Subjective symptoms in idiopathic hypersomnia: beyond excessive sleepiness

Abstract

SUMMAR Y Patients with idiopathic hypersomnia never feel fully alert despite a normal or long sleep night. The spectrum of the symptoms is insufficiently studied. We interviewed 62 consecutive patients with idiopathic hypersomnia (with a mean sleep latency lower than 8 min or a sleep time longer than 11 h) and 50 healthy controls using a questionnaire on sleep, awakening, sleepiness, alertness and cognitive, psychological and functional problems during daily life conditions. Patients slept 3 h more on weekends, holidays and in the sleep unit than on working days. In the morning, the patients needed somebody to wake them, or to be stressed, while routine, light, alarm clocks and motivation were inefficient. Three-quarters of the patients did not feel refreshed after short naps. During the daytime, their alertness was modulated by the same external conditions as controls, but they felt more sedated in darkness, in a quiet environment, when listening to music or conversation. Being hyperactive helped them more than controls to resist sleepiness. They were more frequently evening-type and more alert in the evening than in the morning. The patients were able to focus only for 1 h (versus 4 h in the controls). They complained of attention and memory deficit. Half of them had problems regulating their body temperature and were near-sighted. Mental fatigability, dependence on other people for awakening them, and a reduced benefit from usually alerting conditions (except being hyperactive or stressed) seem to be more specific of the daily problems of patients with idiopathic hypersomnia than daytime sleepiness.k e y w o r d s fatigue, hypersomnia, long sleep time, mental fatigability, sleep drunkenness, sleepiness, tiredness

Waking up is the hardest thing I do all day: Sleep inertia and sleep drunkenness

“…Many IH patients have a need for extended sleep times (e.g., >11 hours) that cannot be fulfilled, and so are functionally sleep deprived; this sleep deprivation would be expected to worsen sleep inertia [63]. Additionally, IH patients have a tendency toward delayed sleep phase, which itself worsens sleep inertia [65], and IH patients with sleep drunkenness are more likely to be evening types than IH patients without sleep drunkenness [66]. However, some of the findings of Vernet et al [66] suggest that sleep drunkenness may be a phenomenon that is distinct from sleep inertia.…”

Cortical–Subcortical Interactions in Hypersomnia Disorders: Mechanisms Underlying Cognitive and Behavioral Aspects of the Sleep–Wake Cycle

“…In addition to non-refreshing sleep, patients report memory and attention deficits and commonly present with digestive system disorders, depression, and anxiety (84, 86). In a recent study based on self-reported cognitive changes, 79% of patients with hypersomnolence disorder (HSD) reported memory problems that included frequent forgetfulness (86).…”

“…In a recent study based on self-reported cognitive changes, 79% of patients with hypersomnolence disorder (HSD) reported memory problems that included frequent forgetfulness (86). A recent study assessing sustained attention in a range of HSD patients found impaired vigilance that did not differ significantly between patient groups (90), suggesting that this is a common feature of HSD.…”

Sleep and its disorders

“…They are poorly defined conditions characterized by excessive daytime sleepiness and not diagnosed as narcolepsy (No REM abnormalities during polysomnography) [27].…”