Idiopathic Hypersomnia is defined as the inability to consistently attain as well as sustain the wakefulness and alertness necessary to meet the demands required to accomplish the tasks of daily living.
It is important to differentiate among hypersomnia in which alertness mechanism fail, causing potentially dangerous sleep attacks, weak alerting systems in which a sleepy person has to put extra effort to stay awake and overactive sleep-promoting processes.
Similar to sleep deprivation, hypersomnia is associated with significant variability in performance deficits as well as subjective impairment. Susceptibility to social, academic, and occupational consequences also differ with respect to daily tasks.
This condition can manifest in a number of ways, such as frequent napping, sleep attacks, micro-sleep episodes, automatic behavior, or hyperactivity.
What is Idiopathic Hypersomnia?
Idiopathic hypersomnia refers to a neurological disease that is defined mainly by excessive daytime sleepiness (EDS). Historically, this condition has rarely been detected and is frequently challenging to detect at an early stage.
This is normally a lifetime chronic condition that is regularly devastating. According to studies, there is low public awareness of the disorder. This usually causes stigma for the victims.
Generally, the term has been used to classify people with prominent excessive daytime sleepiness, but who lack the classic features of narcolepsy or evidence of another disorder known to cause excessive daytime sleepiness.
While narcolepsy has known causes, idiopathic hypersomnia causes have for a long time been unknown, as the name suggests. Nonetheless, studies have pinpointed a number of abnormalities linked with the condition.
In light of this, further research may eventually help to understand the etiology of idiopathic hypersomnia. Researchers have recently found an uncharacteristic hypersensitivity to GABA in patients with the condition.
With that said, this is a neurological condition with no known cause. In individuals with this condition, the switch or mechanism controlling sleep-wake changeover does not function correctly. This makes it harder to get out of sleepiness and into wakefulness.
Symptoms of Idiopathic Hypersomnia
This usually includes difficulties with attention and concentration, automatic behavior, and memory problems. It also includes the impaired ability to problem-solving, manipulates information, plan, inhibit responses, and maintain attention.
The mechanism leading to the cognitive and memory deficit is unclear. Excessive daytime drowsiness may result in the inability to focus and sustain attention. Simply put, patients fall asleep during boring repetitive tasks.
Taking Long, Poor Naps
You can nap for a number of hours, but this may fail to relieve you of sleepiness. In fact, waking up from such naps may be succeeded by sleep drunkenness.
Sleep inertia, also referred to as sleep drunkenness, has been defined as a condition of abnormally excessive confusion occurring during the transition from sleep to wakefulness that lasts from a few minutes up to half an hour.
This period of confusion, which an individual may or may not be aware of, is marked by a decrement in performance, the severity, and duration of which seems to depend a great deal upon several factors prior to awakening.
Sleep inertia following naps is more severe, the longer the nap. This condition is especially severe when awakened from a brief sleep following twenty-four or more hours of sleep deprivation.
Sleep inertia produces decrements in cognitive performance, confusion, and grogginess. Alertness is low and it is easy to return to sleep. Performance on mental tasks is most severely compromised, while perception and movement performance are less severely affected.
Memory is also rigorously compromised during this condition. You may not remember the contents of a phone call or even talking to the phone at all. Or a person might repeat without remembering, a simple behavior such as turning off an alarm clock.
Excessive Daytime Sleepiness (EDS)
EDS is categorized by insistent drowsiness and frequently a general lack of energy, even after apparently enough or even lengthy nighttime sleep.
Excessive daytime sleep can be considered as a broad symptom encompassing several sleep disorders, where increased sleep is a symptom, or as a symptom of another underlying disorder such as narcolepsy, sleep apnea or a circadian rhythm disorder.
Some people with EDS, including those with hypersomnia, such as idiopathic hypersomnia, are obliged to sleep frequently during the day, so as to fight off progressively strong urges to nap during unsuitable times, such as while driving, while at work, or during a meal.
As the urge to nap increases, the capability to complete errands quickly reduces, often mimicking the presence of intoxication. During infrequent and/or stimulating situations, a person with excessive daytime sleep can sometimes remain animated, awake, and alert, for a brief or extended period of time.
