Hypersomnolence & Daytime Sleepiness Treatment in Delhi

Central Disorders of Hypersomnolence

Central Disorders of Hypersomnolence are a group of sleep disorders characterized by excessive daytime sleepiness (EDS) despite getting adequate or even prolonged sleep at night. The problem is not due to poor sleep habits or external factors, but due to a dysfunction in the brain’s ability to regulate sleep-wake cycles.

Types of Central Hypersomnolence Disorders

Narcolepsy Type 1 (NT1)

Excessive daytime sleepiness
Cataplexy (sudden loss of muscle tone triggered by emotions)
Abnormal REM sleep (dreaming at sleep onset)
Often includes sleep paralysis & hallucinations

Cause: Loss of hypocretin (orexin) neurons in the hypothalamus (an autoimmune basis)

Diagnosis: Low CSF hypocretin levels or MSLT findings

Narcolepsy Type 2 (NT2)

Similar to NT1 but without cataplexy
Normal hypocretin levels
Still has excessive sleepiness and abnormal REM patterns

Idiopathic Hypersomnia (IH)

Chronic excessive sleepiness not explained by other disorders
Long and unrefreshing naps, and difficulty waking (sleep inertia)
No cataplexy or REM abnormalities like in narcolepsy
Night sleep may last 9+ hours, yet person still feels tired

Kleine-Levin Syndrome (KLS)

Rare, relapsing-remitting hypersomnia
Mostly affects teenage boys
During episodes: Person sleeps 15–20 hours a day, may have behavioral changes (irritability, hypersexuality, binge eating), and these episodes last days to weeks, then normal in between.

Symptoms

Excessive daytime sleepiness (EDS).
Falling asleep in inappropriate situations (e.g., at work or while talking).
Feeling tired even after a full sleep.
Long naps that don’t feel refreshing.
Sleep inertia in which there is difficulty in waking up and feeling groggy for hours.
Sudden muscle weakness (cataplexy in NT1).
Sleep paralysis or hallucinations (in narcolepsy).

Diagnosis

Sleep History & Questionnaires

Epworth Sleepiness Scale (ESS)
Stanford Sleepiness Scale

Polysomnography (PSG) – Overnight sleep study

It helps to rule out sleep apnea and other sleep disruptions.

Multiple Sleep Latency Test (MSLT)

It helps to measure how quickly you fall asleep in 5 scheduled naps the next day.
People with narcolepsy fall asleep quickly and enter REM sleep early (SOREM – Sleep-Onset REM).

CSF Hypocretin Testing

For Narcolepsy Type 1 (very low levels confirm diagnosis).

Treatment

There is no permanent cure of this, but the symptoms can be very well managed.

Medications

Stimulants: Modafinil, Armodafinil, Methylphenidate
Wake-promoting agents: Solriamfetol, Pitolisant
Sodium oxybate (for NT1) – it helps to improve nighttime sleep and reduces cataplexy.

Lifestyle & Behavioral Management

Scheduled naps during the day
Regular sleep-wake schedule
Avoid alcohol and sedatives
Educate family/friends/employers

Counseling & Support

It is important because these disorders often impact school, work, and mental health

Frequently Asked Questions (FAQs)

1. What’s the difference between Narcolepsy and Idiopathic Hypersomnia?

Both of these causes EDS, but Narcolepsy may have cataplexy, REM abnormalities, and is linked to low hypocretin. And on the other hand IH has longer sleep duration and no cataplexy or REM issues.

2. Is excessive daytime sleepiness the same as being lazy?

No, these are medical conditions, not personality traits. The brain fails to regulate alertness properly.

3. Can these disorders be cured?

No, as they are chronic conditions, but with the right treatment, most people can lead to normal and active lives.

4. Are central hypersomnolence disorders dangerous?

Yes, they can be, especially if remain untreated. Falling asleep while driving, working, or in unsafe situations is risky.