Gipersomniya — the essential increase in duration of a dream which is usually followed by day drowsiness. The main signs of a gipersomniya are: duration of a night dream more than 10 h, constants or pristupoobrazny day drowsiness, the lack of significant improvement of a state after a day dream complicated and the prolonged prosypaniye, is frequent with existence of a symptom "intoxications a dream". The gipersomniya on the basis of clinical yielded, results of testing and a polisomnografiya is diagnosed. Therapy of a gipersomniya consists in observance of a certain mode of a dream, treatment of a causal disease and use of the stimulating medicines.
Gipersomniya presents himself a sleep disorder in the form of increase in its duration and the increased drowsiness. It should be noted that the normal duration of a dream considerably varies and at different people can make from 5 to 12 hours. Therefore, speaking about a gipersomniya, duration of a dream is estimated individually in comparison with the period before emergence of problems with a dream. It is necessary to distinguish a gipersomniya from the increased day drowsiness at the insufficient duration of a night dream caused by the developed vital circumstances or sleeplessness.
In clinical practice the gipersomniya meets considerably less than an insomniya (sleeplessness). It is not always noticed by the patient, but can be revealed when passing of the special test by him. Gipersomniya can be observed at a sleep debt and overfatigue; to be side effect of some medicines, to enter a clinical picture of a narcolepsy and mental disorders; to accompany a syndrome sleepy , injuries and organic damages of a brain, somatic diseases.
Classification of a gipersomniya
In clinical neurology the gipersomniya is classified generally by the etiologichesky principle. According to the cause the gipersomniya shares on psychophysiological, post-traumatic, narkolepsichesky, psychopathic, idiopathic, connected with disorders of breath in a dream and caused by somatic diseases.
On features of manifestation distinguish a permanent and paroksizmalny gipersomniya. The permanent gipersomniya is followed by constant drowsiness and drowsy a state for day. The Paroksizmalny gipersomniya is characterized by suddenly arising attacks of insuperable desire to have a sleep, leading to falling asleep even in the most improper for this purpose conditions. The Paroksizmalny gipersomniya is noted at a narcolepsy and a cataplexy.
Causes of a gipersomniya
The mode of a dream and wakefulness in a human body is regulated by difficult system of the mutual activating and braking influences happening between a cerebral cortex, subcrustal structures, limbic system and a retikulyarny formation. Gipersomniya develops as a result of violation of functioning of this system that can be caused by a number of the various reasons.
The psychophysiological gipersomniya can arise at healthy people after a long sleep debt, physical and mental overfatigue, the postponed stress. Development of this type of a gipersomniya can be connected with reception of some medicines, for example, of neuroleptics, tranquilizers, antihistaminic, antihyperglycemic and hypotensive means.
The post-traumatic gipersomniya is caused by the functional violations of TsNS arising after the postponed craniocereberal trauma. Along with a trauma the cause of a gipersomniya can be organic damages of a brain: intracerebral tumor, brain abscess, intracerebral hematoma, infectious diseases (neurosyphilis, meningitis, encephalitis), vascular disorders (hemorrhagic stroke, chronic ischemia, ischemic stroke). Development of a gipersomniya in patients with the violations of breath happening in a dream arises most likely because of a chronic hypoxia of tissues of brain.
Gipersomniya is the main clinical symptom of a narcolepsy and is often marked out at a kataplekiya. Gipersomniya can be also observed at mental disorders (a neurasthenia, hysteria, schizophrenia) and somatic diseases (a hypothyroidism, diabetes, heart failure, cirrhosis, a chronic renal failure). When the increased drowsiness arises without defined the reasons and out of communication with any disease, it is referred to an idiopathic gipersomniya.
Clinical signs of a gipersomniya
The main sign of a gipersomniya is periodic or constant day drowsiness at the big duration of a night dream. Often the gipersomniya is followed by increase in duration of a night dream till 12-14 o'clock. The complicated awakening, impossibility to rise on an alarm clock, increase in time of transition from a dream to wakefulness is characteristic. Some time after a prosypaniye patients with a gipersomniya can remain slowed down and not absolutely woken up. At the same time their state reminds intoxication what this symptom and received the name "intoxication dream" for.
Day drowsiness at various forms of a gipersomniya can have constant or pristupoobrazny character. It lowers attentiveness and working capacity, prevents to conduct fully work, complicates a normal vital rhythm and forces patients to do breaks on a day dream. In certain cases after a day dream patients note simplification, but more often the condition of drowsiness remains even after a long or numerous day dream.
