What Are the Different Causes of Excessive Sleeping?

In addition, hypothyroidism, hyperglycemia, hypoglycemia, anemia, uremia, hypercapnia, hypercalcemia, liver failure, epilepsy and multiple sclerosis can also cause excessive sleep. Patients with sleep apnea syndrome often have compensatory daytime sleepiness. Through detailed medical history inquiry and physical examination, combined with necessary brain imaging tests and blood and urine tests, most causes of excessive sleep can be identified. Kleine-Levin syndrome is an extremely rare condition that occurs in adolescent boys and manifests as recurrent episodes of excessive sleep and overeating.

Excessive sleep

A pathological increase in absolute sleep time of ± 25%. Causes of chronic oversleeping include mass lesions involving the hypothalamus or upper brainstem, increased intracranial pressure, excessive use or abuse of hypnotics or certain illegal drugs, Or some types of encephalitis. It can also be used as a symptom of depression. Acute, relatively short duration of hypersleep is usually a symptom of acute systemic diseases such as influenza.

In addition, hypothyroidism, hyperglycemia, hypoglycemia, anemia, uremia, hypercapnia, hypercalcemia, liver failure, epilepsy and multiple sclerosis can also cause excessive sleep. Patients with sleep apnea syndrome often have compensatory daytime sleepiness. Through detailed medical history inquiry and physical examination, combined with necessary brain imaging tests and blood and urine tests, most causes of excessive sleep can be identified. Kleine-Levin syndrome is an extremely rare condition that occurs in adolescent boys and manifests as recurrent episodes of excessive sleep and overeating.

Narcolepsy

A rare syndrome consisting of narcolepsy, sudden loss of muscle tone (cataplexy), sleep paralysis, and premature sleepiness.

About 10% of the cases have all the symptoms of tetrad. The cause is unknown, although all cases tested for human leukocyte antigens are special HLA haplotypes, suggesting a hereditary cause. Male and female incidence rates are equal; some cases have a family history. No pathological changes were found in the brain. Life is not affected.

Symptoms and signs

Symptoms usually begin during adolescence or young adulthood. All symptoms and signs are intensified manifestations of normal phenomena. However, the occurrence of symptoms can put patients at risk, often hindering their work or social relationships, and can greatly reduce the quality of life.

Paroxysmal sleep can occur at any time. It can occur a few times or many times a day, and a single episode of sleep lasts from minutes to hours. Patients with such a strong desire for sleep can only resist briefly; as in normal sleep, it is easy to awaken the patient from a sleep episode. Although sleep episodes often occur when the environment is monotonous and causes normal people to fall asleep, they can also occur in dangerous situations (for example, while driving). The patient may feel refreshed when he wakes up from a sleep attack, but falls back to sleep suddenly after a few minutes. Although there are frequent sleep episodes during the day, the total sleep time throughout the day usually does not increase. It can be observed in the EEG recording that it immediately enters the REM sleep phase from the beginning. This type is significantly different from normal sleep. Normally, there is NREM sleep before the emergence of REM sleep, which usually lasts 60 to 90 minutes. Night sleep is often not satisfactory to the patient and can be interrupted by vivid and terrible dreams.

A cataplexy is a transient paralysis without loss of consciousness, caused by a sudden emotional response, such as funny, angry, fearful or happy, or often an unexpected surprise. Weakness may be confined to the limbs (for example, when the fish is suddenly seen hooking, the patient is unable to hold the fishing rod and the hook rod is lost), or the patient may fall to the ground softly, when the patient laughs abruptly or is suddenly angry . These episodic symptoms are similar to the loss of muscle tone that occurs during REM sleep, or to a lesser extent than when ordinary people "come together with a weak smile".

Sleep paralysis means that when a patient wants to move his limbs or body when he is going to sleep but hasn't fully fallen asleep, or has just woke up but hasn't fully awoke, he has found that he can't move for a while. This occasional event can scare patients. Sleep paralysis is similar to the exercise suppression associated with REM sleep, and is also common in normal children and some other normal adults.

Pre-sleeping hallucinations are some particularly vivid auditory or visual illusions or hallucinations that occur just before falling asleep, or more rarely when they just wake up. These phenomena are difficult to distinguish from strong fantasies and are similar to the vivid dreams that normally occur in REM sleep. The hallucinations before falling asleep can also be seen in young children and adults without narcolepsy or other sleep disorders, which are common in the former and occasional in the latter.

The only laboratory abnormality was the rapid low-potential activity typical of REM sleep that immediately appeared on the EEG at the time of the attack.

diagnosis

The history of typical sleep episodes is characteristic and should be queried for other symptoms of tetrad. Based on medical history, multiple sleep latency tests can usually confirm the diagnosis. A few patients have only one symptom of sleep onset, and may also lack the early onset of typical REM sleep.

Some special causes that can cause excessive sleep should be ruled out. The identification of sleep deprivation and depression depends on an assessment of a psychiatric history, the environmental conditions of sleep, the duration of symptoms, and the lack of attention to cataplexy.

treatment

Many people who are normal in other aspects also occasionally have sleep paralysis or hallucinations before falling asleep, but they do not cause trouble, never seek medical treatment, and do not need treatment. For others, modafinil or stimulants can help prevent drowsiness. Modafinil is a single dose in the morning and is administered as a 200 mg or 400 mg oral dose. Dosages depend on the needs of individual patients. Ritalin 20 to 60 mg / d may be most effective during oral administration in the daytime; ephedrine 25 mg, amphetamine 10 to 20 mg or dextroamphetamine 5 to 10 mg, orally, every 3 to 4 hours can also be applied. Tricyclic antidepressants (especially imipramine, chlorpromazine, and protilin) and monoamine oxidase inhibitors are useful for treating cataplexy, sleep paralysis, and pre-sleep hallucinations. Imipramine 10 ~ 75mg / d orally is the drug of choice for the treatment of cataplexy, but it should only be taken during the day to reduce night awakening. Patients who use both imipramine and stimulants are at risk of developing hypertension and should be closely monitored.