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Sleep Eating

Introduction:
Sleep eating is a sleep-related disorder, although some specialists consider it to be a combination of a sleep and an eating disorder. It is a relatively rare and little known condition that is gaining recognition in sleep medicine. Other names for sleep eating are sleep-related eating (disorder), nocturnal sleep-related eating disorder (NS-RED), and sleep-eating syndrome.

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Sleep eating is characterized by  sleepwalking and excessive nocturnal overeating (compulsive hyperphagia). Sleep eaters are comparable to sleepwalkers in many ways: they are at risk for self-injury during an episode, they may (or may not) experience excessive daytime sleepiness, and they are usually emotionally distressed, tired, angry, or anxious. Sleep eaters are also at risk for the same health complications as compulsive overeaters, with the added dangers of sleepwalking. Common concerns include excessive weight gain, daytime sleepiness, choking while eating, sleep disruption, and injury from cooking or preparing food such as from knives, utensils, or hot cooking surfaces. There is also the potential for starting a fire.

As with sleepwalkers, sleep eaters are unaware and unconscious of their behavior. If there is any memory of the episode, it is usually sketchy. A sleep eater will roam the house, particularly the kitchen, and may eat large quantities of food (as well as non-food items). In the morning, sleep eaters have no recollection of the episode. However, in many cases there are clues to their behavior. One woman woke up with a stomachache and chocolate smeared on her face and hands. Candy wrappers littered the kitchen floor. The next morning her husband informed her that she had been eating during the night. She was shocked and distressed because she had no recollection of the event.

As in the case described above, food consumed by sleep eaters tends to be either high sugar or high fat. Odd combinations of foods, such as potato chips dipped in peanut butter or butter smeared on hotdogs, as well as non-food items, have been reported. Oddly, one person was discovered cutting a bar of soap into slices and then eating it as if it were a slice of cheese!

Sleep eating is classified as a parasomnia. It is a rare version of sleepwalking, which is an arousal disorder. In 1968, Roger Broughton published a paper in Science (159: 1070-1078) that outlined the major features of arousal disorders. They are:

•Abnormal behavior that occurs during an arousal from slow wave sleep;
•The absence of awareness during the episode;
•Automatic and repetitive motor activity;
•Slow reaction time and reduced sensitivity to environment;
•Difficulty in waking despite vigorous attempts;
•No memory of the episode in the morning (retrograde amnesia); and
•No or little dream recall associated with the event.

How Common is Sleep Eating?

The actual number of sleep-eating sufferers is unknown; however, it is estimated that 1 to 3 percent of the population is affected by sleep eating. A higher percentage of persons with eating disorders, as many as 10 to 15 percent, are affected. For this reason, sleep eating is more common in younger women. Symptoms typically begin in the late 20s. Episodes may reoccur, in combination with a stressful situation, or an episode may occur only once or twice. Additionally, many parasomnias seem to run in families, which may indicate that sleep eating is genetically linked.

When Should you See a Doctor?

In many cases, sleep eating is the outward sign of an underlying problem. Many sufferers are overweight and dieting. When their control is diminished by sleep, these individuals binge at night to satisfy their hunger. Some sleep eaters have histories of alcoholism, drug abuse, or a primary sleep disorder, such as sleepwalking, Restless Legs Syndrome, or sleep apnea. An article in Sleep (October 1991: 14(5): 419-431) suggested that sleep eating is directly linked to the onset of another medical problem.

Because sleep eating occurs in people that are usually dieting and emotionally distressed, attempts at weight loss may be unsuccessful and cause even more stress. Compounded with the dangers of sleepwalking, compulsive eating while asleep is a sleep disorder that results in weight gain, disrupted sleep, and daytime sleepiness. As these consequences of sleep eating impact daily living, the necessity of seeing a healthcare professional becomes more important.

Parasomnias are complex and often serious in nature. If you think you suffer from sleep eating, consult with your physician or a healthcare professional who can refer you to a sleep disorders treatment center. It is strongly recommended that a sleep specialist carry out the diagnosis and treatment. Medical or psychological evaluation should also be investigated.

Treatment:

The first step in treating any sleep disorder is to ascertain any underlying causes. As with most parasomnias, sleep eating is usually the result of an underlying problem, which may include another sleep disorder, prescription drug abuse, nicotine withdrawal, chronic autoimmune hepatitis, encephalitis (or hypothalmic injury), or acute stress (Sleep 1991 Oct; 14(5): 419-431).

