
• Being Overweight
• Abuse of drugs and alcohol
• Head injury or neurological disorders, such as Parkinson’s disease or multiple sclerosis
• Prescription drugs, such as tranquilizers or antihistamines
• Genetics (having a relative with hypersomnia)
• Depression

What are the symptoms of Hypersomnia?

Constant tiredness is the primary symptom of hypersomnia. Without ever relieving drowsiness, individuals with hypersomnia can take naps during the day. They have trouble awakening from long periods of sleep as well.
Some hypersomnia signs include:

• Anxiety
• Loss of energy
• Restlessness
• Loss of appetite
• Irritability
• Slow speech or thinking
• Difficulty remembering
• Sleep-drunkenness or confusional arousal is also a symptom found in hypersomniac patients. The transition from wake to sleep is difficult. Sleep-drunk patients experience waking up with confusion, disorientation, slowness, and frequent returns to sleep.

How to diagnose Hypersomnia?

A doctor will study the symptoms and medical history to diagnose hypersomnia. A physical examination will check for alertness.
To diagnose hypersomnia, doctors use many tests, including:

• Sleep diary: To track sleeping patterns, you record sleep and waking times throughout the night.
• Epworth Sleepiness Scale: To assess the seriousness of the disorder, you rate your sleepiness.
• Multiple latency sleep tests: During the day, you take a controlled nap. The test tests the sleep forms that you undergo.
• Polysomnogram: You stay overnight at a sleeping center. A computer tracks the brain’s operation, eye movements, heart rate, levels of oxygen, and breathing.
• Another commonly used subjective indicator of patients with sleepiness is the Stanford sleepiness scale (SSS).
• Actigraphy is used by analyzing the patient’s limb movements to monitor the sleep and wake cycles. The patient must regularly wear a brace on his or her hand, which looks like a watch and contains no electrodes, in order to report them. The benefit of actigraphy over polysomnography is that 24 hours a day can be documented for weeks. In addition, it is less costly and non-invasive, unlike polysomnography. Actigraphy is also useful to rule out other sleep disorders, especially circadian disorders, which also contribute to an excess of daytime sleepiness.
• The maintenance of wakefulness test (MWT): It is a test that measures the ability to stay awake. It is used to diagnose excessive drowsiness conditions, such as hypersomnia, narcolepsy, or obstructive sleep apnea. Patients sit comfortably during the examination and are advised to try to remain awake.

Who is at risk for Hypersomnia?

People with medical conditions that make them tired during the day are most at risk for hypersomnia. Sleep apnea, kidney disorders, cardiac conditions, brain conditions, atypical depression, and poor thyroid function are among these conditions. Often, people who regularly smoke or drink are at risk of developing hypersomnia. Similar to hypersomnia, drugs that cause drowsiness may have side effects.

How to manage Hypersomnia?

Depending on the etiology of your hypersomnia, treatments for this disorder can vary.
A crucial aspect of the recovery process is lifestyle changes. A doctor may suggest getting on a daily schedule for sleeping. Avoiding such behaviors, especially at bedtime, may also improve symptoms. Many hypersomnia patients do not drink alcohol or use drugs. To maintain energy levels naturally, a physician can also prescribe a high-nutrition diet.
By making some lifestyle changes, you will initially attempt to cure your hypersomnia. Such as the following:

• Try to maintain a daily routine for sleeping.
• Sleep in a space that is quiet.
• Be in bed early, don’t stay up late.
• Controlled consumption of alcohol (less than 2 drinks per day for men and less than 1 drink per day for women)
• Do not drink caffeine for 4-5 hours before going to bed at night.
• Ask your doctor if you are taking any medications that may make you drowsy. Ask if you should turn to a prescription that is non-drowsy.

Many drugs intended for narcolepsy can treat hypersomnia. These include amphetamine, modafinil, and methylphenidate. These drugs are stimulants that help you feel more awake.
There are three key groups of medicines licensed for the treatment of narcolepsy-associated sleepiness: stimulant medicines (i.e., amphetamine derivatives), wake-promoting non-stimulant medicines (i.e., modafinil, solriamfetol, armodafinil, and pitolisant), and sodium oxybate.

In narcolepsy, stimulants approved for the treatment of sleepiness include dextroamphetamine and methylphenidate. Although stimulants can be effective, dependency, aggressive behavior, dental problems, and heart problems
are possible side effects.

Wake-promoting non-stimulant drugs include modafinil (e.g., Provigil) and armodafinil (e.g., Nuvigil). Although it is not completely evident how these drugs function, they tend to affect the brain chemistry that increases wakefulness, particularly dopamine, the neurotransmitter. In two placebo-controlled trials involving people with IH, Modafinil has been tested and has been shown to help with drowsiness in individuals with this condition.

