Hypersomnia (pathological drowsiness)

Hypersomnia (pathological drowsiness) can complicate the course of many diseases of the main nervous system and manifests itself as a permanent and paroxysmal (periodic) hypersomnia.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]

The main causes of hypersomnia

1. Narcolepsy.
2. Idiopathic hypersomnia.
3. The "sleep apnea" syndrome.
4. Kleine-Levin syndrome.
5. Organic damage to the upper sections of the brainstem and diencephalon (craniocerebral trauma, volumetric formations, encephalitis, progressive hydrocephalus, etc.).
6. With mental illness (depression, dysthymia).
7. After infectious diseases.
8. With night pains and frequent nocturnal seizures (for example, hypnogenic paroxysmal dystonia, periodic limb movements, restless legs syndrome).
9. Syndrome of delayed (delayed) phase of sleep.
10. Psychogenic (stressful, with neurotic disorders).
11. Somatic diseases.
12. Iatrogenic hypersomnia.

Narcolepsy

Pathological drowsiness in narcolepsy has the character of insurmountable bouts of falling asleep, appearing in an inadequate situation. The occurrence of a seizure is facilitated by a monotonous situation, meetings, prolonged sitting, etc. The frequency of seizures varies from single to several hundred per day. The average duration of an attack is 10-30 minutes. During an attack, the patient can be awakened, but this is not always possible to do easily. The detailed picture of narcolepsy includes five main manifestations: besides attacks of daytime sleepiness (hypersomnia), cataplexy is also characteristic (short-term generalized or partial attacks of loss of tonus and strength without disturbance of consciousness); hypnagogic hallucinations, occasionally appearing when falling asleep; cataplexy of awakening and falling asleep ("sleep paralysis") and disturbance of night sleep.

Sleep polygraphy reveals early onset of the fast sleep phase (a characteristic decrease in the latent period of fast sleep), frequent awakenings, reduction of delta sleep and other characteristic disorders of its structure.

Idiopathic hypersomnia

Idiopathic hypersomnia is characterized by lengthening the duration of night sleep in combination with pathological daytime drowsiness; it differs from narcolepsy in the absence of cataplexy, hypnagogic hallucinations and sleep paralysis.

Diagnosis is the diagnosis of an exception; with polysomnography there is a prolonged night's sleep without signs of another pathology of sleep. MTLS shows a shortening of the latency of sleep without the appearance of a phase of sleep with BDG. Treatment similar to the treatment of narcolepsy, with the exception of anti-cataractics.

The syndrome of "sleep apnea" ("Pickwick syndrome")

Snoring and excessive daytime sleepiness are among the most typical external manifestations of the "sleep apnea" syndrome. In contrast to the physiological stops of breathing in sleep, pathological stops of respiration in the sleep develop more often (more than 5 per hour) and they are more prolonged (more than 10 seconds), and the dream is characterized by a typical restless character with frequent awakenings. Sleep apnea accompanies other characteristic signs: severe snoring, increased daytime sleepiness, hypnagogic hallucinations, nocturnal enuresis, morning headaches, arterial hypertension, overweight, decreased libido, personality change, decreased intelligence.

Isolate central, obstructive and mixed apnea.

Causes of central apnea: organic lesions of the brain stem (amyotrophic lateral sclerosis, syringobulbia, primary alveolar hypoventilation or "Undine's curse syndrome," etc.) and peripheral paresis of the respiratory muscles (Guillain-Barre syndrome and other severe polyneuropathies).

Often observed obstructive sleep apnea: hypertrophy of the tonsils, their edema and inflammatory infiltration; anatomical anomalies of the lower jaw; obesity; Prader-Willi syndrome (Prader-Willi); an enlarged tongue or tongue with Down's syndrome, hypothyroidism, or acromegaly; weakness of the dilator of the pharynx (myotonic dystrophy, muscular dystrophy, lesions of the medulla oblongata, amyotrophic lateral sclerosis); swelling of the pharynx; abnormalities of the base of the skull (Arnold-Chiari syndrome, Klippel-Feil syndrome, achondroplasia); dyspnea in the Shay-Draeger syndrome and family disautonomy. The most common mixed apnea. Sleep apnea is a risk factor for sudden death.

