Hypersomnia: when sleep replaces reality

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Hypersomnia is one of the types of sleep disorders. It is characterized by constant drowsiness throughout the day when the body should be awake. However, this condition is not explained by difficulty falling asleep or insufficient time of sleep at night. At Dr. Isaev’s Clinic, hypersomnia is treated using medicinal and non-medicinal methods. You can make an appointment with a doctor by calling the hotline. A psychiatrist's home call service is available for express examination and diagnosis.

General information about the disease

The duration of sleep for a mentally and physically healthy person is from 5 to 12 hours. This is an individual indicator depending on various factors. For some, 5-6 hours is enough to feel cheerful and rested the next morning, for others – at least 8 hours. In the process of diagnosing a pathological condition, the doctor will ask how the person felt before the disorder occurred. Perhaps this condition is caused by insomnia associated with stress or current life circumstances.

General information

Sleeping beauty syndrome or Klein Lewin syndrome was first described in 1786 by a French doctor, however, at that time no one attached importance to such a disease. Later, in 1825, W. Kleine recorded nine cases of the development of this disease among his patients, and he described these symptoms. Later, in 1936, another neurologist M. Levin supplemented the syndrome with a description of five cases, the main emphasis was on the pathological desire to eat immediately after waking up.

In 1942, this disease received its present name Kleine Lewin syndrome (KLS).

The disease consists of uncontrolled falling asleep of a sick person, and the duration of sleep can exceed 18 hours. The maximum sleep time that was recorded was six weeks. In addition to sleep, the patient suffers from uncontrollable bouts of eating. As a rule, this happens during short periods of sleep. In total, the patient can sleep for five to six hours, wake up for 30–40 minutes to eat and go back to sleep, but for a longer period.

The situation is aggravated by the fact that the patient believes that he slept no more than eight hours, and does not remember waking up to eat food.

Classification of hypersomnia

Experts define two main groups of the disease. According to the frequency of manifestation, hypersomnia can be episodic and constant. In both the first and second cases, the causes of the disorder are different. Depending on the etiology, several types of pathology are distinguished:

Lethargic.

It can last for a very long time; the minimum time a person stays in this state is 24 hours. Develops against the background of a disorder of the reticular formation of the brain or lethargic encephalitis. By external signs, it looks like the person is simply in deep sleep. At the physiological level, this manifests itself as follows - lack of reaction to sound, light, touch to any part of the body. Metabolism slows down, the skin becomes cold and pale, the pulse cannot be felt. In this state, there is no secretion of natural biological fluids, and the person has no need for food and drink. Lethargy is a very dangerous condition; in the old days, such patients were often buried alive. It was almost impossible to establish that they were in a state of sleep.

Hysterical.

It is a peculiar reaction of the body to psychological trauma. A violent attempt to open the patient’s eyes meets resistance; the pupil reacts to changes in the light flux. It is impossible to wake up such a person; the sensitivity of his skin decreases. Blood pressure levels are normal, and increased muscle tone is observed. There is sweating of the hands and feet, and rapid heartbeat. When diagnosed using an EEG machine, all signs of wakefulness appear.

Iatrogenic.

This type of drowsiness occurs when you take certain groups of medications. Usually this risk is specified in the instructions for their use. You should carefully read the recommendations and the risks indicated therein.

Psychophysiological.

A type of hypersomnia occurs due to regular lack of sleep or chronic stress. It usually appears between the ages of 15 and 30, when social and professional activity increases. May be accompanied by wandering, short-term memory loss, and involuntary continuation of movements. This state lasts no more than a few seconds. Daytime sleep brings slight relief, but the patient does not feel alert and rested.

Post-traumatic.

This pathology develops after a traumatic brain injury. A bruise, a blow or a fall from a height becomes a catalyst for mental changes.

Medicinal.

A state of chronic sleep deprivation occurs due to the abuse of medications that have a sedative or calming effect.

Psychopathic.

Pathology develops against the background of various mental disorders. Therapy for such disorders should be comprehensive, taking into account the clinical picture.

Kleine-Lewin syndrome

Kleine-Levin syndrome is a rare pathology of the central nervous system that occurs with transient periods of disturbances in sleep and wakefulness. During an attack, hypersomnia is typical - the patient sleeps 18 hours a day. Short intervals between sleep are accompanied by a strong feeling of hunger, changes in behavior and psyche. The diagnosis is established according to clinical criteria, taking into account the results of somnological and neurological examinations. Treatment is under development. In order to shorten hypersomnic episodes, it is possible to use psychostimulants, and to relieve mental disorders - lithium drugs.

