Difference Between Chronic Fatigue And Idiopathic Hypersomnia

Model Construction And Simulation

Chronic Fevers, Fatigue, and Hypersomnolence – Strange Sensations Series with Ross Hauser, MD

Since the construction of dynamic models may not be a well-known method, in Table 3, we present the procedure for their construction using a system-dynamic approach.

Table 3. Procedure of dynamic model creation and simulation.

The data obtained in the interview were used to construct a dynamic simulation model to answer the question of whether the patient-reported course of the disease can be explained by the dynamics of the other parameters obtained from the structured interview. Our research project used the system dynamics methodology, which uses a system of differential equations to capture the dynamics of the phenomena under study . System dynamics have been used repeatedly to describe complex systems and model sleep. Unlike commonly used methods, it allows the inclusion of feedback, nonlinear relationships, time-varying delays, and soft variables .

Obtaining the time dimension of the investigated parameters allows for a retrospective reconstruction of their dynamics. If the beginning and the end of the occurrence of a phenomenon and its maximum value is known, its time course can be expressed as the difference of factors increasing and decreasing the value in a given time period. The value of the parameter is then given by a definite integral:

where PV is the parameter’s value, IF is the sum of the influences increasing the parameter’s value, DF are the factors decreasing the value, and IV is the initial value at the beginning of the period under study.

Are There Different Types Of Hypersomnias

Different sleep organizations and psychiatric organizations have different classification systems and subcategories for hypersomnia. Complicating matters, these classifications continue to evolve.

More commonly accepted criteria is that there are two main types of hypersomnia: secondary hypersomnia and primary hypersomnia.

Secondary hypersomnia

Secondary hypersomnia means your excessive sleepiness is due to some other known cause. Causes include:

Hypersomnia due to a medical condition. Diseases and conditions that can cause hypersomnia include epilepsy, hypothyroidism, encephalitis, multiple sclerosis, Parkinsons disease, obesity, obstructive sleep apnea, delayed sleep phase syndrome, multiple systems atrophy, myotonic dystrophy and other genetic disorders, mood disorders . Hypersomnia can also result from head trauma, tumors and central nervous system diseases.
Hypersomnia due to medications or alcohol. Sedating medications , anti-hypertensive drugs, anti-epileptic drugs, anti-parkinsonian agents, skeletal muscle relaxants, antipsychotics, opiates, cannabis and alcohol can cause hypersomnia. Withdrawal from stimulant drugs can cause hypersomnia.
Hypersomnia due to not getting enough sleep . You may have hypersomnia simply because you’re not going to bed and allowing yourself the chance for seven to nine hours of sleep . Perhaps you’re not practicing good sleep habits to help you get enough quality sleep.

Primary hypersomnia

How Is Hypersomnia Diagnosed

Your sleep specialist will ask about your symptoms, medical history, sleep history and current medications. You may be asked to keep track of your sleep and wake patterns using a sleep diary. You may be asked to wear an actigraphy sensor, which is a small, watch-like device worn on your wrist that can track disruptions in your sleep-wake cycle over several weeks.

Other tests your sleep specialist may order include:

Polysomnography. This overnight sleep study test measures your brain waves, breathing pattern, heart rhythms and muscle movements during stages of sleep. The test is performed in a hospital, sleep study center or other designated site and under the direct supervision of a trained sleep specialist. This test helps diagnose disorders believed to cause sleepiness.

Multiple sleep latency test. This daytime sleep test measures a persons tendency to fall asleep during five, 20-minute nap trials scheduled two hours apart. The test records brain activity, including the number of naps containing REM sleep.
Sleep questionnaires. You may be asked to complete one or more sleep questionnaires that ask you to rate your sleepiness. Popular sleep questionnaires are the Epworth Sleepiness Scale and the Stanford Sleepiness Scale.