It is important to keep in mind that throughout life, people experience varying patterns of sleep and nutrition during positive and negative situations. Problems with eating are defined as overeating or not eating enough. Problems with sleeping can be simplified with two symptoms, too much or not enough sleep. Medical attention is required for abnormal behaviors in either or both areas.

For some people who have been diagnosed with sleep eating, interventions without the use of medications have proven helpful. Courses on stress management, group or one-on-one counseling with a therapist, or self-confidence training may alleviate the stress and anxiety that leads to nighttime bingeing. Although considered an alternative treatment, hypnosis may be an option for some sleep eaters. A change in diet that includes avoiding certain foods and eating at specified times of the day, as well as reducing the intake of caffeine or alcohol, may be therapeutic. Professional advice may also suggest avoiding certain medications.

If the underlying problem is diagnosed as sleepwalking, medications in the benzodiazepinefamily have had some success. In sleepwalkers, this class of drugs reduces motor activity during sleep. Another class of drug found to be effective for sleep eaters has been the dopaminergic agents such as Sinemet (carbidopa or levodopa) and Mirapex (pramipexole dihydrochloride). Refer to the chart in the Restless Legs section of this website for more information about dopaminergic agents and benzodiazepines.

If the underlying problem is a primary sleep disorder, such as sleep apnea or narcolepsy, check out the sections on this web site devoted to the treatment of these disorders.

Night Eating: Another Disorder of Sleep and Eating:
A similar sleep-related eating disorder has also been clinically described. It is different from sleep eating in that the individual is awake during episodes of nocturnal bingeing. This disorder has many names: nocturnal eating (or drinking) syndrome, nighttime hunger, nocturnal eating, night eating or drinking (syndrome), or the “Dagwood” syndrome. Affected individuals are physically unable to sleep without food intake.

The Merck Manual lists night eating under the heading obesity. It states that the disorder “consists of morning anorexia, excessive ingestion of food in the evening, and insomnia.” Because night eating is associated with increased weight gain as well as insomnia, this may cause the individual stress, anxiety, or depression.

Night eating or drinking may occur once or many times during the night. It is diagnosed when 50% or more of an individual’s diet is consumed between sleeping hours. Unlike sleep eaters, this person will eat foods that are similar to his/her normal diet.

People who are night eaters typically avoid food until noon or later, eat small portions frequently when they do eat, and binge in the evening. They are usually overweight and in adults, overly stressed or anxious. They will also complain of not being able to maintain sleep or not being able to initiate sleep. For night eaters, the urge to eat is an abnormal need, rather than true hunger, according to an article in Sleep by Italian researchers (September 1997; 20(9): 734-738).

Night eaters/drinkers are usually children, although the disorder can occur in adults. For children, eating or drinking at night is a conditioned behavior. This is a common occurrence for babies, but most infants can sleep the entire night by the age of 6 months. Sleep disturbance can persist to an older age if the child is allowed a bottle or drinks throughout the night. An older child may consistently wake up during the night and ask for a drink or something to eat and refuse to return to bed until the snack is consumed. In this case, the caregiver should identify actual need versus repeated requests.

According to the International Classification of Sleep Disorders, night eating is characterized as a dyssomnia (as opposed to sleep eating, which is considered a parasomnia). A dyssomnia is a disorder of sleep or wakefulness in which insomnia or excessive daytime sleepiness daytime sleepiness is a complaint. Within the heading of dyssomnia, night eating is classified as an extrinsic sleep disorder, which means that it originates, develops or is caused by an external source. Eating or drinking at night is usually a conditioned, conscious behavior; although it is a disorder, in many cases night eating is not caused by a psychological or medical condition.

Night eating may arise because of an ulcer, by dieting during the day, by undue stress or by a routine expectation (conditioned behavior). Hypoglycemia, or low blood sugar, has also been proposed as possible cause of nighttime bingeing in some people. This can be determined by a glucose tolerance test.
Click to see:->Night eating syndrome

Source:http://www.talkaboutsleep.com/sleep-disorders/archives/parasomnias_sleepeating.htm

