Hypersomnia
Hypersomnia - the term defining presence of raised duration of a sleep. At healthy humans the size of duration of a sleep is individual enough and fluctuates on the average from 5 till 12 o'clock a day and is not a constant. So, on the basis of questionnaires it has been shown, that at the usual schedule of work average duration of a sleep at the healthy was equaled 7.5 hours per the working days and 8.5 hours during week-end.
It is a lot of causes for appearance of a hypersomnia - a psychophysiological hypersomnia, a narcolepsy, an idiopathic hypersomnia, various phenomena of a sleep (a syndrome of somnolent apneas, motorial disorders in a sleep), neurotic disorders, a posttraumatic hypersomnia, reception of the medicinal preparations influencing activity of a brain, disturbance of circadian rhythmes (caused by shift work, transtemporal flights), an insomnia, various somatic, neurologic, mental diseases.
The raised diurnal drowsiness can become perceptible at practically healthy faces at a psychophysiological hypersomnia. The given disorder is characterised by a good night sleep at insufficient duration and shows complaints to diurnal drowsiness, complaints of an asthenic circle. Various stresses, presence of a disadvantage of a night sleep at the raised requirement for a sleep can be the causes of the raised diurnal drowsiness.
The given type of disorders does not demand special treatment. Building of the conforming conditions for adequate duration of a night sleep, the terminal of influence of the stressful factor lead to enriching.
From all listed above the diseases studied in the light of hypersomnias, the great value is doubtless most the narcolepsy has.
In population the narcolepsy meets in 0 percent. The beginning of diseases fluctuates from 2nd life till 5th decade. Meets at men is more often. It is supposed, that the genetical pathology can serve as the cause of development of a narcolepsy.
The clinic narcolepsy has some the basic implications consisting in:
- the "imperative" diurnal drowsiness combined with episodes of "violent" diurnal backfillings
- disturbances of a night sleep
- hypnagogic and hypnopompic hallucinations
- attacks of a cataplexy
- cataplexies of awakening
The combination of all signs wears the name "a narcoleptic pentade". The narcolepsy can show (especially in the disease beginning) and one symptom and then it wears the name the monosemeiotic.
At a monosemeiotic narcolepsy eventually the disease picture can variate, and other symptoms of a narcolepsy join pristine complaints.
1. The raised diurnal drowsiness and imperative episodes of a sleep, as a rule, are in the afternoon the first symptoms of disease. Patients with a narcolepsy not in a condition to overcome own desire to sleep and can fall asleep in various improper conditions. Therefore the question of the raised diurnal drowsiness and imperative diurnal backfillings has the important social value, especially for the persons bound to effecting, demanding attention. Diurnal backfillings can repeat some times in day and to be different duration: from 1-2 seconds to tens minutes. At short episodes of a diurnal sleep in the beginning there is a gradual hypophrasia, dysarthtia appearance which reduction of a muscle tone of muscles of a neck and accordingly "falling" of a head and full deenergizing of consciousness can follow. As a rule, patients have a presentiment of occurrence of a backfilling and try to accept a posture convenient for a sleep. The probability of appearance of a diurnal backfilling is enlarged in a condition of the relaxed wakefulness.
2. Disturbances of a night sleep - frequent enough implication of a narcolepsy. Patients are disturbed usually by frequent night awakenings, a dissatisfaction with quality of the sleep and sense of a sleep lack.
3. Hallucinations appear in a backfilling (hypnagogic) or at the moment of awakening (hypnopompic) during which time the awakening cataplexy can be observed.
4. The cataplexy is an atonia, an event, as a rule, against strong positive or is rarer negative emotions (laughter, surprise, sometimes crying, anger). In a cataplexy attack the paralysis of oculomotor muscles was not described. Falling at a narcolepsy can be dramatic enough and cause even fractures of bones. Duration of attacks of a cataplexy can be from several sec till 30 minutes that corresponds to duration of "violent" diurnal backfillings. The differential diagnosis is necessary with a stroke and drop-attacks. At a stroke become perceptible local and lateral muscle tone changes. At drop-attacks short-term (second) atonias are bound with ishaemisation pyramids, and as the provoking factor change of position of a head usually acts.
5. An awakening cataplexy - a condition when the patient, having woken up and being in full consciousness, adequately estimating events descending round it, cannot make purposeful actions. Decubitus paralitis appearance probably together with hallucinations. As a rule, complaints to impossibility to make any locomotion arises in the morning, right after awakenings, but it is not obligatory, and "decubitus paralitis" can arise as in evening, and at night.
At diagnostics of a narcolepsy the great value is given to paraclinic methods of research. The basic approaches consist in carrying out of genetical consultation, an assessment of diurnal drowsiness with use of the standardised questionnaire, carrying out of the standard test latention a sleep and polysomnography. At sleep research by cardinal diagnostic criterion premature offensive of a phase of a fast sleep is at a backfilling. Since in norm the fast sleep arises after appearance of all stages of a sleep on the average in 80 minutes after a backfilling, and at a narcolepsy the sleep can begin with a phase of a fast sleep or appear within the first minutes after a backfilling. The sleep of patients with a narcolepsy is strongly broken, that shows in reduction representativeness a d-sleep and appearance of frequent episodes of wakefulness in a night sleep. The differential diagnosis is sometimes complex enough, especially at inspection of patients with a syndrome of somnolent apneas at which also there can be changes of structure of a cycle a sleep-wakefulness, similar with narcoleptic, and even premature offensive of a fast sleep is described. Thus it is necessary for research of respiratory disorders to give due attention for statement of the correct diagnosis.