According to diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, you would be diagnosed with hypersomnia if you:

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Adele: My Idiopathic Hypersomnia Diagnosis Story

1/17/2022 1:36:13 PM

I donât really know exactly when it began, all I know is I started noticing strange symptoms when I was in VCE. I was finding it difficult to concentrate, feeling tired all the time, struggling to get out of bed in the morning and losing my memory. At first, I brushed it off and thought, maybe I just need more sleep. As time went on, I began to feel like I was going crazy, my memory loss had gotten much worse, I was doing things without consciously being aware of it and falling asleep during the day in random places like the doctors waiting room. I downloaded brain training apps to help improve my memory, but it continued to worsen. The only explanation I could think of was early onset dementia.At this point in time, I didnât know that in a few yearsâ time my whole world would be flipped upside down.

Narcolepsy â short naps are refreshing, sleep-onset REM, sleep paralysis, hallucinations, sleep attacks that last a few seconds to a few minutes, cataplexy , vivid dreams, and disrupted sleep.What symptoms are the same?Excessive Daytime Sleepiness , automatic behaviour, memory issues, insomnia, and brain fog.

Symptoms Of Idiopathic Hypersomnia

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difficulty remaining awake and attentive during the day
Falling asleep unintentionally at inopportune times

Difficulty waking up after sleeping all night or after daytime naps

Other indicators of IH include excessive sleeping which can be upwards of 10 hours at night. sleep drunkenness is another indicator. This is where a person vacillates between various stages of being awake up to four hours after initially waking up. This state can lead to people being violent, clumsy and irritable, and can sometimes occur following naps as well.

Sleep deprivation and idiopathic hypersomnia have similar symptoms. The difference however is that once someone who is sleep deprived gets additional sleep, most of the symptoms are resolved. This additional sleep is referred to as paying off a sleep debt. This isnt the case for idiopathic hypersomnia. With IH, getting extra sleep does not erase the feeling of excessive sleepiness or other common symptoms associated with it.

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Cortisol Pain Exertion And Cfs

A number of reports suggest cortisol levels may be a marker for neuroendocrine dysfunction in CFS.49-51 One study found that salivary cortisol levels were significantly lower in CFS patients than in healthy controls.49 Depressed cortisol levels correlated with decreased sleep in these adolescent patients with CFS. Similarly, altered cortisol responsiveness was noted in patients with CFS who exhibited a heightened response to exhaustion following exertion.50

Meeus et al continued an exploration of pain in patients with CFS by focusing on cortisol levels to assess intensity of pain.51 Responses of CSF patients with chronic pain were evaluated for evidence of deficient endogenous pain inhibition as the cause of their chronic widespread pain, using an immersion test. The authors found that pain inhibition began more slowly in patients with CFS than healthy controls, and they concluded that the delayed response may help explain the chronic, widespread pain commonly experienced in patients with CFS,51 and by extension FM.

The Difference Between Hypersomnia And Narcolepsy

Idiopathic hypersomnia is often compared to narcolepsy because both disorders share a few traits. There are a few key differentiators, too. Narcoleptics often suffer from nighttime sleep disturbances, which doesnt tend to be an issue for those suffering from Idiopathic Hypersomnia.

Another distinct aspect of narcolepsy is that it can lead to a sudden compulsion to fall asleep, without any warning signs. This is unavoidable, whereas those suffering from hypersomnia can often force themselves to stay awake despite the overwhelming desire and need to sleep.

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Talk To Your Doctor About Chronic Fatigue Syndrome

If you suspect you may have ME/CFS, consult your doctor. You might keep an activity log or health journal to note changes in your wellbeing and help your physician understand your situation. With the aid of your physician, you can eliminate other possible causes of your fatigue. Then, together you can develop a plan for treatment and relief of symptoms.

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Depression and Anxiety

Healthcare providers and patients need to establish which symptoms are most disruptive or disabling and tailor management plans accordingly. Treatment should be directed toward the most problematic symptoms as prioritized by the patient. It is also important to incorporate strategies to prevent worsening of symptoms into initial and subsequent treatment plans.

