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The Rest is Up to You

Dr. Ana Krieger

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from "When Sleep is the Enemy"
by Drs. Jerome M. Siegel, Safwan M. Badr, and Ana C. Krieger
Published in Patient Care, January 2005

Sleep has been a source of interest and speculation for centuries. As recently as 100 years ago, most medical practitioners regarded sleep as something akin to death, a period in which brain activity more or less ceased. We now know that sleep may include some of the most active periods of brain function in the 24-hour cycle. The growing field of sleep medicine is based on neurophysiologic research initially conducted in the 1920s and 1930s. The active period of rapid eye movement (REM) sleep was only discovered in the 1950s.

Hypersomnia is characterized by excessive daytime sleepiness (EDS) or prolonged nighttime sleep. Prevalence of EDS has been variously estimated at between 7% and 20%. In primary care practice, as many as 30% of patients may have a occasional difficulty falling asleep, and 10% of those may report a chronic sleep problem.

EDS can be associated with a number of causes. The most common is simply a lack of adequate, the consequence of poor sleep behavior, an endemic feature of contemporary life. Work pressures, family obligations, and the creeping shift toward a 24-hour lifestyle have placed heavy demands on waking hours and can intrude upon the ability to sleep at night.

Among the pathologies related to EDS, obstructive sleep apnea is the most frequent contributor, and this condition can have a severely detrimental effect on both sleep quality and quantity. Individuals suffering from sleep apnea may wake up hundreds, or even thousands, of times during the night. Their sleep is fragmented so they miss out on the deeper and more restorative stages of the sleep cycle. Sleep apnea also reduces oxygen saturation in the blood, contributing to lower levels of energy that may increase the likelihood of daytime sleepiness.

Narcolepsy is another important cause of EDS. Approximately 200,000 people in the United States suffer from narcolepsy (although only 50,000 have received a diagnosis), making it one half to one third as common as multiple sclerosis and Parkinson's disease.

EDS may also result from a number of pathologies that are not strictly sleep-related. Depression, substance abuse, seasonal affective disorder (SAD), restless leg syndrome (RLS), fibromyalgia, and chronic fatigue syndrome, are all commonly associated with hypersomnia, while hypoglycemia and hypothyroidism may also lead to daytime sleepiness.
Normal use of some medications, such as antihistamines, can lead to EDS. In rare cases, lesions in certain parts of the brain (particularly damage to the posterior hypothalamus), may manifest as hypersomnia.

Individuals who are typically considered night owls, and clinically described as experiencing delayed sleep phase syndrome, are often subject to hypersomnia since the natural pattern of their circadian rhythm may not conform to the demands of normal daily life.

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