A new non-stimulant wake-promoting drug, solriamfetol (Sunosi), was approved to treat sleepiness caused by narcolepsy and obstructive sleep apnea by the United States FDA in March 2019 and by the European Commission in January 2020. It is pharmacologically distinct from either stimulants or modafinil/armodafinil (it is the first dual-acting norepinephrine and dopamine reuptake inhibitor recognized to treat increased daytime sleepiness).

Another new wake-promoting non-stimulant drug, pitolisant (Wakix), was approved by the U.S. FDA in August 2019 and approved in Europe in 2016. This new drug is a selective histamine 3 (H3) receptor antagonist/inverse agonist that acts to increase the synthesis and release of a wake-promoting neurotransmitter in the brain called histamine through a novel mechanism of action. Pitolisant improved sleepiness in approximately one-third of people with intracranial hypertension(IH) whose symptoms did not respond well to other drugs.

Sodium oxybate (Xyrem) is a drug taken at bedtime that induces deep sleep and enhances daytime sleepiness in individuals with narcolepsy. However, its effects are not as well characterized in those with idiopathic hypersomnia. A 2016 study showed that sodium oxybate increased daytime sleepiness to the same degree in individuals with IH as in individuals with type 1. narcolepsy. The drug also improved extreme sleep inertia in 71 percent of people with IH.

How to prevent Hypersomnia?

Get enough sleep throughout the night.
This might sound obvious, but in the morning or at night, many of us negotiate to trim an hour or two off our sleep to do other things. The majority of adults require seven to nine hours of sleep a night, where adolescents generally need a full nine hours of sleep. Block out eight to nine hours of regular sleep.

Keep distractions away from your room.
Avelino Verceles, MD, assistant professor (University of Maryland School of Medicine) and director of the school’s sleep medicine fellowship, says, “Reserve your bed for sleep and sex,” You should not read, watch television, play video games, or use laptop computers in bed. Do not pay your bills or hold tense talks in bed. You could be left sleepless by them.

Set a wake-up time that is consistent.
It is also recommended that people who have issues with sleeping are advised to sleep and wake-up every day at the same time, even on weekends.

Switch progressively to an earlier bedtime.
Try to go to bed 10 to 15 minutes earlier every night for four nights is another solution to settling on a consistent routine. Then stick to bedtime. Adjusting the routine gradually like this typically works better than deciding to go to sleep an hour earlier unexpectedly.

Set safe, regular meal times.
Regular mealtimes help control our circadian rhythms, not just regular sleep times. Instead of grabbing a doughnut and coffee in the morning or a late sandwich on the run, having a good breakfast and lunch on time often avoids energy shortages during the day that will intensify the sleepiness. Plan two to three hours before bedtime to finish eating meals.

Exercise
Daily exercise (on most days, 30 minutes a day) has numerous sleep benefits. Generally, exercise, especially aerobic exercise, makes it easier to fall asleep and helps to give a deep sleep.
Exercise also provides you with more energy for the day and keeps your mind clear. And you even get more advantages if you exercise outdoors in the daytime. Since daylight helps to control our sleep habits, sleep experts suggest 30 minutes of exposure to sunlight a day.

Change your schedule
If you don’t think you cannot p for seven or eight hours, you need to look at your routine and make some improvements. Move certain tasks from late evening to early evening or from early morning to late morning. Try to avoid assignments that are not really important. During your remaining tasks, having enough sleep at night will help you work better.

Until you’re sleepy, don’t go to bed.
You’ll still not be able to fall asleep if you go to bed because you’re just tired. Distinguish between the sensation of being exhausted and asleep. Get into bed when you’re sleepy, drowsy, or feel like you’re nodding off. It’s a very different kind of feeling.

Don’t sleep late in the day.
Late afternoon sleep can make daytime sleepiness worse if because it can interfere with nighttime sleep.

Build a calming routine for bedtime.
You can be separated from the day by a relaxing routine before bedtime, particularly from stressful or over-stimulating activities, making it difficult to sleep. Try to meditate, soak in a hot bath, listen to comforting music, or read a book. It can also be relaxing to have a cup of herbal tea or warm milk, but avoid it if it causes you to wake up at night to go to the bathroom.

Stop those “nightcaps.”
People always believe that alcohol helps sleep. You will definitely be wide awake again when the effects of alcohol wear off during the night.

See a sleep specialist.
If you are chronically tired regularly during the day, even though you sleep well, or if you fall asleep without warning, daytime sleepiness may be induced by sleep disorders. So, for a better opinion, it is better to see a sleep specialist.