The first description of the disease dates back to 1786. The observation of several patients suffering from attacks of hypersomnia in combination with uncontrolled appetite is given in the work of the German psychiatrist W. Kleine in 1825. In 1936, the description of the disease was supplemented by the American neurologist M. Levin. In honor of the researchers of the phenomenon, in 1942 the pathology was named Kleine-Levin syndrome. Due to the peculiarities of the clinical picture, the name “sleeping beauty syndrome” is used in popular scientific literature. The prevalence of the disease is 1-2 cases per 1 million population. In most cases, the syndrome manifests itself during puberty; boys get sick more often than girls.

The etiofactors leading to the development of the disease have not been determined. Thanks to the examination of patients using positron emission tomography, the leading role of dysfunction of the reticular formation, the thalamus, was established. An important function of the reticular formation is to regulate the sleep-wake cycle. Its close connection with the neuroendocrine system (hypothalamus, pituitary gland) explains the characteristic debut of symptoms during the period of hormonal changes in the body.

Causes of hypersomnia and risk factors

A common group of prerequisites for the development of this disease is dysfunction of the central nervous system. In some cases, obvious neurological disorders are secondary; mental illnesses are behind them.

This condition often occurs in healthy people as a response to psycho-emotional stress or exposure to a strong stress factor. Often, patients at a doctor’s appointment can voice a cause-and-effect relationship between their illness and a previous traumatic event.

Among the most common causes of hypersomnia are:

chronic diseases of the cardiovascular or endocrine system (hypothyroidism, diabetes, hypertension);
traumatic brain injuries;
malignant tumors in the brain;
neurasthenia, depersonalization, schizophrenia, dissocial personality disorder and other mental disorders;
cerebrovascular accidents in the acute phase;
failure of the mechanisms regulating sleep and wakefulness;
as a side effect of certain medications;
severe stress (sharp change in life scenario, military operations, life-threatening natural disasters;
dysfunction of the hypothalamus;
imbalance of neurotransmitters;
diseases of brain tissue caused by viruses or bacteria (meningitis, encephalitis).

The patient may experience panic attacks, their cause is the fear of another attack approaching.

Hypersomnia syndromes

Experts identify several types of the disease, which differ in clinical signs.

Narcolepsy

The patient has an irresistible desire to fall asleep, and it does not matter where this happens. This could be a cafe, a store, an office at work, a gym. The disorder is characterized by paroxysmal character. The patient falls into a short sleep, not having time to take a comfortable position.

As the pathology develops, he may feel the first signs of an upcoming attack. This will help him prepare - take the appropriate body position or find a suitable place. The situation becomes more complicated if the patient experiences hallucinations. Brief visions occur while falling asleep and at the moment of full awakening. A person with hypersomnia experiences a state of catalepsy. Within a few minutes after waking up, increased tone of all muscles is observed. The patient cannot move either his arm or his leg.

Kleine-Levin syndrome

A person constantly wants to sleep and can go to bed anywhere. The secondary disorder is bulimia. Before an attack, the patient begins to eat everything in large quantities. He cannot stop, and a violent attempt to take food from him leads nowhere. Muscle tone increases, the person becomes very strong and actively resists. This disorder is usually diagnosed in young patients.

Before the onset of an attack, prolonged insomnia or severe psychomotor agitation is observed. The duration of this condition ranges from several days to 2-3 weeks. A person wakes up on his own, but at the same time feels confused. He doesn't always understand what happened to him. If you forcefully wake him up, he may show signs of aggression.

Pickwickian syndrome

This is another form of hypersomnia, which is characterized by a combination of several disorders. In addition to the constant desire to sleep, breathing problems are observed, and obesity is also diagnosed in such patients. It occurs against the background of uncontrolled eating in large quantities. Even if a night's sleep lasts at least 8 hours, a person feels empty and overwhelmed in the morning. It is characterized by constant headache.

Sleepy intoxication syndrome

After the patient suddenly falls asleep, he wakes up and feels very bad. In the first 15 minutes after waking up, there may be signs of confusion. This condition can last up to 2 hours.

