Primary or idiopathic hypersomnia is usually a chronic condition that does not resolve spontaneously and involves excessive sleepiness during the day that is not relieved by naps. Many patients find that adequate treatment for the condition helps to reduce symptoms of excessive sleepiness during the day and improve their overall quality of life.
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The optimal treatment of hypersomnia depends on the specific symptoms experienced by the individual. The aim of treatment is usually to reduce symptoms during the day to allow the patient to partake in normal daily activities, thus increasing their quality of life.
Distinct from most sleep disorders, patients who suffer from hypersomnia typically sleep well during the night and get more than 10 hours of sleep per night. For this reason, making lifestyle changes to improve sleeping habits is not usually useful in helping to reduce daytime sleepiness symptoms.
However, it is worthwhile to confirm that patients are taking measures to improve their nighttime sleep quality. This may include ensuring the sleep environment is a comfortable temperature with low sound and light levels. Additionally, stimulants such as caffeine, alcohol, and nicotine should be avoided in the hours before bedtime.
How can hypersomnia be treated?
Addressing underlying causes
In some cases, symptoms of hypersomnia present as a result of an underlying cause or health condition. In these situations, the condition is instead referred to as secondary hypersomnia.
For example, psychological or emotional issues can interfere with sleeping habits and cause symptoms of hypersomnia. In this instance, antidepressant medications such as selective serotonin reuptake inhibitors (SSRIs) can help to address the underlying cause and improve symptoms of hypersomnia.
Stimulants and other medications
There are currently no medications specifically targeted for use in the treatment of hypersomnia. However, several drug options that are indicated in narcolepsy are often able to provide relief from daytime symptoms for patients with hypersomnia.
Modafinil is commonly used in the treatment of narcolepsy and has helped to improve symptoms of hypersomnia in some patients. The psychostimulant medication helps to enhance alertness and is associated with fewer side effects than similar amphetamine drugs, such as jitteriness and anxiety. Modafinil is thought to act in the anterior hypothalamus and increase the release of the dopamine neurotransmitter, although its exact mechanism of action is not known.
Other stimulant medications that are used in the management of attention-deficit hyperactivity disorder (ADHD), such as dexamphetamine and methylphenidate, may help to sustain alertness during the day for some patients, although they have a greater potential for adverse effects. Other drugs that are sometimes used and may be beneficial in hypersomnia treatment include clonidine, levodopa, bromocriptine, and monoamine oxidase inhibitors.
Flumazenil is an emerging treatment for hypersomnia that may be able to provide adequate relief for the condition in the future. However, more research is required in this area prior to this becoming a regular medical recommendation.
Legal responsibilities during management
It is important for health practitioners to recognize when certain medical conditions may impact the ability of an individual to safely partake in some activities.
In particular, hypersomnia can negatively affect patients’ driving ability, as they are more prone to falling asleep while driving. For this reason, it is important that these issues are clearly discussed during the the doctor-patient consultation. Patients who are unfit to drive may require their drivers’ license to be suspended, which is the physician’s legal responsibility.