Excessive sleep

Introduction

Introduction

Oversleeping refers to a pathological increase of absolute sleep time of ±25%. Causes of chronic oversleeping may involve space-occupying lesions of the hypothalamus or upper brainstem, increased intracranial pressure, excessive application or abuse of hypnotics or certain illicit drugs, or certain types of encephalitis. It can also be used as a symptom of depression. Acute, relatively short-lived oversleeping is usually a concomitant symptom of an acute systemic disease such as influenza. In addition, hypothyroidism, hyperglycemia, hypoglycemia, anemia, uremia, hypercapnia, hypercalcemia, liver failure, epilepsy and multiple sclerosis can also cause excessive sleep. Patients with sleep apnea syndrome often have compensatory oversleeping during the day. Kleine-Levin syndrome, also known as narcolepsy, is an extremely rare condition that occurs in adolescent boys and is characterized by periodic episodes of excessive sleep and overeating.

Pathogen

Cause

The cause is unclear, and it is generally considered that the inter-brain brain lesions, especially the subthalamic lesions, are considered to be a malignant type of snoring rather than an independent disease; others believe that the disease is associated with infection and belongs to mild encephalitis. Some people think that it is an epilepsy according to the abnormal EEG of the patient.

According to modern medical research on neurobiochemistry and pathophysiology, it is believed that the drowsiness-Bulimia syndrome is a mild phenomenon caused by the function of the limbic system-hypothalamus-brain backbone network structure infection, trauma and congenital defects. Potential lesions cause the patient to develop the disease after puberty due to dysfunction of the internal environment and endocrine system.

The generally accepted pathogenesis is thought to be related to the dysfunction of the diencephalon, especially the hypothalamus. Neuroanatomy and pathology studies indicate that the hypothalamus is the center that controls sleep, diet, sexual behavior, and vigilance. Patients with existing syndromes are found. There are many reports of hypothalamic pathological abnormalities. Therefore, it is considered that the syndrome is caused by the unsatisfaction of sleep, diet, and the like caused by hypothalamic dysfunction. Neurosecretory studies have found that hormone levels and rhythm changes in the pituitary gland controlled by the thalamus during the onset of the syndrome, but not in the normal phase of the attack may be caused by a decrease in dopamine function in the hypothalamus during the onset of the syndrome, thus suggesting a hypothalamic-pituitary axis dysfunction. Hypothesis.

In addition, the dysfunction of other parts of the diencephalon, the thalamus, the surrounding tissues of the third ventricle, and the structure of the brainstem, which are related to the sleep arousal center and the ascending activation system, is also considered to be one of the pathogenesis of the syndrome. Due to the discovery of single-electron emission tomography, the proposed mechanism hypothesis has primary cortical power regulation disorder, frontal-thalamic dysfunction, and dysfunction of the limbic system. At present, the specific cause of this syndrome is unknown, and can be divided into idiopathic, organic and spiritual. According to the literature, the following factors may be the cause or triggering factor.

The cause of infection and the first proposed syndrome may be infection and inflammation. Almost the syndrome has a slight viral infection before the first onset of the disease, but subsequent episodes are different from viral infections. In addition, in the autopsy of the patient after the death of the syndrome, the perivascular inflammatory infiltration of the hypothalamus and the third ventricle was found, and the third ventricle was enlarged, which suggested that the midbrain was inflamed and impaired. Despite this, there is little direct evidence of a viral infection that may trigger the same disease as other factors. It is also possible that the syndrome has more flu-like symptoms and is mistaken for a provirus infection. Infections closely related to the syndrome include flu, upper respiratory tract infection, and acute viral encephalitis. There have been many reports of post-traumatic syndrome in domestic and foreign countries. The hypothalamus is a site that is easy to be secondary to traumatic blood and infarction. In the past, brain function such as concussion and other secondary brain dysfunction was changed, but in recent years, It is believed that brain trauma can often cause interstitial traction and torsion to form organic damage. The pathological findings of thalamic, hypothalamic and pituitary occupying tumors and patients with hemorrhagic infarction syndrome were hypothalamic infarction, pituitary tumors, and hypothalamic morphological abnormalities. Psychosocial pharmacology studies suggest that mental disorders cause a decline in the function of the transmitter-receptor system, such as tryptamine, dopamine, and adrenaline, and the syndrome may have a common pattern of onset with mental disorders. In the clinically reported etiology, mental factors have a close relationship with the syndrome. The onset of the syndrome can be induced by mental factors. In the process of the disease, mental factors can aggravate the onset of symptoms, and the disease is accompanied by mental, emotional and behavioral problems. . Metabolic disorders Metabolic disorders can cause the function of the ascending reticular activation system to be low and cause salivation.

Many of the female cases reported in menstruation are related to the menstrual cycle, suggesting that it is associated with menstrual hormone and endocrine changes. Autoimmune factors Some people think that the linkage analysis of patients with this syndrome suggests that autoimmune factors are involved, and other conditions such as dehydration, drinking, and fatigue can be the cause or trigger factors.

Examine

an examination

Related inspection

Polysomnography (PSG) EEG examination

The history of typical sleep episodes is characteristic and should be examined for other symptoms of quadruple disease. According to the medical history, plus multiple sleep latency tests can usually confirm the diagnosis. A few patients have only one symptom of sleep episodes, and may lack typical The early appearance of REM sleep.

Patients with mild EEG abnormalities during seizures need to be differentiated from epilepsy, encephalitis, brain tumors, etc. In addition, in the attack period, it is also necessary to distinguish from spontaneous hypoglycemia, hypothyroidism, and periodic psychosis.