Operationalizing The Seid Criteria

What is Chronic Fatigue Syndrome (CFS)? Not what you might think

In order to meet SEID criteria, a patient must have a substantial reduction or impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities , that persists for more than 6 months and is accompanied by fatigue , which is often profound, is of new or definite onset , is not the result of ongoing excessive exertion , and is not substantially alleviated by rest and is accompanied by post-exertional malaise , unrefreshing sleep , and either cognitive impairment or orthostatic intolerance . The IOM guidelines acknowledge that there are multiple questions and scales that are useful for capturing these components, rather than specifying a single tool or set of tools that must be used. We operationalized these IOM criteria using components of our clinical battery.

Criterion 1 was assessed based on the FSS. If a patient rated their agreement with the statements Fatigue interferes with carrying out certain duties and responsibilities or Fatigue interferes with my work, family or social life as 5 or greater, they were considered positive for criterion 1.

As part of their initial evaluation, patients self-reported information regarding symptom onset and duration, which was used to assess whether they fulfilled the criterion for duration of 6 months or more, but not lifelong .

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What Can I Do To Better Cope With Having Hypersomnia

Consider making some lifestyle changes to help improve the quality of your sleep and keep you safe and avoid injuries and accidents.

Things you can try include:

Go to bed at the same time each night. Make sure your bedroom is well-ventilated, cool in temperature, dark, quiet, and comfortable in terms of mattress, pillows and sheets and blankets.

Avoid caffeinated products within several hours of bedtime. Caffeine is a stimulant.
Avoid alcohol before bedtime. Although alcohol is a depressant and seems like it might help you fall asleep, as its metabolized by your body, it causes awakenings and is often associated with nightmares and sweats.
Avoid tobacco and nicotine-containing products near bedtime. Nicotine is a stimulant.

Ask your sleep specialist about what to avoid in terms of foods or specific medications.
Be careful about driving or operating equipment that can be dangerous to you or others. Work with your healthcare team, family and employer to make adaptations or adjustments to keep you and others around you safe.
Avoid night shift work.

It may be helpful to talk to a psychologist or counselor and find a support group to learn to cope with the challenges of having hypersomnia. Ask your sleep specialist for referrals and names of support groups. Bring loved ones with you to these sessions. People with hypersomnia are often misunderstood as being lazy or incompetent and educating them on this condition will help your relationships.

Type 1 Narcolepsy Vs Idiopathic Hypersomnia

Narcolepsy and IH share three important symptoms:

Excessive daytime sleepiness.This can include feeling extremely tired during the day or an overwhelming need to sleep during the day.

Sleep attacks. During a sleep attack, an individual falls asleep without warning. A sleep attack can last several seconds or up to a few minutes.
Brain fog. Feeling tired all the time can lead to brain fog, which is characterized by problems with memory, attention, or concentration. You may also feel like your mind has gone blank.

While there are some similarities between the two conditions, there are also several differences. Lets go into a little more detail about each condition and how they can present.

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Ask The Doctor: Ih Cfs And Fibromyalgia How Do They Differ

August 20, 2019 in Ask the Doctor, Diagnosis, Idiopathic Hypersomnia, Other Hypersomnias

Lynn Marie Trotti, MD, MSc, of Emory University, and the Chair of our MAB

Whats the difference between chronic fatigue syndrome and idiopathic hypersomnia ? How do they differ from fibromyalgia? And how many people with IH also have CFS or fibromyalgia? A medical expert explains! We are very pleased to have Lynn Marie Trotti, MD, MSc, of Emory University, and the Chair of our Medical Advisory Board, answer these questions.

QUESTION: Whats the difference between chronic fatigue syndrome and idiopathic hypersomnia ? Is it just sleep attacks? Or is it part of the differential diagnosis? What about fibromyalgia? How does the medical community differentiate between these 3 diseases? How many patients with IH ALSO have fibromyalgia or CFS?

Diagnosis of IH also requires sleep testing. This can include any of three tests: a multiple sleep latency test, a 24-hour sleep study, or actigraphy . At least one of these three tests usually is abnormal in people with IH. These tests have not been studied as extensively in people with chronic fatigue, as none of these tests are used for chronic fatigue diagnosis.

References:

The Spectrum Of Tiredness

During the day, we may experience different kinds of tiredness.

For some, its a weighty feeling in the limbs that makes physical movement difficult.

