Sleep disorder Hypersomnia : A

Literature Review
Sleep disorder Hypersomnia : A Literature Review
Wahyudo Imami Muhammad1
1
Departement of Neurology, Faculty of Medicine, Sriwijaya University, Palembang,
Indonesia

Abstrak
Sleep disorders, according to the DSM-IV, are difficulties with sleep that cause severe personal
stress or impairment in social, occupational, or other responsibilities. One of the most prevalent
concerns among patients who attend the office is sleep disruption. Sleep difficulties are projected
to be affecting a growing number of people each year, creating health concerns. Patients are
provided important information about proper sleep hygiene in order to help them overcome
various sleep problems. In certain people, hypersomnia can vary with time and improve with
age.

Keyword: Hypersomnia, sleep disorder

Background

Sleep is described as a state of consciousness that can be awoken by the application of sensory or
other stimuli.1 The DSM system classifies sleep difficulties that cause severe personal stress or
impairment in social, occupational, or other roles as a sleep disorder. Sleeping might be difficult
for certain people due to sleep disorders. Insomnia is the most commonly reported sleep issue.2

One of the most prevalent concerns among patients who attend the office is sleep disruption.
Sleep problems affect people from all walks of life, including the wealthy, the poor, the
educated, and the young, and are most common among the elderly. Prolonged sleep disruptions
in normal individuals cause alterations in their biological sleep cycle, lower endurance and job
performance, irritability, sadness, loss of focus, and weariness, which can lead to fatigue.

hazard to one's own or others' safety According to some studies, persons with chronic sleep
problems are 2.5 times more likely than those who receive enough sleep to suffer vehicle
accidents.3

Sleep difficulties are projected to be affecting a growing number of people each year, creating
health concerns. In daily practice, there is a propensity to use hypnotic medicines without first
diagnosing the underlying cause of the condition, which frequently leads to new issues as a result
of insufficient drug usage. Given the foregoing, it is obvious that sleep problems will continue to
be a health issue in the future.3

Classification of Sleep Disorders

Sleep disorders are defined as sleep difficulties that cause considerable personal stress or
impairment in social, occupational, or other activities, according to the fourth edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).2

Hypersomnia is a condition characterized by excessive sleep and daytime sleep episodes that
occur on a regular or recurring basis and impede social and vocational functioning.7

Sleep disorders are classified in the fourth edition of the Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV) using clinical diagnostic criteria and an estimated cause. The DSM-
IV divides sleep disorders into three categories:5 1. Primary sleep disorder, 2. Sleep disturbances
related to other mental disorders, and 3. Other sleep disorders, especially sleep disorders due to a
general medical condition or caused by substances. Classification of sleep disorders according to
the International Classification of Sleep Disorders is: Dissomnia, Parasomnia, and Sleep
disruptions as a result of medical or psychiatric issues.

Epidemiology
Sleep disruptions are quite frequent; 40% of the population has experienced difficulty sleeping in
the last year, 10% of which may be classified as insomnia, and 3-4 percent as hypersomnia.8

A total of 132 individuals were polled for this study. In the United States, 56 percent of people
have sleep difficulties, compared to 31 percent in Western Europe and 23 percent in Japan. The
majority of those with sleep disorders said it affected their everyday lives, with family life being
the most affected in the Western European sample, personal activity in the US sample, and
professional activity in the Japanese group.9 Nearly half of people with sleep difficulties never
seek help, and the majority of those polled said they have never spoken to a doctor about their
condition.3

Prescription medicines were provided to roughly half of individuals who saw a doctor in Western
Europe and the United States, and to 90% in Japan. Almost everyone has had sleep problems at
some point in their lives. Every year, it is believed that 20 percent to 40 percent of adults have
trouble sleeping, with 17 percent having significant issues.3

Every year, the prevalence of sleep problems rises, owing to a combination of factors including
growing age and diverse causes. According to Kaplan and Sadock, 40-50 percent of the senior
population suffers from sleep problems. Psychiatric problems, drug and alcohol addiction are the
leading causes of chronic sleep disturbances (10-15%).3

Daytime hypersomnia affects 0.3-4 percent of the population, according to surveys and
laboratory research. In 1981, a research in the United Kingdom indicated that up to 4000
individuals suffer from idiopathic hypersomnia.3

Etiology
Sleep disruptions can be caused by a variety of factors, such as Anxiety. Worrying about job,
school health, or family can keep the mind active late at night, making sleeping difficult.
Insomnia can be caused by stressful life events such as the death or illness of a loved one,
divorce, or job loss. Anxiety and depression. This may be due to a chemical imbalance in the
brain or because of the anxiety that accompanies depression. Some of them also because of
medications. Some antidepressants, heart and blood pressure medicines, allergy medications,
stimulants (such as ritalin), and corticosteroids can all have an effect on sleep.

Caffeine, nicotine, and alcohol are all stimulants. Stimulants such as coffee, tea, cola, and other
beverages containing caffeine are well-known. Nicotine is a stimulant that can lead to
sleeplessness. Alcohol is a sedative that can help people fall asleep, but it inhibits them from
sleeping deeper and frequently causes them to wake up in the middle of the night.

Health Problems Chronic discomfort, trouble breathing, and frequent urination are all signs of
insomnia. Arthritis, cancer, heart failure, lung illness, GERD, stroke, Parkinson's disease, and
Alzheimer's disease are all linked to sleeplessness.