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Narcolepsy

Definition:
Narcolepsy is chronic sleep disorder, or dyssomnia. The condition is characterized by excessive daytime sleepiness (EDS) in which a person experiences extreme fatigue and possibly falls asleep at inappropriate times, such as whilst at work or at school. A narcoleptic will most probably experience disturbed nocturnal sleep and also abnormal daytime sleep pattern, which is often confused with insomnia. When a person with narcolepsy falls asleep or goes to bed they will generally experience the 4th stage of sleep REM (rapid eye movement/dreaming state), within 10 minutes; whereas for most people, this shouldn’t occur until generally 30 minutes of slumber.
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Cataplexy, a sudden muscular weakness brought on by strong emotions (in most cases, there are many people who will experience cataplexy without having a emotional trigger), is known to be one of the other problems that some narcoleptics will experience. Often manifesting as muscular weaknesses ranging from a barely perceptible slackening of the facial muscles to the dropping of the jaw or head, weakness at the knees, or a total collapse. Usually only speech is slurred, vision is impaired (double vision, inability to focus), but hearing and awareness remain normal. In some rare cases, an individual’s body becomes paralyzed and muscles will become stiff.

The term narcolepsy derives from the French word narcolepsie created by the French physician Jean-Baptiste-Édouard Gélineau by combining the Greek narke numbness, stupor and lepsis attack, seizure.

Symptoms
The main characteristic of narcolepsy is excessive daytime sleepiness (EDS), even after adequate night time sleep. A person with narcolepsy is likely to become drowsy or fall asleep, often at inappropriate times and places. Daytime naps may occur with little warning and may be physically irresistible. These naps can occur several times a day. They are typically refreshing, but only for a few hours. Drowsiness may persist for prolonged periods of time. In addition, night time sleep may be fragmented with frequent awakenings.

Four other classic symptoms of the disorder, often referred to as the “tetrad of narcolepsy,” are cataplexy, sleep paralysis, hypnagogic hallucinations, and automatic behavior. These symptoms may not occur in all patients. Cataplexy is an episodic condition featuring loss of muscle function, ranging from slight weakness (such as limpness at the neck or knees, sagging facial muscles, or inability to speak clearly) to complete body collapse. Episodes may be triggered by sudden emotional reactions such as laughter, anger, surprise, or fear, and may last from a few seconds to several minutes. The person remains conscious throughout the episode. In some cases, cataplexy may resemble epileptic seizures. Sleep paralysis is the temporary inability to talk or move when waking (or less often, falling asleep). It may last a few seconds to minutes. This is often frightening but is not dangerous. Hypnagogic hallucinations are vivid, often frightening, dreamlike experiences that occur while dozing, falling asleep and/or while awakening.

Automatic behavior means that a person continues to function (talking, putting things away, etc.) during sleep episodes, but awakens with no memory of performing such activities. It is estimated that up to 40 percent of people with narcolepsy experience automatic behavior during sleep episodes. Sleep paralysis and hypnagogic hallucinations also occur in people who do not have narcolepsy, but more frequently in people who are suffering from extreme lack of sleep. Cataplexy is generally considered to be unique to narcolepsy and is analogous to sleep paralysis in that the usually protective paralysis mechanism occurring during sleep is inappropriately activated. The opposite of this situation (failure to activate this protective paralysis) occurs in rapid eye movement behavior disorder.

In most cases, the first symptom of narcolepsy to appear is excessive and overwhelming daytime sleepiness. The other symptoms may begin alone or in combination months or years after the onset of the daytime naps. There are wide variations in the development, severity, and order of appearance of cataplexy, sleep paralysis, and hypnagogic hallucinations in individuals. Only about 20 to 25 percent of people with narcolepsy experience all four symptoms. The excessive daytime sleepiness generally persists throughout life, but sleep paralysis and hypnagogic hallucinations may not.

Although these are the common symptoms of narcolepsy, many people with narcolepsy also suffer from insomnia for extended periods of time. The symptoms of narcolepsy, especially the excessive daytime sleepiness and cataplexy, often become severe enough to cause serious problems in a person’s social, personal, and professional life. Normally, when an individual is awake, brain waves show a regular rhythm. When a person first falls asleep, the brain waves become slower and less regular. This sleep state is called non-rapid eye movement (NREM) sleep. After about an hour and a half of NREM sleep, the brain waves begin to show a more active pattern again. This sleep state, called REM sleep (rapid eye movement sleep), is when most remembered dreaming occurs. Associated with the EEG-observed waves during REM sleep, muscle atonia is present (called REM atonia).

