Hypersomnia And Hypersomnolence Disorder: Why Do You Sleep Plenty, But Are Still Always Tired?

We all know what insomnia is — a sleep disorder in which someone is consistently plagued by an inability to fall asleep, by frequent night-time awakenings, or in which they often wake up much earlier than they planned to, like before the crack of dawn, and then can't go back to sleep. 

Insomnia is so well-known because it's shockingly common. While some statistics indicate that between 10 and 30 percent of the adult population live with insomnia, others even go as far to see the true number may be closer to 50 or even 60 percent. 

Because not everyone knows there's even a name for it and because it's sorely neglected in the literature compared to insomnia, people who have hypersomnia may struggle to understand what's happening to them. 

What is hypersomnia?

In terms of diagnosis, the term hypersomnolence disorder would be a possible "label" patients who sleep a lot but don't enjoy restorative sleep might end up with. People with hypersomnolence disorder spend at least seven hours a night asleep, in line with general health recommendations — and sometimes considerably longer. Despite their ample sleep, people with hypersomnia will be excessively sleepy during the day, and may wake up feeling unrested and unrefreshed. This is what "hypersomnolence" means. 

The diagnostic criteria — the symptoms you have to have to be diagnosed — for hypersomnolence disorder are:

• At least one of these — repeatedly taking naps or unintentionally falling asleep during the day despite sleeping at night, sleeping more than nine hours at night (or during your main sleep time) yet waking up feeling unrefreshed, or trouble being truly awake after being waking up suddenly.
• Your hypersomnolence episodes last at least three months, during which time they happen a minimum of three times a week.
• The symptoms make it hard for you to function in daily life, which will be reflected in multiple areas of your life, such as at work or in school, in relationships you have with people, or in your ability to think clearly.
• Other sleep disorders, from narcolepsy to sleep apnea, have been ruled out as a primary cause. Substances, medications, or other mental disorders such as depression, have also been ruled out as the main factor responsible for the symptoms. 

Hypersomnolence disorder can, however, be diagnosed with a specifier — hypersomnolence disorder "with a mental disorder", "with a physical health disorder", or "with another sleep disorder".

You deserve to get to the bottom of your symptoms. Please see a doctor; your family physician is a good starting point. 

What causes hypersomnia?

A pattern of oversleeping (sleeping more than the recommended 7 to 9 hours), yet feeling tired or still needing to take naps during the day, is associated with a variety of causes. The risk factors for hypersomnia include:

• Taking certain prescription, over the counter, or illicit drugs. Examples of medications known to be linked to oversleeping and sleepiness include antihistamines, anti-epilepsy medications, anxiety medications, and hypnotics. Alcohol, and especially excessive alcohol use, can induce hypersomnia as well.
• Mental disorders such as major depressive disorder (depression) and other mood disorders can also trigger hypersomnia.
• Interestingly, it has been noted in the medical literature that hypersomnia also often follows a viral infection, or goes hand in hand with such a viral illness. Examples would be HIV, mononucleosis, pneumonia, and Guillain-Barre syndrome, and hypersomnolence can go on for months in all these cases. 
• Significant head trauma can lead to symptoms of oversleeping yet being tired all the time, too.
• Neurological conditions as varied as Alzheimer's disease, Parkinson's disease, narcolepsy, and brain tumors may all cause hypersomnolence.
• Metabolic and hormonal disorders, such as diabetes or hypothyroidism, can be the cause of hypersomnia and hypersomnolence as well.
• Sleep disorders like obstructive sleep apnea and periodic limb movements in sleep (yes, that is the name of an actual sleep disorder) are obvious causes of daytime sleepiness; even if you sleep, your sleep won't be very restful.
• Genetics also have a lot to answer for — if hypersomnolence disorder runs in your family, you may be more likely to develop it, too.

How are hypersomnia and hypersomnolence treated?

Hypersomnolence — the condition of sleeping a sufficient number of hours, or even excessively, but still being tired pretty much all the time — can be treated in a variety of ways. Stimulants are one obvious choice, since they give you the "fuel" you need to feel more awake. These include amphetamines, but also antidepressants of various kinds and the drug levodopa, often used in the treatment of Parkinson's disease. 

If the cause is physical, for instance in the form of some sort of airway obstruction, even surgery may be suggested.

Good "sleep hygiene" practices are also recommended as part of the treatment of hypersomnolence. If you're always tired despite sleeping adequately, you may have tried these same steps often recommened to insomniacs already, or maybe not — since you have np trouble actually falling asleep. 

You might try:

• Establishing a bedtime routine including set hours. Engage in the same relaxing rituals before you to to bed, such as taking a bath or doing some meditation. 
• Having a "rise and shine" routine in place too, to help your body realize it's supposed to be energetic and awake now. Maybe some light physical exercise like a walk or some yoga, a nice protein-rich breakfast, and some happy music?
• Making sure you have access to plenty of daylight during the day, while considering investing in lights that can be dimmed as the night goes on.
• Steering clear of alcohol and caffeine, as well as spicy foods, before you go to bed. 

Finally, talk therapy may be able to help you with your hypersomnolence, as well, not just if it was caused by an underlying psychological disorder like depression, but also if neither you nor your medical team have any idea what led to your hypersomnolence, or the underlying cause is physical.