SLEEP
APNEA And HYPERSOMNIA
Following is some information on Sleep Apnea - This
page is not medical advice in any way, shape or form and is intended to provide
support for those experiencing similar procedures -
Sleep Apnea Information
Here's a few links that talked about sleep apnea and
sleep studies - there are hundreds of sites from hospitals, medical
professionals, etc that talk about the different types of sleep disorders,
study methods and so on - a lot of 'testimonial' pages on the GREAT success a
lot of people have had when their sleep disorders were brought under control -
after I started to 'spread it around', several of my friends came forward
(closet CPAPers) and virtually all raved about the improvement in their lives
with the usage of the CPAP - none would give it up - you have nothing to fear,
it is more the aggravation of dealing with the medical profession, get this
test, get that test, and wait .... - And I think you have an excellent chance
at gaining a major improvement in the quality of your life - I wish you the
best of luck
http://www.sleepapnea.org/geninfo.html
http://www.talkaboutsleep.com/basics/basics_index.htm
http://www.talkaboutsleep.com/basics/psg/Wired_2.htm
http://www.sleepfoundation.org/disorder.html
http://www.respironics.com/health_information/sleepdisorders.cfm?objectID=7E8F9909-E4B6-4C33-B71FB0FAF896E11C&method=nextSteps
http://health.discovery.com/diseasesandcond/encyclopedia/1397.html
http://www.sleep-breathing.bc.ca/sleep.htm
http://www.talkaboutsleep.com/sleepdisorders/idiopathic_hypersomnia.htm
An Introduction To Hypersomnia
A sleep disorder is a physical and
psychological condition or disturbance of sleep and wakefulness caused by
abnormalities that occur during sleep or by abnormalities of specific sleep
mechanisms. Although the sleep disorder exists during sleep, recognizable
symptoms manifest themselves during the day. Accurate diagnosis requires a
polysomnogram, widely known as a "sleep test."
It is estimated that some 40 million
Americans suffer from chronic, long-term sleep disorders. Another 20 to 30
million Americans suffer from some kind of sleep disorder on an irregular
basis. The annual costs in productivity, health care, and safety have been
estimated in the billions of dollars.
What Is Hypersomnia?
Hypersomnia refers to either
excessive sleepiness during the day or extended, overly long periods of
nighttime sleep. Other words that are synonymous with hypersomnia are excessive
daytime sleepiness (EDS), excessive sleepiness, or somnolence.
Hypersomnia is fairly common, with
nearly 5% of the population affected. The age groups most affected by
hypersomnia are teenagers and young adults. As with most sleep disorders,
hypersomnia is underreported because many people inaccurately believe that
always feeling sleepy and taking naps are normal behavior.
A distinction should be made between
simple tiredness, fatigue, or depression, and hypersomnia. Sleep deprivation is
a common state for most of the population - many people are tired or sluggish
at certain periods during the day.
The depressed person either will not
want to get out of bed or will suffer from insomnia, even though he or she
feels a nap will improve the depression. On the contrary, hypersomniacs are so
sleepy during the day that they are compelled to sleep or "take a
nap."
These individuals fall asleep during
movies, dinner, or even in conversation. Similarly, they may sleep ten hours or
longer during one sleep cycle, rather than the average eight.
There are various types of
hypersomnia: post-traumatic, recurrent, idiopathic, and normal.
Post-traumatic Hypersomnia
This type of hypersomnia may arise
from a head injury or a traumatic incident involving the central nervous
system. It is usually associated with related symptoms such as headaches,
fatigue, memory impairment, as well as difficulty concentrating. Hypersomnia is
more commonly seen immediately after the accident, however, in some cases,
symptoms are delayed more than a year. Duration of symptoms may last only a
short time, can continue for months or years, or can remain indefinitely.
Recurrent Hypersomnia
This disorder is characterized by
recurring episodes of hypersomnia. Kleine-Levin Syndrome, a disorder that
causes individuals to sleep for extended periods of time followed by a normal
period of alertness, is a type of recurrent hypersomnia. The length of the
episode or the time period between episodes is indeterminate. It may or may not
be accompanied by other symptoms such as overeating (also called gluttony or
clinically, compulsive hyperphagia) and hypersexuality.
Idiopathic Hypersomnia
The term "idiopathic"
means without known cause. This type of hypersomnia is similar to narcolepsy in
that the individual is excessively sleepy, falls asleep at inappropriate times,
frequently takes naps, and sleeps at night for greater than 10 hours. In some
cases of idiopathic hypersomnia, cataplexy and hypnagogic hallucinations may be
present and resemble the symptoms of narcolepsy. However, in idiopathic
hypersomnia there are insufficient sleep onset REM periods to justify the
diagnosis of narcolepsy.
Normal Hypersomnia
Often a genetic predisposition, a
"normal" hypersomniac is one who simply requires more sleep, i.e.
more than 10 hours of sleep per day. The problem that results is when sleep
patterns and requirements interfere with a daily schedule. These individuals
are typically called "long sleepers."
What Causes Hypersomnia?
There are many potential causes of
hypersomnia. The simplest reason for excessive sleepiness during the day or
night is need. If an individual has repeatedly lacked a good night's sleep, he
or she will inevitably compensate for the loss by taking a nap or sleeping
longer at night. Most individuals will not allow this trend to continue for an
extended period of time and these persons are not diagnosed with clinical
hypersomnia.
Causes of Clinical Hypersomnia
·
Sleep
Deprivation in a naturally long sleeper
·
Another
sleep disorder or illness
·
Central
nervous system disorder, damage or dysfunction
·
Medical
withdrawal
·
Certain
Medications
·
Head
injury or trauma
·
Genetic
predisposition
Hypersomnia may be a symptom of a
primary sleep disorder such as Periodic Limb Movement Disorder or narcolepsy.
