Everyone is tired from time to time. Depending on your lifestyle, you may be tired a lot of the time. However, if you find yourself napping frequently throughout the day, sleeping much longer at night than is typical for your age group, and still feeling excessively tired, then you may have a condition called hypersomnia or hypersomnolence disorder. This is a lesser-known condition that can require medical and mental health treatment to eliminate the symptoms and improve functioning:
Hypersomnolence Disorder: What Does It Mean?
Hypersomnolence is a disorder defined by excessive sleepiness. This can appear during the daytime with recurrent episodes and frequent napping. It can also occur with prolonged nighttime sleeps. Individuals who have hypersomnolence do not necessarily feel tired due to poor sleep. In fact, they are likely getting more than enough sleep. These individuals are so tired they feel almost compelled to sleep. They may nap during the day, even during inappropriate times (for example, at work). Despite the naps, the person is still tired and feels no sense of relief from their sleepiness. The condition was previously called hypersomnia, but the name was changed to better capture the symptoms.
Originally, the disorder entitled hypersomnia was named to capture two terms: “hyper” meaning “too much” and “somnia” meaning “sleep.” Put together those terms captured the condition of excessive sleeping, called hypersomnia. Later, the terminology was updated to hypersomnolence (meaning too much sleepiness). This new term was intended to capture both long sleep durations and excessive sleepiness that occurs during the daytime.
In some classifications, the terminology ‘idiopathic hypersomnia’ is used to define the sleep disorder. Individuals who have ‘idiopathic hypersomnia’ will usually wake still feeling tired even after they have slept for a long period of time. Individuals with this diagnosis will also exhibit difficulty waking up in response to alarms. Once awake, they may demonstrate ‘sleep inertia’ with difficulty thinking (even confusion) and difficulty moving after being awakened(sleep drunkenness).
Is Hypersomnia a Mental Disorder?
Hypersomnia/hypersomnolence is listed in the Diagnostic and Statistical Manual, along with mental health disorders. It can also impair functioning in ways that are similar to the impairment caused by mental health disorders. However, it is not really a mental health disorder. It is considered a neurological disorder. This is because it is often due to an irregularity of one kind or another in the nervous system that acts almost like a sleeping pill on the brain.
Stats: How Many Suffer from This Disorder?
Hypersomnia/hypersomnolence disorder is not very common. Some studies indicate that approximately 4% to 6% of the population may have the disorder. It is even rarer in children.
Why am I Sleeping so Much? – Causes of Hypersomnolence
Some individuals have hypersomnolence due to a genetic predisposition. Certain medications, substance abuse, medical conditions, and other sleep disorders can contribute to these same symptoms. However, in many people there is no known cause for their hypersomnia.
Signs and Symptoms of Hypersomnia
As noted, hypersomnolence is defined primarily by excessive sleepiness. This leads to frequent napping and prolonged sleeps. The excessive sleepiness and excessive time spent sleeping can cause problems in people’s daily life. The compulsion to sleep may override commitments to other obligations. This could affect a person’s life at home and work. It could also affect their relationships.
What are the Common Behaviors/Characteristics?
The most common symptom of hypersomnolence is excessive sleepiness. The most common behaviors are frequent naps and prolonged sleeping. Additional characteristics include difficulty waking from sleep. Individuals with this disorder may awake feeling rather disoriented.
Other symptoms of the disorder can include: increased anxiety, irritation, restlessness, slowed thinking, impaired memory, slower speech, low appetite, and even hallucinations. The symptoms of this disorder can significantly impair functioning at home, work, and other settings.
Testing: What are the Diagnostic Criteria Per the DSM-5
If you experience the symptoms described above, you will need to seek help before your functioning becomes overly impaired. You will want to start by visiting a medical doctor and they may also recommend visiting a mental health provider for additional intervention to improve the symptoms.
Typically, a physical exam will be needed to assess for medical problems that could cause the excessive sleepiness. A doctor may also request a sleep study to further understand what is happening in the brain during sleep. Substance abuse must also be ruled out as a cause of the symptoms. In some cases, a psychological evaluation will be needed to further assess any existing mental health symptoms. This information will be used to make a formal diagnosis. To assign a diagnosis, professionals must use the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5), which presents the following criteria to define hypersomnolence disorder:
- Excessive sleepiness for at least one month (in acute conditions) or at least three months (in persistent conditions) as evidenced by either prolonged sleep episodes or daytime sleeping that occurs at least three times per week.
- Excessive sleepiness causes clinically significant distress or at least impairment in social, occupational, and other important areas of functioning.
- Excessive sleepiness is not accounted for by insomnia or another sleep disorder (such as narcolepsy, breathing-related sleep disorder, circadian rhythm sleep disorder, or parasomnia).
- Excessive sleepiness is not accounted for by a generally inadequate amount of sleep.
- This disturbance is not caused by the effects of a substance (medication or drug abuse) or another general medical condition.
The condition of hypersomnolence can occur at the same time as other mental and medical disorders and can be concurrently diagnosed if those other conditions do not fully account for the excessive sleepiness. It is important to discern that the excessive sleepiness is a symptom that is either separate from any other conditions and or is at least significant enough to diagnose it as hypersomnolence.
The symptom of hypersomnia can be caused by physical problems including head trauma, tumor, and other injuries to the nervous system. Medical conditions such as multiple sclerosis, encephalitis, epilepsy, and obesity may also contribute to hypersomnia. Depression and other mental health conditions may also be associated with excessive fatigue. In these causes, hypersomnolence may not be able to be diagnosed. It will be important for a trained professional to fully assess the symptoms and decide.
