Feeling chronically tired? It may be narcolepsy

Around 5 people from 10 would say “yes” if you ask them whether they feel chronically tired and need several cups of coffee a day to keep going. This may be because they have less than 8 hours of sleep at night or suffer from one of the types of hypersomnia.

What is hypersomnia?

Hypersomnia is a term that comprises several disorders that have in common either excessive daytime sleepiness or need for excessive night sleep. There are various reasons for hypersomnia which require different approaches.

There is a psycho-psychological hypersomnia that occurs in healthy individuals in insufficient night sleep, in stress, and the pathological forms of hypersomnia, for instance, narcolepsy, idiopathic hypersomnia, and different sleep phenomena such as sleep apnea, and sleep movement disorders, neurotic disorders, posttraumatic hypersomnia, drug-induced hypersomnia, violation of circadian rhythms, and so on.

Some people who suffer from hypersomnia also develop a loss of social, domestic, and professional skills. Hypersomnia usually occurs at a young age. There are different tests and scales for the diagnosis of hypersomnia.

What are the types of hypersomnia?

There are different classifications of hypersomnias. First of all, they are divided into primary and secondary. Primary occur as a separate condition/set of symptoms not resulting from any other disorders, traumas, infections, and so on.

Secondary hypersomnia is excessive sleepiness which roots can be traced to a separate disease or disorder.

Primary hypersomnias are:

- The most clinically pronounced type of hypersomnia is narcolepsy. It means that this disorder has the peak intensity of sleepiness symptom. The symptoms of the disorder include irresistible daytime sleepiness episodes/attacks even when an individual gets sufficient night sleep; restless night sleep and a feeling of lack of sleep; hallucinations when falling asleep or upon awakening; cataplexy (sudden loss of muscle tone, usually arising in relation to strong emotional experiences); cataplexy of awakening. Besides, in narcolepsy, the sleep starts with the REM, i.e. rapid eye movement phase which is considered a deep sleep phase. Narcolepsy is a lifelong disease that requires symptomatic treatment. To date, the nature of narcolepsy isn’t fully studied so its cause cannot be cured. It can develop in the ages between 5 and 50 but most frequently develops by the age of 30.

- An often occurring form of the disorder is idiopathic hypersomnia that usually develops in young age (15-30 years). This type of disorder is distinguished by the increased daytime sleepiness that persists even if a person is active. It can also manifest in the episodes of daytime falling asleep when an individual is relaxed but these sleepiness attacks are not as irresistible as in narcolepsy. In this type of disorder, morning awakening is difficult and can be followed by aggression. Slow-wave sleep (consists of stage three of non-rapid eye movement sleep) is usually well pronounced and its major part can occur in the last phases of sleep which is not typical for healthy individuals and individuals with narcolepsy.

The causes of primary hypersomnias are not fully understood. The secondary hypersomnias can be related/caused by:

- Brain injury;

- Neurotic disorders;

- Major depressive disorder;

- Uremia;

- Fibromyalgia;

- Sleep apnea;

- Restless legs syndrome.

Hypersomnia can also develop as a side effect of certain psychotropic drugs, in drug or alcohol abuse. It is also assumed that it can develop due to genetic predisposition.

Although there is primary and secondary hypersomnia, several types can be present in one person and intensify each other.

Diagnosis of hypersomnia

Although today you can buy Armodafinil or other wakefulness-promoting medicines at an online drugstore without prescription and use them in practically any time of hypersomnia, it is important to identify the cause of the disorder in your case. There are multiple diseases that can manifest as narcolepsy but in fact are caused by the underlying diseases which require serious treatment. These diseases are brain tumors, Alzheimer's disease, Parkinson's disease, multiple sclerosis, lesions of the brain that can cause stroke, disorders of the function of thalamus, hypothalamus, or brainstem.

If you believe that you have started suffering from excessive daytime sleepiness lately, you should go to a physician who will then based on your complaints and overall survey results appoint you the tests which will show whether you suffer from primary or secondary hypersomnia.

If there are no underlying reasons for the excessive sleepiness, the basic sleep tests are made to confirm primary hypersomnia and to distinguish it from narcolepsy:

- Sleep latency test (sleepiness onset test);

- Multiple sleep latency test (MSLT).

How is hypersomnia treated?

First of all, not all types of hypersomnia can be cured.

- Narcolepsy is a lifelong disease that cannot be cured but only managed by wakefulness-promoting medicines such as amphetamines or nootropics.

- Idiopathic hypersomnia is not as severe as narcolepsy but it is also incurable to date so the symptoms can only be managed by the medicines that promote wakefulness.

- In the secondary hypersomnia when there is an identified cause for sleepiness (i.e. brain trauma, tumor, etc.), the treatment is aimed at the curing of the underlying disease one of which symptoms is excessive daytime sleepiness. However, if the main treatment doesn’t provide sufficient results and sleepiness persists, additionally, wakefulness-promoting medications are also prescribed. For instance, people treated for depression with low productivity can use Armodafinil; it doesn’t have the negative effects of amphetamines and can be used in mental disorders. In obstructive sleep apnea besides continuous positive airway pressure, Armodafinil can also be prescribed.

What drug for wakefulness-promotion should you use?