Diagnostics

The first step in diagnosis is drawing up a life history and medical history. The diagnosis of SCL is based on the following criteria:

abnormal sleep duration – from 16-29 hours. The appearance of “sleeping attacks” 1-2 times a year;
feeling tired and apathetic after waking up;
hyperphagia – bouts of gluttony upon awakening;
uncontrollable nervousness and aggression;
the appearance of visual and auditory hallucinations;
sweating during sleep and upon awakening. Blueness of the palms, fingers and toes, lips and nasolabial triangle;
drop in blood glucose levels;
hypersomnia is not combined with neurological and mental disorders such as epilepsy or depression;
the syndrome is not combined with pathological conditions such as apnea (cessation of pulmonary ventilation) or myoclonus (involuntary shudders at the moment of falling asleep);
absence of enuresis.

Instrumental diagnostics are of secondary importance and include:

electroencephalography. Allows you to record and decipher the functional activity of the brain. With SCL, low-amplitude peaks of the localization zone are recorded - the temporal and temporo-parietal zones;
polysomnography. Allows you to identify a shortening of the 3rd and 4th phases of sleep, a decrease in the period of falling asleep;
PET-CT of the brain. During the period between attacks, no changes are recorded. During exacerbations, a disturbance in the blood supply to the brain is detected in the areas of the thalamus and hypothalamus.

Attention is paid to differential diagnosis. Kleine-Levin syndrome is differentiated from depression, narcolepsy, and encephalitis lethargica.

Diagnosis of hypersomnia

Patients do not always realize that they have health problems. They cannot objectively assess what exactly is happening, what type of disease is inherent in them based on the symptoms they exhibit. Specialists use the following diagnostic methods:

Stanford Sleepiness Scale.
Sleep latency test.
Assessment of physical condition (presence of concomitant diseases).
Study of qualitative and quantitative indicators of sleep using special equipment.

In some cases, consultation with a psychotherapist is required. This is relevant if the patient has suffered a traumatic situation or has any other negative experience that has caused sleep disturbances.

Treatment of hypersomnia in Moscow

Hypersomnia is a separate diagnosis. It is necessary to conduct a thorough examination of the patient so as not to confuse it with depression, asthenia or chronic fatigue. Additionally, a consultation with a neurologist, ophthalmologist, endocrinologist, gastroenterologist, or cardiologist may be prescribed. The diagnosis is made if the signs of the disease are persistent and observed for at least one month.

Treatment of hypersomnia in Moscow at Dr. Isaev’s Clinic is carried out comprehensively. Medications with a specific spectrum of action are used to eliminate symptoms and normalize sleep and wakefulness. Drug therapy includes the following medications:

antibiotics – if the disease occurs due to viruses or infections entering the body;
drugs that restore the balance of brain neurotransmitters;
nootropic substances – prescribed in the presence of organic pathologies in order to improve brain function;
medications aimed at correcting endocrine, somatic and oncological diseases;
psychostimulants – medications that eliminate excessive sleepiness during the day;
antidepressants - their use is justified in the presence of symptoms of catalepsy and chronic depression;
sedatives that calm the nervous system;
immunostimulants – these drugs awaken the body’s internal reserves, improve the functioning of all systems;
vitamins are prescribed as maintenance therapy.

The use of any medications should only be done under the supervision of a physician. He takes into account the patient’s condition and adjusts the dosage of active substances. The type, duration and frequency of hypersomnia attacks are important.

Treatment of this disease without the use of drugs is also possible. This is relevant if the cause of the development of pathology is psychotrauma. Individual sessions with a psychologist are aimed at teaching patients the following skills:

resistance to stress factors, regardless of their intensity;
managing negative emotions;
communication with others without conflicts;
constructive problem solving;
relieving muscle and emotional tension with the help of painting, music, and other techniques.

It is important to maintain a sleep schedule; night rest should last at least 8 hours. It is advisable to wake up and go to bed at the same time, turning evening going to bed into a kind of ritual. It is not recommended to watch TV, use a mobile phone or computer 2 hours before going to bed.

Getting rid of bad habits is the primary task of a patient suffering from hypersomnia. Moderate physical activity and sports are encouraged to avoid overworking the body.

