Hypersomnia

Signs and symptoms of hypersomnia include:

• Anger and anxiety
• Reduced energy
• Restlessness
• Slow thinking, slurred speech, trouble concentrating, and memory issues
• Headache
• Episodes of extreme drowsiness occurring regularly throughout the day
• Decrease in appetite
• Hallucinations
• Daytime naps not increasing attentiveness and being unrefreshing and nonrestorative
• Trouble waking up in the morning (sleep drunkenness) or after a nap during the day and occasionally being confused or hostile
• Sleeping longer than usual (10 hours or more) but still feeling quite sleepy during the day and finding it difficult to stay up

Several circumstances and events might contribute to excessive daytime sleepiness, including:

• Insufficient or inadequate sleep: Long workdays and overtime can be tolerated for months or years before the effects of fatigue become noticeable. Teenagers who stay out late on the weekends could feel exhausted throughout the week.
• Environmental factors: A snoring partner, a baby that wakes up, noisy neighbors, heat and cold, or sleeping on an uncomfortable mattress are just a few of the factors that might disrupt your sleep.
• Shift work: Working a shift job, especially a night shift, makes it exceedingly difficult to get a good night's sleep. Aside from the difficulty falling asleep, there is also the negative effect of being out of sync with the body's natural schedule (the circadian rhythm).
• Mental state: Anxiety can keep some people up at night, which increases their likelihood of becoming sleepy throughout the day. Stress drains your energies.
• Medication: Tranquilizers, sleeping pills, alcohol, caffeinated drinks, and antihistamines can disrupt sleeping patterns.
• Medical conditions: Esophageal reflux, nocturnal asthma, hypothyroidism (underactive thyroid gland), and chronic pain can disrupt sleep.
• Time zones: Changes in time zones, such as jet lag, can affect the biological clock inside the body, which controls sleep. The light activates this clock.
• Sleep disorders: Sleep disruption or fragmented sleep can be brought on by various sleep disorders, including sleep apnea, narcolepsy, sleepwalking, restless legs syndrome, and insomnia.

Your symptoms, medical and sleep history, and current medications will all be discussed with your doctor. You may be asked to maintain a sleep diary to track your sleep and wake patterns. Your doctor may ask you to wear an actigraphy sensor (a small, watch-like device) on your wrist that tracks disruptions in your sleep-wake cycle for weeks.

Other tests your doctor may order include:

• Polysomnography: Measures your brain waves, heart rhythms, breathing patterns, and muscular movements during different stages of sleep. The test is performed in a hospital setting under the supervision of a trained sleep specialist. 
• Multiple sleep latency tests: Used to assess your propensity to fall asleep during five 20-minute nap trials spaced two hours apart. The test monitors brain activity, including the number of rapid eye movement naps.
• Questionnaires on sleep: You may be asked to fill out sleep questionnaires in which you rate your level of sleepiness.

If you meet the following diagnostic criteria, you will be diagnosed with hypersomnia:

• Despite getting at least seven hours of sleep, you still feel excessively sleepy, and you experience at least one of the following additional symptoms:
  • Lapsing into sleep numerous times within the same day
  • Not feeling refreshed or awake even after getting more than nine hours of sleep 
  • Not feeling fully awake after a sudden awakening
• For at least three months, you must have hypersomnia at least three times per week.

Inform your doctor if your hypersomnia is leading to significant distress or impairment in your mental, social, occupational, or other areas of functioning.

The course of treatment will depend on the cause of your hypersomnia, which includes pharmacological options and lifestyle modifications.

Medications

• Wakefulness-promoting agents: Provigil® (modafinil), Nuvigil® (armodafinil), Wakix® (pitolisant), and Sunosi® (solriamfetol) are among the substances that promote wakefulness. Usually, one of these drugs is tried initially.
• Psychostimulants: Amphetamine; Ritalin, Daytrana, Methylin, and Concerta (methylphenidate) and Procentra, Dexedrine, and Zenzedi (dextroamphetamine) are a few examples of psychostimulants. However, these pharmaceuticals have significant side effects and are more likely to be misused than first-line drugs.
• When the above treatments don't work, there are still other drug possibilities, such as Romazicon® (flumazenil), Biaxin® (clarithromycin), and Xyrem® or Xywav® (sodium oxybate).

Lifestyle modifications

• Go to bed at the same time every night.
• Avoid caffeinated products (including coffee, cola, tea, chocolate, and over-the-counter medicines) within several hours of bedtime.
• Avoid alcohol before bedtime. 
• Avoid tobacco and nicotine-containing products before bedtime. Nicotine is a stimulant.
• Ask your sleep specialist about what to avoid regarding foods or specific medications.
• Be careful about driving or using equipment or heavy machinery that can be dangerous to you or others.
• Avoid night-shift work.