In narcolepsy, the order and length of NREM and REM sleep periods are disturbed, with REM sleep occurring at sleep onset instead of after a period of NREM sleep. Thus, narcolepsy is a disorder in which REM sleep appears at an abnormal time. Also, some of the aspects of REM sleep that normally occur only during sleep — lack of muscular control, sleep paralysis, and vivid dreams — occur at other times in people with narcolepsy. For example, the lack of muscular control can occur during wakefulness in a cataplexy episode; it is said that there is intrusion of REM atonia during wakefulness. Sleep paralysis and vivid dreams can occur while falling asleep or waking up. Simply put, the brain does not pass through the normal stages of dozing and deep sleep but goes directly into (and out of) rapid eye movement (REM) sleep.

This has several consequences. Night time sleep does not include as much deep sleep, so the brain tries to “catch up” during the day, hence EDS. People with narcolepsy may visibly fall asleep at unpredicted moments (such motions as head bobbing are common). People with narcolepsy fall quickly into what appears to be very deep sleep, and they wake up suddenly and can be disoriented when they do (dizziness is a common occurrence). They have very vivid dreams, which they often remember in great detail. People with narcolepsy may dream even when they only fall asleep for a few seconds.

Causes
Although the cause of narcolepsy was not determined for many years after its discovery, scientists had discovered conditions that seemed to be associated with an increase in an individual’s risk of having the disorder. Specifically, there appeared to be a strong link between narcoleptic individuals and certain genetic conditions. One factor that seemed to predispose an individual to narcolepsy involved an area of Chromosome 6 known as the HLA complex. There appeared to be a correlation between narcoleptic individuals and certain variations in HLA genes, although it was not required for the condition to occur. Certain variations in the HLA complex were thought to increase the risk of an auto-immune response to protein-producing neurons in the brain. The protein produced, called hypocretin or orexin, is responsible for controlling appetite and sleep patterns. Individuals with narcolepsy often have reduced numbers of these protein-producing neurons in their brains. In 2009 the autoimmune hypothesis was supported by research carried out at Stanford University School of Medicine.

The neural control of normal sleep states and the relationship to narcolepsy are only partially understood. In humans, narcoleptic sleep is characterized by a tendency to go abruptly from a waking state to REM sleep with little or no intervening non-REM sleep. The changes in the motor and proprioceptive systems during REM sleep have been studied in both human and animal models. During normal REM sleep, spinal and brainstem alpha motor neuron depolarization produces almost complete atonia of skeletal muscles via an inhibitory descending reticulospinal pathway. Acetylcholine may be one of the neurotransmitters involved in this pathway. In narcolepsy, the reflex inhibition of the motor system seen in cataplexy is believed identical to that seen in normal REM sleep.

In 2004 researchers in Australia induced narcolepsy-like symptoms in mice by injecting them with antibodies from narcoleptic humans. The research has been published in the Lancet providing strong evidence suggesting that some cases of narcolepsy might be caused by autoimmune disease. Narcolepsy is strongly associated with HLA-DQB1*0602 genotype. There is also an association with HLA-DR2 and HLA-DQ1. This may represent linkage disequilibrium. Despite the experimental evidence in human narcolepsy that there may be an inherited basis for at least some forms of narcolepsy, the mode of inheritance remains unknown. Some cases are associated with genetic diseases such as Niemann-Pick disease or Prader-Willi syndrome.

How common is narcolepsy
The prevalence of narcolepsy is similar to that of Parkinson’s disease and multiple sclerosis. In the United States, the National Institute of Neurological Disorders and Stroke estimates narcolepsy affects one in every 2,000 people. However, in some countries (for example, Israel), the prevalence of narcolepsy is much lower (one per 500,000) while in other countries (for example, Japan), it is much higher (one per 600). The American Sleep Association estimates that approximately 125,000 to 200,000 Americans suffer from narcolepsy, but only fewer than 50,000 are properly diagnosed.

Narcolepsy often remains undiagnosed or misdiagnosed for several years. This may occur because physicians do not consider the diagnosis of narcolepsy frequently enough. They may think of narcolepsy only in people who have the main symptom of excessive daytime sleepiness. Narcolepsy may not be considered in the evaluation of patients who come to doctors complaining of fatigue, tiredness, or problems with concentration, attention, memory, and performance, and other illnesses (seizures, mental illness, etc.).
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Narcolepsy has its typical onset in adolescence and young adulthood. There is an average 15-year delay between onset and correct diagnosis which may contribute substantially to the disabling features of the disorder. Cognitive, educational, occupational, and psychosocial problems associated with the excessive daytime sleepiness of narcolepsy have been documented. For these to occur in the crucial teen years when education, development of self-image, and development of occupational choice are taking place is especially damaging. While cognitive impairment does occur, it may only be a reflection of the excessive daytime somnolence.