Prognosis after treatment

Properly selected drugs and methods of drug therapy help get rid of this disease. In most cases, the prognosis is favorable, and the patient feels well at the end of the course. He gets enough sleep at night and does not experience drowsiness during the day.

It is important to consult a doctor in time, as this disease has several adverse consequences:

worsening chronic diseases;
violation of adaptation in society;
decreased performance;
deterioration of social interactions, including professional ones.

Characteristic symptoms

Kleine-Levin syndrome makes itself felt unexpectedly in the daytime or morning. The first sign of it is the occurrence of hypersomnia - severe drowsiness. A person who did not intend to go to bed suddenly feels very drowsy and falls asleep for several days. He wakes up energetic and rested, but feels very hungry. Indiscriminate eating is similar to an attack of bulimia. When diagnosing, it is necessary to distinguish between these disorders, since the correct choice of treatment method depends on this.

Sleeping Beauty syndrome is characterized by bouts of binge eating in the evening and at night. Hunger is so strong that a person cannot control the voice of reason. He is not able, for example, to go to the store, cut food for salad, or cook food. This seems very long to him. The patient grabs and eats literally everything that can be eaten on the spot and immediately. He also does not care about the taste of food. For example, a bite of a piece of herring with a cake does not constitute an uncomfortable combination for such a patient.

Regardless of any connection with meals, the patient experiences increased irritability, nervousness, sexual activity, and emotional instability. Patients experience a narrowing of consciousness, lack of self-control, and sometimes schizophrenia-like attacks. Some vegetative disorders are expressed, especially increased sweating.

If a person begins to suffer from this disorder at a young age, his attacks recur periodically. The patient’s relatives can even roughly calculate and predict the time of such an attack. This mode of the disease is observed up to 20 years inclusive. Then the periods of remission lengthen, and the disease gradually goes away on its own. The patient's family should be patient and understand that this will end eventually.

Although relatives are worried, the patient usually does not have any concerns about his own health. A person with severe symptoms of Sleeping Beauty syndrome cannot remember his bouts of sleep and binge eating. His memory suggests nothing more than one night of “normal” sleep and a small late-night snack. All the stories of loved ones about these events seem to him just fiction, a joke, a practical joke.

Treatment of hypersomnia reviews

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Prevention

Any disease can be treated preventively, but not in this case. It is impossible to prevent something that appears suddenly without warning and also disappears suddenly.

But some recommendations can be given like this:

it is necessary to carefully monitor your psycho-emotional state and, in case of even minor deviations, contact a specialist;
it is necessary to be more attentive to your relatives and monitor their psycho-emotional state.

So, sleeping beauty syndrome is a rare and unpleasant illness that can cause a lot of inconvenience to a person. It is important to remember that this disease is not dangerous and disappears on its own after some time, so you just need to wait out the unpleasant period, perhaps even with the support of loved ones.

Questions and answers

Is it possible to treat excessive sleepiness at home?

No. A patient with hypersomnia cannot independently assess the severity of his disease, diagnose its form, or prescribe symptom correction.

Will the symptoms of the disease go away after taking antidepressants?

These drugs will improve the condition only if they are prescribed to the patient by a doctor in the presence of concomitant pathologies. Antidepressants are not used as a stand-alone medication for the treatment of hypersomnia. If prescribed incorrectly, they will harm the body and worsen the prognosis of therapy.

Treatment

There is no single treatment regimen for Sleeping Beauty syndrome. Scientists all over the world are searching for it. The immediate mechanism of the disease is known to science only hypothetically; medicine is powerless to completely stop the development of the syndrome. It is impossible to take medications regularly because the patient sleeps almost all the time. It is completely impossible to follow a diet, because after waking up the patient is ready to eat everything that is close and edible.

But something can be done. Most often, doctors try to support only the patient’s nervous system. To do this, he may be prescribed antidepressants, nootropic drugs, sedatives (close relatives of the patient who require nerves of iron to survive his illness sometimes also need sedatives). Relieving drowsiness and correcting mental disorders are the only methods known today to combat this syndrome.

However, the effect of drugs is limited in time. In addition, it is not always easy to persuade a person to take the drug. Or he may not have time to take the pill, falling back asleep.

The surest path to treatment is to wait out the attacks. The difficulty is that you will have to wait a long time, because failures in sleep are repeated over the course of several years. But after these years they “unexpectedly” go away on their own.