Classification Hypersomnia

There is a categorization of Non-organic Hypersomnia based on the PPDGJ-III book. 4 Recurrent

hypersomnia, idiopathic hypersomnia, and post-traumatic hypersomnia are classified as recurrent
hypersomnia in the International Classification of Sleep Disorders, while primary hypersomnia is
classified as primary hypersomnia in the Diagnostic and Statictical Manual of Mental Disorders
fourth edition (DSM-IV).5

Primary hypersomnia affects 5% of the adult population, and both men and women are equally
susceptible. Excessive sleep, sleep attacks, or wake time delays are all examples of primary
hypersomnia. Hypersomnia can be caused by a mental disorder, an organic condition (such as
medications), or it might be idiopathic. This condition is the polar opposite of insomnia. Patients
are frequently misdiagnosed as having mental illnesses or being sluggish. Hypersomniacs require
more sleep than the average person. The patient will generally sleep 1-2 times each day, with
each nap lasting more than an hour. Despite the fact that they sleep a lot, they are usually weary
and sluggish during the day. This disorder is not life threatening and may be managed by the
individual using self-management methods. In individuals with primary hypersomnia,
polysomnography indicates a reduction in delta. waves, greater awareness, and decreased REM
latency.11,12

Diagnosis
It is preferable to ascertain the kind and length of sleep problem (duration of sleep disorder)
before obtaining a diagnosis of the reason of the sleep disorder. Knowing the type and duration
of the sleep disorder, in addition to assisting identify the cause, may also offer proper therapy.3

The patient complains of a morning headache, not feeling refreshed upon waking, issues with
mental or emotional functioning, excessive daily drowsiness, and weariness throughout the
examination. When a person has sleep apnea, their sleeping companion may complain of
snoring. Individuals and their relatives with narcolepsy complain of falling asleep at
inconvenient times, cataplexes, hypnagogic hallucinations, and a brief incapacity to move or talk
when they wake up (sleep paralysis). To rule out daytime drowsiness caused by drug usage, it's
vital to know what you're taking and when you took it.13

Polysomnography is another test that can be performed. It is an overnight test in which a

monitoring device is connected to an individual to assess different stages of sleep for the
electrical activity of the brain (electroencephalogram, or EEG), heart (electrocardiogram),
muscle movement (electromyogram), and eyes (electromyogram). Blood oxygen levels and
breathing patterns are also monitored. Some sleep latency tests (MSLT) assess how long it takes
to fall asleep in a calm environment during the day. The Epworth drowsiness scale and the
maintenance wakefulness test are two more tests that may be used.14

Treatment
For the treatment of primary insomnia, the psychological approach has several drawbacks.
Overall, the cognitive-behavioral approach to insomnia treatment has proved to be effective.2

The short-term focus of cognitive-behavioral theory is on reducing physiological circumstances,

altering maladaptive sleep practices, and changing dysfunctional thinking. The most common
approach used in this therapy is logical restructuring, which is a mix of various strategies.
Changes in environmental cues linked with sleep are part of simultaneous control. We learn to
associate cues associating laying in bed with sleep under normal circumstances, thus exposure to
these stimuli might increase sensations of sleepiness. However, if a person utilizes the bed for a
variety of activities, the bed may lose its sleepy connotation.2

Simultaneous control approaches seek to improve the bed-sleep relationship by restricting the
amount of time spent in bed in order to fall asleep as much as feasible. A person is usually told to
restrict the amount of time they spend in bed attempting to sleep to 10 or 20 minutes. If the
individual is still unable to fall asleep at the scheduled hour, they should get out of bed and move
to another room to get into a calm state of mind before relaxing.2

Sedative-hypnotic medications, in addition to causative therapy, can be used to treat the

symptoms of sleep problems. Almost all hypnotic medicines work by inhibiting the activity of
the reticular activating system (ARAS) in the brain. 3 Identifying the underlying reason or using
hypnotic medicines as an additional treatment is the most essential aspect of using hypnotic
drugs. The sort of medication that reacts rapidly should be considered while choosing hypnotic
drugs (short action). By restricting its usage to as little time as possible, regular sleep patterns
can be restored.3

Stimulant medications that can keep you awake are used to treat primary hypersomnia;
dextroamphetamine and methylphenidate both have short half-lives and are administered orally
in split dosages. Femoline, a stimulant with a lengthy half-life, can also be utilized. Modafinil, a
narcolepsy medication, may also be used to treat primary hypersomnia. Antidepressants that are
tricyclic (like protriptyline) can also be utilized. Stimulant medications must be used with
caution since they might lead to addiction.

Prognosis
When hypersomnia is induced by a mood illness, the main disease determines the clinical course.
In some people, idiopathic hypersomnia can vary with time and improve with age.

Conclusion
Hypersomnia is a sleep condition characterized by extreme daytime drowsiness for a month or
longer. Excessive drowsiness can manifest itself in a variety of ways, including difficulties
waking up after a lengthy period of sleep or a pattern of napping episodes that occur on a daily
basis in the form of expected or unexpected naps.

Patients are provided important information about proper sleep hygiene in order to help them
overcome various sleep problems. Because of the potential for adverse effects, medication usage
must be limited and closely monitored. As a result, drug use must be properly customized to the
patient's unique needs.

References
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