The prevalence of narcolepsy is about 1 per 2,000 persons. It is a reason for patient visits to sleep disorder centers, and with its onset in adolescence, it is also a major cause of learning difficulty and absenteeism from school. Normal teenagers often already experience excessive daytime sleepiness because of a maturational increase in physiological sleep tendency accentuated by multiple educational and social pressures; this may be disabling with the addition of narcolepsy symptoms in susceptible teenagers. In clinical practice, the differentiation between narcolepsy and other conditions characterized by excessive somnolence may be difficult. Treatment options are currently limited. There is a paucity in the literature of controlled double-blind studies of possible effective drugs or other forms of therapy. Mechanisms of action of some of the few available therapeutic agents have been explored but detailed studies of mechanisms of action are needed before new classes of therapeutic agents can be developed. Narcolepsy is an underdiagnosed condition in the general population. This is partly because its severity varies from obvious to barely noticeable. Some people with narcolepsy do not suffer from loss of muscle control. Others may only feel sleepy in the evenings.

Diagnosis
Diagnosis is relatively easy when all the symptoms of narcolepsy are present, but if the sleep attacks are isolated and cataplexy is mild or absent, diagnosis is more difficult. It is also possible for cataplexy to occur in isolation. Two tests that are commonly used in diagnosing narcolepsy are the polysomnogram and the multiple sleep latency test (MSLT). These tests are usually performed by a sleep specialist. The polysomnogram involves continuous recording of sleep brain waves and a number of nerve and muscle functions during nighttime sleep. When tested, people with narcolepsy fall asleep rapidly, enter REM sleep early, and may awaken often during the night. The polysomnogram also helps to detect other possible sleep disorders that could cause daytime sleepiness.

For the multiple sleep latency test, a person is given a chance to sleep every 2 hours during normal wake times. Observations are made of the time taken to reach various stages of sleep (sleep onset latency). This test measures the degree of daytime sleepiness and also detects how soon REM sleep begins. Again, people with narcolepsy fall asleep rapidly and enter REM sleep early.
You may click to learn more     http://www.medicinenet.com/narcolepsy/page4.htm

Treatment
Treatment is tailored to the individual, based on symptoms and therapeutic response. The time required to achieve optimal control of symptoms is highly variable, and may take several months or longer. Medication adjustments are also frequently necessary, and complete control of symptoms is seldom possible. While oral medications are the mainstay of formal narcolepsy treatment, lifestyle changes are also important.

The main treatment of excessive daytime sleepiness in narcolepsy is with a group of drugs called central nervous system stimulants such as methylphenidate, racemic – amphetamine, dextroamphetamine, and methamphetamine, or modafinil, a new stimulant with a different pharmacologic mechanism. In Fall 2007 an alert for severe adverse skin reactions to modafinil was issued by the FDA.  Other medications used are codeine and selegiline. Another drug that is used is atomoxetine (Strattera), a non-stimulant and Norepinephrine reuptake inhibitor (NRI), that has little or no abuse potential. In many cases, planned regular short naps can reduce the need for pharmacological treatment of the EDS to a low or non-existent level.

Cataplexy and other REM-sleep symptoms are frequently treated with tricyclic antidepressants such as clomipramine, imipramine, or protriptyline, as well as other drugs that suppress REM sleep. Venlafaxine, a newer antidepressant which blocks the reuptake of serotonin and norepinephrine, has shown usefulness in managing symptoms of cataplexy[citation needed]. Gamma-hydroxybutyrate (GHB), a medication recently approved by the FDA, is the only medication specifically indicated for cataplexy. Gamma-hydroxybutyrate has also been shown to reduce symptoms of EDS associated with narcolepsy. While the exact mechanism of action is unknown, GHB is thought to improve the quality of nocturnal sleep.

In addition to drug therapy, an important part of treatment is scheduling short naps (10 to 15 minutes) two to three times per day to help control excessive daytime sleepiness and help the person stay as alert as possible. Daytime naps are not a replacement for nighttime sleep. Ongoing communication between the health care provider, patient, and the patient’s family members is important for optimal management of narcolepsy. Finally, a recent study reported that transplantation of hypocretin neurons into the pontine reticular formation in rats is feasible, indicating the development of alternative therapeutic strategies in addition to pharmacological interventions.