Because KLS is extremely rare, it is not classified separately in the International Classification of Sleep Disorder (ICSD) and the American Diagnostic and Statistical Manual of Mental Disorders, and is classified as a type of disease in recurrent narcolepsy. In ICSD, the symptomatic criteria for recurrent narcolepsy are: lethargy, unstoppable eating, and some abnormal behavior (mainly excessive sexual impulses). Among the above three symptom criteria, unstoppable eating and abnormal behavior are not considered necessary for diagnosis; cognitive and mood disorders are accessory symptoms. The course of disease was: continuous sleepiness of not less than 3 days and more than 2 times per year. KLS must first be differentiated from recurrent sleepiness caused by organic diseases. Organic recurrent narcolepsy can occur in third ventricle tumors, encephalitis, and brain trauma; these diseases can be identified by neurological examination and imaging examination. One patient with multiple sclerosis also showed symptoms similar to KLS in the early stages of the disease. KLS is often misdiagnosed as a mental disorder in the clinic, such as: emotional disorders, schizophrenia and the separation symptoms of snoring. Due to the intermittent course of KLS and good response to mood stabilizers, it is most often misdiagnosed as affective disorder. However, if the patient's age and gender characteristics are noted during the diagnosis and treatment, as well as their unexplained sleepiness and behavioral disorders, they can be clearly identified.

There is no objective basis for the diagnosis of the disease at present, mainly based on the diagnostic criteria of the International Classification of Diseases:

1 A paroxysmal sleep, diet, and behavioral disorder.

2 The seizure period showed obvious lethargy and prolonged sleep time and increased food intake.

3 Unfixed personality changes can be expressed as irritability, hallucinations and depression.

4 The episode lasts for a few days to a few weeks, and the interictal interval is completely normal, while EEG, polysomnography, and sleep latency test are helpful for diagnosis.

If sleepiness, greed, and psychological abnormalities occur as typical cases, if one of the symptoms is the opposite, it is called an atypical case, and if only one of the main symptoms is called an incomplete case. Differential diagnosis of the syndrome due to the complexity of clinical symptoms, easy to mix with some diseases, and cause unnecessary diagnosis and treatment process, not only bring unnecessary grievances and economic burden to patients, but also increase the complexity of clinical manifestations In order to attract the attention of clinicians, it is necessary to distinguish from the following diseases.

Mild depression depressive neurosis and tense schizophrenia, because the syndrome is mostly accompanied by abnormal emotions, emotions, behaviors, and personality during the period before, during, and after the attack. Psychological barriers, if not noticed, are easily diagnosed as depression, schizophrenia, etc., and the latter have no episodes of periodic episodes of sleepiness. Patients with periodic psychiatric female syndrome, the episodes are mostly related to the menstrual cycle, and should be differentiated from periodic psychosis. The latter develops during puberty, which is more common in women. The monthly incidence is periodic and closely related to the menstrual cycle. The period is often accompanied by obvious autonomic nervous system and endocrine disorders. Encephalitis generally does not take sleep as the main manifestation, often has fever, consciousness changes, mental symptoms, convulsions, hemiplegia, aphasia and increased intracranial pressure. EEG shows diffuse abnormalities based on unilateral or focal changes. Cerebrospinal fluid examination can have changes in protein and cell number. Clinical narcolepsy is mainly characterized by episodes of unstoppable sleep, wrestling, sleep paralysis and bedtime hallucinations. Most of them start with one year old, and each episode lasts for a few seconds and hours. In a few minutes, the degree is mostly not deep, easy to wake up, and can be attacked many times a day. Obesity-dyspnea sleepiness syndrome is mainly characterized by lethargy episodes with obvious obesity and respiratory insufficiency.

Psychomotor epilepsy 1. Syndrome patients have seizure temperament personality behavior changes, anti-epileptic drugs have a certain effect, should be differentiated from psychomotor epilepsy, the latter with different degrees of disturbance of consciousness and various manifestations The main symptoms of autonomic disease, generally do not show lethargy, duration of seconds to hours, EEG painful discharge, anti-epileptic treatment is effective.

Diagnosis

Differential diagnosis

Some specific causes that can cause oversleeping should be ruled out. The identification of sleep deprivation and depression relies on a history of psychiatric illness, environmental conditions of sleep, assessment of the duration of symptoms, and a lack of attention to cataplexy.

(1) Drowsiness: It means that the sleep time is too long, which is several hours longer or several days longer than the normal sleep time. There is no REM phase at the beginning of sleep, and NREM and REM sleep periods are similar to normal sleep throughout sleep.

Excessive sleep can occur in many brain diseases, such as cerebrovascular disease, brain trauma, encephalitis, brain tumors near the bottom of the third ventricle and the sella, and also in urinary poisoning, diabetes, excessive sedatives.

(2) Narcolepsy: An irresistible sudden onset of sleep accompanied by cataplexy, sleep paralysis, and illusion of falling asleep. Can not be restrained during sleep episodes, can occur suddenly in any occasion such as eating, talking, working, walking. Monotonous work, quiet environment and easier episodes after a meal. Sleep is similar to normal sleep, and the EEG also shows a normal sleep waveform. Generally, the degree of sleep is not deep, easy to wake up, but wakes up and falls asleep again. It can occur from a few times to dozens of times a day, and the duration is usually more than ten minutes.

Trips are the most common complication of this disease, accounting for about 50 to 70. The consciousness is clear when the attack occurs, and the muscles of the trunk and body suddenly fall and fall down, usually lasting 1 to 2 minutes.

Sleep sputum in 20 to 30 patients with narcolepsy, manifested as conscious and unable to move, systemic flaccid paralysis. When a patient is touched by a person, the episode can be stopped, and some patients have to shake hard to recover.

The illusion of falling into sleep accounts for about 25 of the disease. It is more common in audio-visual hallucinations. The content is mostly daily experience. The patient is aware of the surroundings, but it seems to be in a dream.