Hypersomnia
Primary hypersomnia (PH) is a disorder of presumed central nervous system etiology, associated with a normal or prolonged major sleep episode and excessive sleepiness consisting of prolonged (1 or 2 h) episodes of non-REM sleep. Although the presentation is similar to narcolepsy, it is not generally associated with cataplexy or sleep-onset REM. Another significant difference is that people with narcolepsy experience a sudden onset of sleepiness, while people with PH experience increasing sleepiness over time.
Some patients have recurrent episodes of hypersomnia, often associated with compulsive overeating and hypersexuality. This presentation is known as Kleine-Levin syndrome. Theseperiods of hypersomnia occur for days to weeks at a time and recur several times a year.
Causes
The mechanism of PH remains unclear. It may be caused by the following:
- Presence of another SD such as narcolepsy or sleep apnea.
- Dysfunction of the autonomic nervous system.
- Drug or alcohol abuse.
- Head trauma or injury to the central nervous system.
- Medical conditions such as multiple sclerosis, chronic fatigue syndrome, encephalitis or epilepsy.
- Prescription drugs such as tranquilizers.
- Genetic predisposition.
Treatment
The management of PH involves pharmacologic as well as nonpharmacologic measures. Good sleep hygiene is of utmost importance. Pharmacotherapy should only be initiated if the nonpharmacological measures fail. The first-line stimulant is caffeine. If caffeine intake does not cause any improvement, stimulant drugs such as methylphenidate, d-amphetamine and modafinil can be tried. Modafinil can be taken on a daily basis, while d-amphetamine taken before activities requiring alertness.
Written by: Healthplus24 team
Date: Jan28th,09
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