This also applies to certain medical, psychiatric or neurological illnesses.
Hypersomnia can be the result of a
central nervous system disorder, tumor, brain damage, or dysfunction. Recurrent
hypersomnia is thought to be caused by a hypothalamic dysfunction (located in
the hypothalamus). Similarly, post-traumatic hypersomnia is more likely to
occur in individuals whose injury involved certain parts of the central nervous
system, specifically the hypothalamic or brain stem region, although the
specific region is unknown. In the case of the "normal" hypersomniac
in which the person requires at least 10 hours of sleep a day, his or her
schedule may not accommodate that need, resulting in perpetual sleepiness.
The use or withdrawal of certain
medications may also cause hypersomnia. Tranquilizers and sleeping pills, known
for their sedative affect, can promote sleepiness during the day. Hypersomnia
is often experienced in people attempting to withdraw from caffeine, alcohol,
or stimulants.
What Are The Consequences Of
Hypersomnia?
Excessive sleepiness, napping, and
long nighttime sleeping can all interfere with a normal schedule and work
routine. Related symptoms of hypersomnia, including irritability, mild
depression, memory loss, and lack of concentration, impair performance. For
this reason, persons suffering from hypersomnia should be careful when
operating machinery, especially driving a motorized vehicle, as accidents are
likely to happen.
When Should I See a Doctor?
Hypersomnia may be referred to as
excessive sleepiness during the day, the time when many people are awake. Excessive
sleepiness is a major complaint of shift workers or individuals who suffer from
another sleep disorder. The key for identifying when it is necessary to see a
professional is the point at which one's life or mental well being is
disturbed.
Diagnosis
As mentioned above, there are many
causes of hypersomnia. It is important for a healthcare provider to analyze and
identify the underlying cause. Consultation with a sleep specialist may be
necessary. In some cases, a primary care physician will be able to refer
patients to a reputable, licensed sleep specialist in the area. Because it is
common for people who are suffering from another sleep disorder or medical
condition to present with a complaint of excessive sleepiness, a sleep
specialist will want to investigate and analyze most patients with an overnight
polysomnogram.
One night spent in the sleep clinic
may require more testing. To that end, a multiple sleep latency test (MLST) is
a good indicator of excessive sleepiness. It is a test that reveals how quickly
a patient falls asleep and whether he/she progresses to REM sleep. For the
MSLT, the patient is asked to spend a night in the sleep laboratory to make
sure he or she receives adequate sleep and that no other sleep disorders are
present. The next day, the MSLT is performed. Electrodes are attached to
various areas on the body. The patient is asked to take four or five 20-minute
naps every two hours. A diagnosis of excessive sleep is made if the patient
falls asleep within 5 minutes of each nap.
Other quantification tests used by
sleep specialists for determining excessive sleepiness are the Maintenance of
Wakefulness Test (MWT) and vigilance testing. The MWT is similar to an MSLT
except that it encourages the patient to remain awake during the designated
naptime. This test is useful for establishing efficacy of certain medications
or the ability to operate heavy equipment. Vigilance testing refers to various
tests that measure alertness. These can be subjective by self-rating scales, or
physiological by pupillometry, MLST, or MWT. Vigilance testing can also include
asking the patient to perform tasks that reveal concentration levels.
Subjective tests of sleepiness can
be found here on our website. You may assess your sleepiness by using our Self
Assessment Test or the Epworth Sleepiness Scale The Self Assessment Test asks
you to select the statements that describe your daily (and nightly) behavior.
The results of the test may help you ascertain symptoms of a sleep disorder.
The Epworth Sleepiness Scale is a short and standard assessment test that
estimates on a scale from 0 to 24 whether you are experiencing excessive
sleepiness possibly requiring medical attention.
Please keep in mind that both tests
are intended as a general source of information only. A specific diagnosis
should not be assumed as only a trained professional can accurately diagnose
and treat medical conditions. Scores from either test neither confirm nor
eliminate the possibility that you have a sleep disorder.
Treatment
Depending on the cause of the
hypersomnia, treatments for various symptoms are available. If the hypersomnia
is caused by sleep deprivation, the treatment can be as simple as making more
time in one's schedule to get enough sleep. If it is caused by certain
medications, an adjustment to the dosage or time of day, or even a switch to a
different drug, may be the solution.
Hypersomnia is the major complaint
of patients suffering from other medical conditions or disorders, including
other primary sleep disorders. If an underlying medical condition is the cause
of the hypersomnia, the principal disorder will need to be treated directly.
Treatment of post-traumatic
hypersomnia is usually confined to controlling the symptoms of excessive
daytime sleepiness. Stimulant medications used to improve mental activity, such
as methylphenidate (Ritalin), modafinil (Provigil), or pemoline (Cylert), may
be prescribed.
Because recurrent hypersomnia occurs
for relatively short, temporary periods of time and on average, twice per year,
treatment is largely support-oriented. Informing family, friends, coworkers and
employers of the disorder is the best means of establishing support and
understanding. Pharmacologic treatment of recurrent hypersomnia is limited to
an "as needed" basis.
Treatment of idiopathic hypersomnia
is similar to that of narcolepsy patients. Remaining alert is the goal of
treatment for excessive sleepiness. A stimulant medication such as modafinil
(Provigil) may be initially prescribed and monitored for adequate response.
Other drugs may be added or considered if initial attempts at treatment are not
satisfactory. Lifelong treatment is usually required.