Sometimes we yawn all day long and crave naps.
We may feel cognitive fog, in which thoughts and words come slowly.
We may become overwhelmed with a sense of exhaustion that we feel in our brains, our bones, and our moods.

Does it matter that we distinguish between these kinds of tiredness?

Tired is tired or is there a meaningful difference?

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Hypersomnia Secondary To Other General Medical Conditions

Excessive daytime hypersomnia also may occur from frequent chronic pain or from repeated awakenings because of an underlying medical disorder.

As the use of medications can result in hypersomnia, a careful history and chronology of the symptoms are necessary to clarify the underlying cause. In the hospital, especially in intensive care units, hypersomnia may also be secondary to a disruption of the sleep-wake cycle or, in severe cases, may reflect an underlying delirium due to a general medical condition.

Similar Adverse Effects Of Hypersomnia And Insomnia

Although hypersomnia and insomnia influence sleep patterns in different ways, both are characterized by a feeling of sleepiness and fatigue during the daytime and a decline in alertness. Thus, both disorders can profoundly disrupt normal functioning in social and professional life. In the long-term, insomnia and hypersomnia can increase the risk of cardiovascular diseases, obesity and mood disorders, including anxiety and depression.

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Talking With Your Healthcare Provider About Your Symptoms

Since chronic fatigue syndrome can be difficult to diagnose, it is helpful to come prepared to your doctors appointment. Think back to when your symptoms first started, and whether they may be linked to a stressful event or an illness. Make a note of all the symptoms you have experienced, even if they do not seem directly related to chronic fatigue syndrome. This can help your doctor rule out other conditions.

You may also want to prepare a list of questions to ask your doctor. Treatment for chronic fatigue syndrome tends to focus on managing symptoms through medication, therapy, and lifestyle changes. Tell your doctor about your preferences regarding activity levels, so they can help establish a treatment plan that works for you. They may need to refer you to specialists for more targeted treatment of certain symptoms.

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Can You Have Both Sleep Disorders At The Same Time

Michelle Emrich, MD – “A Doctor’s Once Agile Brain Broken by IH”

There are instances where both hypersomnia and insomnia have been observed in the same individual. Such instances of co-occurrence are generally observed along with psychiatric disorders, such a major depressive disorder. For example, a study found that 30% of patients with major depressive episode showed co-occurrence of hypersomnia and insomnia. Such joint presentation is associated with more severe depressive symptoms in children and adults.

How Is Hypersomnia Treated

Treatment depends on whats causing your hypersomnia. There are both medication approaches and lifestyle changes.

Medications

Wakefulness-promoting agents include modafinil , armodafinil and pitolisant and solriamfetol . One of these medications is usually tried first.

Psychostimulants include amphetamine, methylphenidate or dextroamphetamine . These drugs have more abuse potential and side effects than first-line agents.

Other drug options, when other medications fail, including sodium oxybate , flumazenil and clarithromycin .

Its important to see your sleep specialist for follow-up appointments. Your healthcare provider will need to find out how youre feeling and determine how well your medication is working, if dose adjustment is needed or if a switch to another medication should be made.

Lifestyle changes

Maintain good sleep habits. This includes things like establishing a regular sleeping schedule, having an environment that allows for sleep and limiting caffeine and exercise before bedtime.

Cognitive And Somatic Symptoms

Some somatic problems regarding the autonomic nervous system have already been described in hypersomnia . In this study, some functional equivalents are indeed more frequent in hypersomniacs than in controls, while there is no more headache in the patient group. In addition, half of the hypersomniacs are near-sighted, 38% are allergic and 25% have problems regulating their temperature. The mechanism of these symptoms is unknown, they could contribute to the burden of the disease.

The symptoms reported in this article are subjective, which constitutes a limitation of this work. There is no formal testing of the cognitive status by a neuropsychologist, no measure of supine hypotension, no systematic sight assessment in the controls, so that a bias towards over-reporting in patients is still possible. The questionnaire is, however, the same for any subject, whether hypersomniac or not. On the contrary, we try to catch the somatic problems of the patients, which are by definition subjective.