Learning as much about narcolepsy as possible and developing a support system or finding a support group may help patients and families deal with the practical and emotional effects of the disorder, possible occupational limitations, and situations that might cause injury. Individuals with narcolepsy should avoid jobs that require driving long distances or handling hazardous equipment or that require alertness for lengthy periods. They may find it helps to take a nap before driving if possible or have a scheduled nap break during a long driving trip.
Click to learn more-> 1.Medication 2.Non Medication treatment

The National Sleep Foundation, University at Buffalo, and Mayo Clinic suggest it may help sufferers if they alert their employers, co-workers and friends in the hope that others will accommodate their condition and help when needed. The foundation say it may help if the sufferer breaks up larger tasks into small pieces and focuses on one small thing at a time, and if they carry a tape recorder, if possible, to record important conversations and meetings. The clinics say taking several short walks during the day may help sufferers.

What’s in the future for narcolepsy?

The discovery that a lack of hypocretins in the cerebrospinal fluid (CSF) may be related to the cause of narcolepsy could lead to the development of tests to determine the level of hypocretins in the CSF. Such tests could help in the diagnosis of narcolepsy. The expectation is that these tests will be simple (drawing blood), and will reflect the level of hypocretins in the CSF. In addition, the discovery of the role of hypocretins in the development of narcolepsy may lead to the development of new drugs for the treatment of narcolepsy.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.


Resources:

http://en.wikipedia.org/wiki/Narcolepsy
http://www.medicinenet.com/narcolepsy/article.htm

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Hypersomnia

Definition
Hypersomnia refers to a set of related disorders that involve excessive daytime sleepiness.It is characterized by reoccuring episodes of excessive daytime sleepiness or prolonged nighttime sleep. Different from feeling tired due to lack of or interrupted sleep at night, persons with hypersomnia are compelled to nap repeatedly during the day, often at inappropriate times such as at work, during a meal, or in conversation. These daytime naps usually provide no relief from symptoms. Patients often have difficulty waking from a long sleep, and may feel disoriented. Other symptoms may include anxiety, increased irritation, decreased energy, restlessness, slow thinking, slow speech, loss of appetite, hallucinations, and memory difficulty. Some patients lose the ability to function in family, social, occupational, or other settings.

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Description:
There are two main categories of hypersomnia: primary hypersomnia (sometimes called idiopathic hypersomnia) and recurrent hypersomnia (sometimes called recurrent primary hypersomnia). Both are characterized by the same signs and symptoms and differ only in the frequency and regularity with which the symptoms occur.

Primary hypersomnia is characterized by excessive daytime sleepiness over a long period of time. The symptoms are present all, or nearly all, of the time. Recurring hypersomnia involves periods of excessive daytime sleepiness that can last from one to many days, and recur over the course of a year or more. The primary difference between this and primary hypersomnia is that persons experiencing recurring hypersomnia will have prolonged periods where they do not exhibit any signs of hypersomnia, whereas persons experiencing primary hypersomnia are affected by it nearly all the time. One of the best documented forms of recurrent hypersomnia is Kleine-Levin syndrome, although there are other forms as well.

There are many different causes for daytime sleepiness that are not considered hypersomnia, and there are many diseases and disorders in which excessive daytime sleepiness is a primary or secondary symptom. Feelings of daytime sleepiness are often associated with the use of common substances such as caffeine, alcohol, and many medications. Other common factors that can lead to excessive daytime sleepiness that is not considered hypersomnia include shift work and insomnia. Shift work can disrupt the body’s natural sleep rhythms. Insomnia can cause excessive daytime sleepiness because of lack of nighttime sleep, and is a separate disorder.

Causes and symptoms:Hypersomnia can be caused by genetics (heredity), brain damage, and disorders such as clinical depression, uremia and fibromyalgia. Hypersomnia can also be a symptom of other sleep disorders such as narcolepsy, sleep apnea, and restless leg syndrome.

People who are overweight may be more likely to suffer from hypersomnia. This can often exacerbate weight problems as excessive sleeping decreases metabolic energy consumption, making weight loss more difficult.