Excessive daytime sleepiness may interfere with the ability to function in family, occupational, social, or other settings. A proper diagnosis of the underlying cause and ultimately treatment of signs and/or an underlying cause can help mitigate such complications.
Other symptoms include
Living with Idiopathic Hypersomnia
You may be preparing yourself to go to work, thinking that everything is normal. Then you start feeling a little sluggish, and you grab yourself an energy drink and carry on with your day. But the entire experience changes when you cannot seem to get out of sleepiness.
Maybe you did not get enough sleep, you think to yourself. The next thing you know you wake up the next day and subsequent days with the same problem. And the problem seems to get worse by the day. You start wondering if you are suffering from depression.
You even realize that you get the fastest sleep time in your life. You hit REM in under five seconds. This is unprecedented, but this condition is not unfamiliar to healthcare providers.
You go on for further evaluation, you take a couple of blood sample and a couple of sleep tests. The next thing you know, you have been diagnosed with the terminal illness by the name of idiopathic hypersomnia.
It is extremely important to know whether or not you are suffering from this condition, especially if you are an employed person. This way, you can consult your physician and social security disability attorney to find a way that you can keep your job.
Diagnosis of Idiopathic Hypersomnia
The diagnosis of idiopathic hypersomnia is established on the basis of the finding of quantifiable excessive daytime sleepiness on the multiple sleep latency test. Unlike patients with narcolepsy, those with idiopathic hypersomnia have no sleep onset REM episodes and have normal levels of hypocretin.
There is less consensus on the treatment approach to idiopathic hypersomnia than with other sleep disorders. Patient education regarding adequate sleep is critical. A common strategy is initially to request patients to extend sleep time by at least an hour with the intent to aid patients whose sleepiness may be related to inadequate nocturnal sleep.
Because of the broad differential diagnosis, the evaluation for idiopathic hypersomnia must be in depth. Ideally, the diagnostic testing consists of wrist actigraphy, polysomnography, multiple sleep latency testing and drug screening.
Is Idiopathic Hypersomnia Considered a Disability?
Through studies conducted, the evidence did not show any confirmed diagnosis of disability causing excessive daytime sleepiness. Idiopathic hypersomnia has been considered to be a symptom rather than a disease.
If you are struggling with idiopathic hypersomnia while at work, it is better to apply for short-term disability benefits. You can also apply for long-term disability benefits through your employer. This ensures that you are supported financially.
Is Idiopathic Hypersomnia the Same as Narcolepsy?
Idiopathic hypersomnia is similar to narcolepsy. They both make you feel extremely sleepy. However, they differ slightly because idiopathic hypersomnia does not involve falling asleep suddenly. When suffering from narcolepsy, you experience excessive daytime sleepiness.
The cause of narcolepsy is yet to be known: however, a gene strongly associated with the disorder has been identified. The genes control production of chemicals in the brain, which may signal awake and sleep cycles.
Similar symptoms experienced in narcolepsy and idiopathic hypersomnia include excessive daytime sleepiness and sleep paralysis. In contrast to narcolepsy, daytime naps are not encouraged because they are not refreshing.
Treatment of Idiopathic Hypersomnia
Currently, there is no cure for this disorder because the disease mechanism is not yet understood. Treatment efforts have been focused on symptoms management. There are no Food and Drug Administration approved treatments for idiopathic hypersomnia. Treatment; therefore, generally involves the use of off-label medications approved for narcolepsy.
Medication options may include:
- Wakefulness-promoting agents.
- Traditional psycho stimulants.
- Sleep-promoting medications. They help by ensuring you get effective sleep as well as sleeping at an appropriate time.
- Histamine-directed medications.
- GABA-directed medications. Given the role of hyperactive GABA receptors, medication which could counteract the activity improve sleepiness.
There are a number of emerging therapies for the cases that may not respond to the mentioned types of medication. This includes: avoiding activities which may be dangerous such as driving or operating dangerous machinery, and follow up with physicians at least once a year is recommended for assessing side effects, work-related or social issues, mood disturbances and so on.
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