Hypersomnia and insomnia are sleep disorders characterized by the disruption of normal sleep patterns. Both hypersomnia and insomnia may occur as symptoms of other disorders in the form of secondary sleep disorders. Primary hypersomnia or insomnia refers to the occurrence of these disorders independent of other conditions.

Differences in Core Symptoms

Hypersomnia refers to excessive sleepiness during the day that is generally not related to getting a good, full night’s sleep. Hypersomnia is primarily characterized by the following symptoms:

  • Inability to stay awake during the day
  • Sleep inertia, or trouble waking up after normal sleep hours
  • Sleep drunkenness

Insomnia is primarily characterized by difficulty falling or remaining asleep, despite being tired.  The most common symptoms of insomnia include:

  • Poor quality of sleep due to psychological and/or physiological arousal
  • Trouble sleeping once awakened during the night
  • Waking up early in the morning

Symptoms of Hypersomnia

Besides excessive daytime sleepiness, hypersomnia is also often characterized by the following symptoms:

  • Feeling the need to nap despite adequate sleep
  • Cognitive deficits involving attention and memory
  • Reduced appetite
  • Restlessness
  • Anxiety

These symptoms must present for more than three months to be characterized as hypersomnia. Besides these symptoms, specific symptoms may vary depending on the specific type of hypersomnia a person has. For example, individuals suffering from idiopathic hypersomnia do not feel refreshed after a nap during the daytime, whereas individuals suffering from narcolepsy do. Furthermore, unlike idiopathic hypersomnia, narcolepsy is accompanied by cataplexy.

Symptoms of Insomnia

The essential symptoms of insomnia include difficulty falling asleep and remaining asleep even when adequate opportunities are available to attain adequate sleep. Besides these core symptoms, individuals with insomnia may also exhibit one or more of the following impairments during the daytime:

  • Impaired cognitive functioning affecting concentration and memory
  • Impaired functioning in social and professional life
  • Exhaustion and fatigue
  • Emotional disturbances and irritability

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.    

Rates of Occurrence

Symptoms of insomnia have been reported in 30% of the adult population, whereas only 10% of the population has been reported to be suffering from chronic insomnia. Hypersomnia is less prevalent than insomnia and is seen in 4–6% of the population. The rate of primary hypersomnia, not caused by other disorders or substance use, is much lower. Narcolepsy affects about 0.05–0.1% of American and European populations, whereas idiopathic hypersomnia is 60% as prevalent as narcolepsy.

Treatment Methods

The first step in the treatment of hypersomnia and insomnia is to ensure that the respective symptoms are not secondary symptoms of another disorder. If the symptoms of hypersomnia or insomnia are secondary symptoms, the primary disorder must be the target of therapy. In cases of primary hypersomnia or insomnia, treatment generally involves the use of medications, psychotherapy and lifestyle modifications.

Hypersomnia Treatment

Treatment of primary hypersomnia generally involves the use of stimulants to combat daytime sleepiness. Modafinil, the stimulant used for the treatment of attention-deficit hyperactivity disorder, is particularly effective, but medications belonging to the amphetamine family such as dexamphetamine may also be used. Antidepressants may be prescribed in cases of narcolepsy. Sleep hygiene, involving maintaining a regular sleep schedule, exercising and managing habits such as access to electronic devices before bedtime, can also be effective when combined with appropriate medications.

Insomnia Treatment

Insomnia treatment generally involves lifestyle changes and psychotherapy to alter behavioral and thinking patterns that interfere with normal sleeping patterns. Medications may also be used in combination with these non-pharmacological interventions.

Common insomnia treatment strategies include:

  • Sleep Hygiene: Involves adopting strategies that promote sleep at the right time and avoiding practices that impair sleep. This includes maintaining a strict sleep schedule, avoiding stimulants such as caffeine and nicotine late in the day and exercising daily.
  • Stimulus Control Therapy: Based on the premise that the association between sleeping time and the sleeping environment is disrupted. This involves eliminating habits or cues (such as watching TV while in bed) that associate the bed or bedtime with staying awake and restricting the use of the bed for sleeping.
  • Cognitive Behavioral Therapy: Involves identifying patterns of thoughts and behaviors that impair sleep. Individuals suffering from insomnia often have anxieties regarding their ability to acquire adequate sleep and stay asleep. Cognitive behavior therapy seeks to help the individual overcome these anxieties.
  • Medications: Although effective in the short-term, there are some concerns over the long-term use of medication for insomnia. Sedatives or hypnotics may alleviate short-term symptoms, and include benzodiazepine receptors agonists, antihistamines and melatonin receptor agonists.

Can You Have Both Sleep Disorders at the Same Time?

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.

Key Points: Hypersomnia vs. Insomnia

Some important points to remember about hypersomnia and insomnia are:

  • Hypersomnia is characterized by excessive sleepiness during the day, whereas insomnia is characterized by an inability to attain adequate nocturnal sleep
  • Both conditions are characterized by feelings of fatigue during the day, impaired cognitive functioning and negative effects on the individual’s social and professional life
  • Both disorders can result in higher incidences of comorbid mood disorders, with depressive symptoms being the most common

Both insomnia and hypersomnia can sometimes occur simultaneously with substance abuse disorders. If you or some you know is struggling with a substance abuse disorder co-occurring with a sleep disorder, The Recovery Village can help. Please call a representative for more information.

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