The Narkolepsichesky gipersomniya differs in existence of attacks of violent falling asleep at which desire to sleep is so insuperable that patients fall asleep in the most improper places and poses for a dream. Over time at patients with a narcolepsy the presentiment of the coming attack develops and they try to accept more comfortable position for a dream in advance. The Narkolepsichesky gipersomniya can be followed by emergence during falling asleep and awakening of hallucinations, and also an awakening cataplexy — the considerable decrease in a muscular tone which is not allowing the patient to make any any movements the first minutes after a dream.
The psychopathic gipersomniya is characterized by an unpredictable clinical picture of day drowsiness. For example, at patients with hysteria after the psychoinjuring situation "dream" lasting several days can be observed. However carrying out a polisomnografiya does not find at them the real signs of a dream in the afternoon, and opposite, EEG shows a condition of intense wakefulness. Often it turns out that patients just lie blindly.
The post-traumatic gipersomniya develops after the injuries which are not followed by considerable damages of brain fabrics more often and most likely is connected with the stress endured during traumatizing. In such cases her clinical picture can be similar to manifestations of a psychopathic gipersomniya.
The idiopathic gipersomniya takes place at persons of young age (15-30 years) more often. Patients complain of constant drowsiness, the complicated awakening from a dream, feeling of a nevyspannost in the mornings with the sufficient duration of a night dream. The symptom "intoxications by a dream" can be noted. The day dream at such patients gives some relief, however finally does not save them from drowsiness. In certain cases the idiopathic gipersomniya can be followed by episodes of out-patient automatism lasting several seconds. Most often the similar symptom is observed at the patients refusing a day dream.
The condition of the continuous dream proceeding more than a day is called a lethargical sleep. The similar gipersomniya often is display of epidemic lethargic encephalitis or various defeats of a retikulyarny formation.
Diagnostics of a gipersomniya
As patients can not always objectively estimate the problems with a dream which are available for them, the standard tests are applied to diagnostics of a gipersomniya: Stanford scale of drowsiness and test of a latention of a dream.
Important diagnostic value has carrying out a polisomnografiya. In case of a narkolepsichesky gipersomniya when carrying out a polisomnografiya shortening of the period of falling asleep, frequent night awakenings and early approach of a phase of a REM sleep while normal the REM sleep arises on average in 80 min. after falling asleep comes to light. The similar picture of a dream can be observed at the gipersomniya connected with a syndrome sleepy . In this case identification allows to make the correct diagnosis during a polisomnografiya of the accompanying respiratory violations. Shortening of the period of falling asleep is characteristic of an idiopathic gipersomniya, as well as of narkolepsichesky, however at the same time the normal ratio of phases of a dream and a night dream without frequent awakenings remains.
Gipersomniya demands differentiation from an adynamy, a depression, a syndrome of chronic fatigue. For an exception of the organic nature of pathological drowsiness careful neurologic examination, consultation of the ophthalmologist with an oftalmoskopiya, Ekho-EG, brain MPT or KT is held. Identification of connection of a gipersomniya with existence of a somatic disease can demand additional consultation of the therapist, the endocrinologist, the cardiologist, the gastroenterologist, the nephrologist.
The diagnosis of a gipersomniya, as a rule, is established by the neurologist in case its signs are observed within at least 1 month and are not connected with violation of a night dream or reception of medicines. If after disappearance of a gipersomniya during up to 2 years its symptoms appear again, then speak about a recurrent form of a disease.
Treatment of a gipersomniya
Successful therapy of a gipersomniya is closely connected with effective treatment of that disease, one of symptoms of which it is. If full treatment of the main disease is impossible (for example, in case of a narcolepsy), then treatment of a gipersomniya is directed to the maximum improvement of quality of life of the patient.
In treatment of a gipersomniya observance of the mode of a dream is important. The patient needs to exclude work during evening and night shifts, to adhere to the same time of an otkhozhdeniye to a dream, it is obligatory to include 1-2 day dreams in the schedule. It is desirable that duration of a night dream did not exceed 9 h. At an idiopathic gipersomniya the recommended duration of a day dream makes 45 min. Along with hygiene of a dream it is necessary to avoid the use of alcoholic beverages and too heavy food, and also meal just before a dream.
At a gipersomniya apply excitants to elimination of day drowsiness: pemoline, , modafinit, , propranolol. If the patient has a cataplexy, then reception of antidepressants is shown him: protriptilina, imipramina, klomipramina, fluoxetine, viloksazin. Dosages of the specified medicines select individually, trying to achieve the maximum therapeutic efficiency at the minimum side effects.
Forecast of a gipersomniya
Symptoms of a post-traumatic gipersomniya often have reversible character. Worse the situation with the gipersomniya developing at a narcolepsy or owing to organic damage of a brain is. And though the gipersomniya in itself does not pose a threat for the patient's life, it considerably increases risk of his death from an industrial accident or when driving the car.