Addiction to sleep

Classification according to ICD-10
F51.1	inorganic hypersomnia
G47.1	pathologically increased need for sleep
G47.4	Narcolepsy and cataplexy
ICD-10 online (WHO version 2019)

Hypersomnia or sleep addiction is one of the leading symptoms in sleep medicine and occurs in the form of daytime sleepiness . This means a reduction in central nervous activation ( wakefulness , sustained attention) and the need to fall asleep. As a result of unrefreshing sleep , daytime sleepiness leads to sleep in monotonous situations with short latency.

The other key symptom, insomnia , however, refers to problems falling asleep and staying asleep.

(Also the old classification scheme for diseases in the two categories hypersomnia against insomnia Agrypnie , Hyposomnie or sleep disorder called) is obsolete by newer sleep medical point of view. On the one hand, there is no scientifically exact quantification of the necessary amount of sleep; on the other hand, there are nosological disease entities that appear both as hypersomnia and insomnia and secondary sleep disorders in which hypersomnia, insomnia, parasomnia and sleep-related breathing disorders can occur side by side . For example, narcolepsy , a disease classically seen as hypersomnia, predominantly results in disorders of sleeping through the night. For historical reasons, the terms hypersomnia and insomnia can also be found in the literature and in the classification systems in the sense of a classification of diseases and are even part of the name for individual diseases such as " idiopathic hypersomnia ". The term “sleep disorder” is also used synonymously for insomnia and as a generic term for all sleep medical diagnoses, including hypersomnias.

Main findings and causes

What all hypersomnic diseases have in common is the constant daytime sleepiness in the patient. The causes are quite different, can be organic and non-organic, contain genetic and hereditary factors and are also related to other diseases.

Classification of hypersomnias

Various classification systems are now available for classifying sleep disorders and thus also hypersomnias:

ICSD-2 ( International Classification of Sleep Disorders , American Academy of Sleep Medicine )
ICD-10 ( International Classification of Disorders , WHO )
DSM-IV ( Diagnostic and Statistical Manual of Mental Disorders , American Psychiatric Association )

The contents reflect the development since the first classification system for sleep medical diagnoses, which appeared in 1979 under the title "Diagnostic Classification of Sleep and Arousal Disorders". The division of sleep disorders in this publication was made into four sections. At that time, a distinction was made between disorders in the induction and maintenance of sleep (insomnias), disorders with excessive sleepiness, disturbed sleep-wake rhythm and parasomnias.

Classification according to ICSD-2

In sleep medicine, according to the classification system for sleep disorders "International Classification of Sleep Disorders" (ICSD-2) from 2005, a distinction is made between various forms of hypersomnias of central nervous origin that are not caused by circadian sleep-wake rhythm disorders, sleep-related breathing disorders or another Reason for disturbed night sleep:

Narcolepsy in the various forms with and without cataplexy (ICD-10 code G47.4),
Recurrent hypersomnia in the form of Kleine-Levin syndrome and as "menstrual-related hypersomnia" (ICD-10 code G47.8),
Idiopathic hypersomnia in various forms (ICD-10 code G47.1 / F51.1),
Behavior -induced sleep deprivation syndrome (ICD-10 code F51.8),

such as

Hypersomnia due to physical illness, medication, drugs or substances (ICD-10 code G47.1 + underlying disease),
Unspecified non-specific non-organic hypersomnia (ICD-10 code code F51.9) and
Unspecified unspecific organic hypersomnia (ICD-10 code code G47.1).

Classification according to ICD-10

According to ICD-10, sleep disorders are classified under, among other things, depending on the suspected cause (psychogenic versus organic)

F51 Inorganic sleep disorders in the chapter Mental and behavioral disorders and
G47 (organic) sleep disorders in the chapter Diseases of the nervous system .

Hypersomnia is explicitly mentioned at

Inorganic hypersomnia (F51.1),
Inorganic disorders of the sleep-wake cycle leading to complaints of insomnia and hypersomnia (F51.2) and
Pathologically increased need for sleep - hypersomnia (G47.1)

and is used in classic hypersomnic diseases like

Narcolepsy and cataplexy (G47.4) and
Other sleep disorders - Kleine Levin syndrome (G47.8)

contain.

Classification according to DSM-IV

The division of sleep disorders according to DSM-IV takes place in the categories “primary sleep disorders”, “sleep disorders in the context of a psychiatric illness” and “other sleep disorders”.

Count when it comes to hypersomnic diseases

to the "primary sleep disorders" the "primary hypersomnia" (307.44) and the narcolepsy (347),
to the "sleep disorders in the context of a psychiatric illness" the "hypersomnia in the context of an axis I / II disorder" (307.44) and
to the “other sleep disorders” the “hypersomnia in the context of an organic disease” (780.54).

Severity of hypersomnia

The guideline "Non-restful sleep / sleep disorders" contains a table adopted from the ICSD-R for the classification of a hypersomnic disease into degrees of severity. The evaluation of the severity of hypersomnia on the levels “mild”, “medium” and “severe” takes into account the frequency of involuntary sleep episodes, the conditions under which they occur and the social and occupational impairment as criteria.

According to this, hypersomnia is “mild”, in which involuntary falling asleep episodes that do not occur daily in relaxed and rather monotonous situations such as watching TV, reading or as a passenger are associated with little social and professional impairment.

According to this, "medium" is hypersomnia, in which involuntary falling asleep episodes that occur daily occur even with light physical activity and the will to stay awake in situations such as being a spectator in the cinema or theater and are associated with moderate social and professional impairment.

According to this, hypersomnia is “severe”, in which involuntary sleep episodes that occur daily also occur during physical activity and in situations such as eating, in (personal) conversations, driving a car or at work and are associated with severe social and professional impairments.

Individual evidence

↑ ^a ^b ^c ^d ^e S3 guideline for non-restful sleep / sleep disorders of the German Society for Sleep Research and Sleep Medicine (DGSM). In: AWMF online (as of 2009)
↑ ^a ^b Michael J. Thorpy: Classification of Sleep Disorders . In: Neurotherapeutics . tape 9 , no. 4 , 2012, p. 687-701 , PMID 22976557 (English).
^ Sleep Disorders Classification Committee, Howard P. Roffwarg: Diagnostic classification of sleep and arousal disorders . In: Sleep . tape 02 , no. 01 , 1979, p. 1-137 , PMID 531417 (English).

[S3-1] S3 guideline for non-restful sleep / sleep disorders of the German Society for Sleep Research and Sleep Medicine (DGSM). In: AWMF online (as of 2009)

[Thorpy-2] Michael J. Thorpy: Classification of Sleep Disorders . In: Neurotherapeutics . tape 9 , no. 4 , 2012, p. 687-701 , PMID 22976557 (English).

[3] Sleep Disorders Classification Committee, Howard P. Roffwarg: Diagnostic classification of sleep and arousal disorders . In: Sleep . tape 02 , no. 01 , 1979, p. 1-137 , PMID 531417 (English).