The question of treatment of a narcolepsy remains to the most complex since there are no the schemes, allowing to achieve full recover. It is possible to speak about the expected treatment of the given disease allowing some to enrich quality of life only.
First of all it is necessary to explain to the patient essence of disease. It is especially important to notice that a narcolepsy - long (lifelong) disease.
Medicamental therapy consists in appointment of excitants (dextroamphetamine, Pemolinum, Mazindolum, modafinil, propranolol), antidepressants (Melipraminum, protriptyline, a clomipramine, a viloxazine, a fluoxetine). At treatment by these medicines it is necessary to select individual a medicine dose on purpose to minimise undesirable effects of preparations and to be careful of a possible overdosage of medicines. Treatment by the preparations set forth above has a certain orientation on disease symptoms. So, treatment by excitants is referred on elimination of superfluous diurnal drowsiness, and antidepressants are desirable for applying in the presence of a cataplexy.
As well as in all medicine of a sleep, at narcolepsy treatment it is necessary to pay attention to hygiene of a sleep. For patients it is important to have regular time of a withdrawal to a sleep. Duration of a sleep is desirable till 9 o'clock for a night.
It is necessary to exclude shift work, the use of serious nutrition and alcohol. It is important to plan in a daily routine time for a diurnal sleep to 2 times a day, it is better in second half of day.
Other usually surveyed form hypersomnia is the idiopathic hypersomnia. Age of the beginning of development of an idiopathic hypersomnia enough young (from 15 till 30 years). Clinical implications of disease are the complaints bound to raised diurnal drowsiness, such as sensation of a sleep lack, the constant desire to sleep even in a condition of intense wakefulness.
Episodes of a diurnal sleep come to several times a day, mainly in a condition of the relaxed wakefulness. The idiopathic hypersomnia is characterised by appearance of a diurnal sleep without imperativeness, characteristic for a narcolepsy. Diurnal drowsiness is isolated and not combined with disturbance of a night sleep. This clinical symptom is similar enough to one of narcolepsy symptoms that can cause difficulties in differential diagnostics with a monosemeiotic narcolepsy. During wakefulness patients with an idiopathic narcolepsy can have episodes of out-patient automatism about several seconds, especially if the patient is not inclined to go to bed specially in the afternoon.
Awakening in the morning difficult, is often accompanied by a symptom of "somnolent intoxication". During awakening patients can be aggressive. All it leads to desire to sleep so longly, as soon as probably.
The episodes of the diurnal sleep noted at given bunch of patients, bring short "restoration" and do not solve completely problems of the raised diurnal drowsiness.
Objective researches of a night sleep show, that at patients with an idiopathic hypersomnia of awakening at night are rare, the d-sleep is presented well, its appreciable part can fall to last cycles of a sleep that is uncharacteristic for healthy faces and patients with a narcolepsy. The test latention a sleep notes reduction of time of a backfilling.
The differential diagnosis is combined enough with a monosemeiotic narcolepsy. As well as at a narcolepsy, disease proceeds without remission. Genetical consultation, polygraphy of a night sleep and test carrying out latention a sleep are important. Nevertheless it is necessary to notice, that the found changes at the spent inspection are not completely pathognomonic.
At treatment of an idiopathic hypersomnia the great value is given to hygiene of a sleep. However unlike treatment of a narcolepsy the diurnal sleep recommended by the patient with an idiopathic hypersomnia, should not be long and exceed 45 minutes. Medicamental treatment similarly used at a narcolepsy also is symptomatic. Used tricyclic antidepressants, monoamine oxidase inhibitors, as a rule, are ineffective. Such preparations, as Melipraminum, Pemolinum, Mazindolum, Methylphenidate, Dexedrin have appeared the most common in this direction.
Hypersomnichesky conditions often appear at various neurotic disorders. The most unpredictable clinic of the raised drowsiness can be observed at a hysteria. " The sleep "arising at the given disease, can proceed long enough, at times about several days. As feature of the given disorder that"hibernation"development descends both against significant psychoinjuring situations can serve, and on excision on time from them. In night time patients with a hysterical hypersomnia under characteristics of a night sleep can not differ from the healthy. Objective researches of structure of the sleep, spent in the afternoon at the given bunch of patients, have shown, that at patients it did not become perceptible sleep signs. They lay blindly, being thus in a wakefulness condition, and at carrying out of polygraphic research of hysterical"sleep"it is possible to note on an EEG signs exerted or is rarer the relaxed wakefulness, sphygmus and breath increase.
Difficultly distinguishable from neurotic disorders there are implications of the hypersomnia arising against brain injuries (concussions and a bruise of easy degree of a brain). Absence of essential structural damages of a brain allows to assume, that the raised drowsiness at the given bunch of patients is defined by mainly stressful influence of the got trauma. While the expressed structural changes in brainstem range can cause both hypersomnic, and insomnic disorders.
The special vigilance is necessary for having at endogenous diseases since complaints to a hypersomnia sometimes meet at depressive disorders.
The wide circulation in practice of treatment of various diseases psychotropic, hypotensive, Saccharum of preparations reducing (insulin) can lead to a medicamental hypersomnia where a hypersomnia principal cause is reception of medicinal preparations.
Presence at the patient of a disadvantage of the night sleep bound to an insomnia, disturbances of the circadian rhythmes caused by shift work, transcontinental flights, can cause appearance of complaints to the raised diurnal drowsiness.
Thus, the implications of a hypersomnia extended in modern medical practice have polyetiological character and demand systematic diagnostic search of causes of illness.
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