Another possible cause is an infection of mononucleosis, as several instances of hypersomnia have been found to arise immediately after such an infection (Dr. Givan, MD, Riley Hospital).

In some instances, the cause of the hypersomnia cannot be determined; in these cases, it is considered to be idiopathic hypersomnia.

Hypersomnia may also occur as a side effect of taking certain medications (i.e some psychotropics for depression, anxiety, or bipolar disorder).
People experiencing hypersomnia do not get abnormal amounts of nighttime sleep. However, they often have problems waking up in the morning and staying awake during the day. People with hypersomnia nap frequently, and upon waking from the nap, do not feel refreshed. Hypersomnia is sometimes misdiagnosed as narcolepsy. In many ways the two are similar. One significant difference is that people with narcolepsy experience a sudden onset of sleepiness, while people with hypersomnia experience increasing sleepiness over time. Also, people with narcolepsy find daytime sleep refreshing, while people with hypersomnia do not.

People with Kleine-Levin syndrome have symptoms that differ from the symptoms of other forms of hypersomnia. These people may sleep for 18 or more hours a day. In addition, they are often irritable, uninhibited, and make indiscriminate sexual advances. People with Kleine-Levin syndrome often eat uncontrollably and rapidly gain weight, unlike people with other forms of hypersomnia. This form of recurrent hypersomnia is very rare.

The causes of hypersomnia remain unclear. There is some speculation that in many cases it can be attributed to problems involving the hypothalamus, but there is little evidence to support that claim.

Demographics:
Hypersomnia is an uncommon disorder. In general, 5% or fewer of adults complain of excessive sleepiness during the daytime. That does not mean all those who complain of excessive sleepiness have hypersomnia. There are many other possible causes of daytime sleepiness. Of all the people who visit sleep clinics because they feel they are too sleepy during the day, only about 5–10% are diagnosed with primary hypersomnia. Kleine-Levin syndrome is present in about three times more males than females, but it is a very rare syndrome.

Hypersomnia generally appears when the patient is between 15 and 30 years old. It does not begin suddenly, but becomes apparent slowly, sometimes over years.

Diagnosis:
Hypersomnia is characterized by excessive daytime sleepiness, and daytime naps that do not result in a more refreshed or alert feeling. Hypersomnia does not include lack of nighttime sleep. People experiencing problems with nighttime sleep may have insomnia, a separate sleep disorder. In people with insomnia, excessive daytime sleepiness may be a side effect.

The Diagnostic and Statistical Manual of Mental Disorders, which presents the guidelines used by the American Psychiatric Association for diagnosis of disorders, states that symptoms must be present for at least a month, and must interfere with a person’s normal activities. Also, the symptoms cannot be attributed to failure to get enough sleep at night or to another sleep disorder. The symptoms cannot be caused by another significant psychological disorder, nor can they be a side effect of a medicinal or illicit drug or a side effect of a general medical condition. For a diagnosis of recurrent hypersomnia, the symptoms must occur for at least three days at a time, and the symptoms have to be present for at least two years.

An adult is considered to have hypersomnia if he or she sleeps more than 10 hours per day on a regular basis for at least two weeks, or if he or she is compelled to nap repeatedly during the day.

One diagnosis tool is the Epworth Sleepiness Scale, which helps determine the extent of EDS in a subject. A self test is available from Stanford University Medical School.

Treatments:Treatment is symptomatic in nature. Stimulants, such as amphetamine, methylphenidate, and modafinil, may be prescribed. Other drugs used to treat hypersomnia include clonidine, levodopa, bromocriptine, antidepressants, and monoamine oxidase inhibitors. Changes in behavior (for example avoiding night work and social activities that delay bed time) and diet may offer some relief. Patients should avoid alcohol and caffeine.
No substantial body of evidence supports the effectiveness of these treatments. Stimulants are not generally recommended to treat hypersomnia as they treat the symptoms but not the base problem. Some researchers believe that treatment of the hypothalamus may be a possible treatment for hypersomnia.

Prognosis:
Kleine-Levin syndrome has been reported to resolve occasionally by itself around middle age. Except for that syndrome, hypersomnia is considered both a lifelong disorder and one that can be significantly disabling. There is no body of evidence that concludes there is a way to treat the majority of hypersomnia cases successfully.

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Massage Therapy for Hypersomnia

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.minddisorders.com/Flu-Inv/Hypersomnia.html
http://en.wikipedia.org/wiki/Hypersomnia

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