Hypersomnia and Other Conditions
When making a diagnosis, medical and mental health professionals also rule out other conditions:
Hypersomnolence Disorder vs Narcolepsy
Narcolepsy is a more familiar sleep disorder. It is similarly characterized by excessive sleepiness. However, narcolepsy also has other symptoms. Individuals who have narcolepsy are not only excessively tired, they also sometimes suddenly and unexpectedly fall asleep. When this occurs, they may experience cataplexy, which is a loss of muscle control. The sleep episodes are sometimes triggered by strong emotions. These individuals may also sometimes experience dream-like hallucinations during the daytime. At night, they may have vivid nightmares.
Other sleep disorders such as insomnia and sleep apnea can also be associated with excessive sleepiness. In these cases, the fatigue is due to poor sleep. Some other disorders may also include symptoms of excessive fatigue and frequent sleeping. For example, these symptoms are associated with depression. In those cases, the fatigue is a symptom of the broader condition.
Hypersomnia in Adults/Children
Children may exhibit hypersomnia during certain health conditions. However, the distinct disorder of hypersomnolence is relatively rare in children. If you suspect the disorder, consult a pediatrician.
Example Case of Hypersomnia
Consider this example of hypersomnolence to see if it reminds you of yourself or someone you know:
Martha always feels tired. In the evening she goes to bed as soon as she can. She sleeps through the night and struggles to get up in the morning. She often sleeps through her alarm and hits snooze a few times. She drags herself out of bed when she must, to get to work. However, she never feels fully awake. She feels tired all day and tries to work in a few naps when she can. Usually, she skips her lunch break to take a nap. She has fallen asleep a few times during meetings and at her desk. It is starting to affect her success at work.
How to Deal/Coping with Hypersomnia
Individuals with hypersomnia and hypersomnolence will likely feel distressed by their symptoms and the repercussions of those symptoms. The condition can affect functioning at school/work and in relationships. Others may also feel frustrated with the symptoms and their effects on the relationship.
Look Out for These Complications/Risk Factors
Some individuals who have hypersomnolence disorder may experience negative repercussions in their daily life. The condition and any negative effects it has could lead to other mental health problems, including suicidality. To avoid these complications, it is important to see out medical and mental health assistance. The appropriate providers can help you reduce the symptoms.
Hypersomnolence Disorder Treatment
Individuals with hypersomnolence disorder will need to seek medical and mental health treatment. Psychotropic medications are frequently prescribed to manage the symptoms. Mental health treatment is also typically recommended. In a therapy setting, behavioral techniques will likely be taught. These can be used to help regulate the sleep schedule to promote daily functioning.
Possible Medications for Hypersomnia
Individuals with hypersomnolence may need medications to reduce their excessive sleepiness. The specific medication prescribed will depend on the individual and their symptoms. Oftentimes, stimulant medications are used. These typically involve dose-controlled amphetamines, which can help to sustain alertness. Sometimes activating antidepressants will be used. Other medications that may be used include clonidine, levodopa, and bromocriptine.
Home Remedies to Help Hypersomnia
As noted, individuals who have hypersomnolence can learn behavioral techniques that will be helpful in regulating their sleep schedule. For example, it is helpful to make a regular schedule with a regular bedtime. This means avoiding work and social activities late at night that might prevent meeting the planned bedtime. Also, avoid caffeine and alcohol that might disrupt sleep. In addition, people with hypersomnia should practice certain routines at bedtime. This includes turning lights down an hour beforehand and doing activities that will promote relaxation and sleep. Morning routines to get one’s energy going will also be helpful to lift the sleepiness.
Living with Hypersomnia
Individuals who have hypersomnia and hypersomnolence disorder may experience some distress about their symptoms and the effect those symptoms have on their life. Medical treatment and psychosocial support through therapy can be helpful to reduce that distress. Taking medications as prescribed and following other recommendations will be helpful.
Insurance Coverage for Hypersomnia
The medical and mental health fields consider hypersomnolence disorder as a serious condition. After a formal diagnosis of this condition, it is likely that health insurance will cover any necessary treatment including therapy. Call your insurance company to ask about your options. Your provider’s office may also be able to assist you with checking into insurance coverage.
How to Find a Therapist
If you are concerned about your own or someone else’s sleeping patterns and excessive sleepiness, you should first seek help by asking your medical provider about your symptoms. They may prescribe medical tests, physical exams, and therapeutic support from a mental health provider. You can also search online for therapists, using the name of your location.
What Should I be Looking for in an LMHP?
When seeking out a mental health provider to support you with hypersomnolence disorder, you will want to make sure they are trained and licensed in their field. You will also want to find a provider who is specially trained to work with hypersomnolence disorder.
Questions to ask a Potential Therapist
When meeting with a therapist, ask about their training working with hypersomnolence and other sleep disorders. You may also want to ask about their approach to therapy, how they would plan to address/monitor your symptoms, and the likely duration of treatment.
Hypersomnia Resources and Support Helpline
There are resources online regarding hypersomnia and hypersomnolence disorder that may be helpful:
- The Psychology Today website is a valuable tool to help locate mental health providers.
- SAMSHA has a provider locator to assist in finding nearby low-cost treatment options.
If you have questions about your own mental health or the mental health of a loved one, consider contacting the National Alliance on Mental Illness Helpline or the SAMSHA Helpline. If your hypersomnia symptoms lead to suicidality, consider calling the Suicide Prevention Lifeline for mental health support.
Although the symptoms of hypersomnia/hypersomnolence disorder can be challenging and difficult to manage, it is a diagnosable condition and help is available to alleviate the symptoms. Consider seeking treatment from medical and mental health providers so that you can improve your daily functioning.