The best way to diagnose is night polysomnography, which allows you to objectively register and measure apnea, as well as the associated hypoxemia (reduced oxygen saturation of the blood).

Klein-Levine Syndrome

The disease manifests itself in episodes of periodic drowsiness with increased hunger (voracity) and psychopathological disorders (confusion, anxiety, psychomotor agitation, hallucinations, hypersexuality). The duration of the attack is from several days to several weeks. A violent awakening can provoke a marked aggressive behavior. The disease debuts for no apparent reason, mostly at pubertal age and affects almost exclusively male patients.

Organic damage of the upper parts of the brain stem and diencephalon

Epidemics encephalitis in the acute phase is often accompanied by pathological drowsiness ("ophthalmoplegic hypersomnia"). Craniocerebral injury is another possible cause of hypersomnia. Minor drowsiness is possible in acute stage and in the period of convalescence of virtually any infection; it is sometimes noted and after a slight craniocerebral trauma. Acute disorders of cerebral circulation, as well as brain tumors, can be accompanied by prolonged hypersomnia states. Hyperpsomal syndromes differ from a coma with relative awakening: external influences allow the patient to be taken out of hibernation and to obtain from him a more or less adequate response to verbal stimuli. Clarification of the nature of organic damage is achieved using, in addition to clinical research, methods of neuroimaging and lumbar puncture, if the latter is not associated with the risk of dislocation of the brainstem.

Hypersomnia is sometimes observed with multiple sclerosis, Wernicke's encephalopathy, African sleeping sickness.

Among the degenerative diseases, which are sometimes accompanied by hypersomnia, most often are Alzheimer's disease, Parkinson's disease, multisystem atrophy.

Mental diseases

Mental diseases, especially endogenous nature, can sometimes be accompanied by increased drowsiness. The states of depression (for example, with seasonal affective disorders) are manifested by a decrease in activity and drowsiness. The debut of schizophrenia in adolescence is often marked by increased need for a day's sleep.

Infectious diseases

Infectious diseases, especially in the stage of convalescence, are accompanied by increased drowsiness in the picture of the asthenic state.

Night pains and other pathological conditions, interrupting night sleep

Nocturnal pains of somatogenic or neurogenic origin, as well as frequent nocturnal seizures (for example, frequent attacks of hypnotic paroxysmal dystonia), periodic movements of limbs in the dream or restless leg syndrome, causing fragmentation of night sleep, can lead to compensatory daytime sleepiness and cause a decrease in working capacity and adaptation .

Syndrome of delayed (delayed) phase of sleep

This syndrome, like some other similar syndromes, is caused by a disturbance of the circadian rhythm and is manifested by complaints about an extremely difficult awakening that requires a long time and excessive morning drowsiness. However, these patients do not have evening sleepiness and they go to bed late at night.

Psychogenic hypersomnia

"Hysterical hibernation" (in obsolete terminology) can manifest as an episode (s) of hours or hours of hibernation in response to acute emotional stress. There is a behavioral picture of sleep (the patient looks like a sleeper and can not be awakened by external stimuli), however, a clear a-rhythm with a pronounced approximate response to external stimuli is recorded on the EEG.

Somatic diseases

Hypersomnia can occur with such somatic diseases as hepatic insufficiency, renal failure, respiratory failure, electrolyte disorders of various nature, heart failure, severe anemia, endocrine disorders (hypothyroidism, acromegaly, diabetes mellitus, hypoglycemia, hyperglycemia).

Iatrogenic hypersomnia

Hypersomnia of iatrogenic origin is often found in neurological practice. It is caused by benzodiazepines, nonbenzodiazepine hypnotics (phenobarbital, zolpidem), sedative antidepressants, neuroleptics, antihistamines, narcotic analgesics, beta-blockers.

The so-called physiological hypersomnia is observed in the deprivation of sleep associated with lifestyle and violation of the usual sleep and wakefulness.

A catamenial hypersomnia associated with the menstrual cycle is also described.

Among the intoxications causing hypersomnia, alcohol abuse is most common.

Diagnostic tests for pathological somnolence

Electroglypics of wakefulness and night sleep with breath recording; clinical evaluation of somatic, mental and neurological status; if necessary - CT and MRI, examination of cerebrospinal fluid (rare).

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