Here, the need for sleep is more important than in average sleepers (more than 10 hours).
No matter how intense his/her « stress level » can be, that subject will never know the dread of insomnia.
He/she is under a constant excessive sleep pressure and takes advantage of every opportunity to « doze off a little ». (And is teased by friends how consider him/her like a « marmot »).
If possible, the person will adopt fitted out work schedules which leave opportunities to satisfy his/her need for sleep.
The diagnosis requires that pseudo-hypersomnias and secondary hypersomnias are taken into account.
Sleep insufficiency because of an excessive need ...
Normal sleep duration varies a lot : statistics show that 35% of the population sleeps less than 5 hours or more than 9 hours.
The notion of «big sleeper » must imperatively lead to sleep explorations in order to confirm the diagnosis and to exclude the possibility of an underlying illness :
When the excessive need for sleep has no detectable cause and implies a true handicap, idiopathic hypersomnia is mentioned.
That type of "extreme big sleeper" presents an excellent sleep quality when recorded, which only remarkable features are its duration and depth (rich in slow wave activity).
Even if the subject has slept well the night before recording (so that a sleep debt can be excluded), he/she falls asleep during more than one of the 5 naps which make the test which measures sleepiness objectively.
To the opposite of narcolepsy, no sleep onset that occurs directly in REM sleep is noted, and there is either no disturbance of the level of orexin in the cerebro-spinal fluid.
In the typical forms, starting off in the morning is very difficult.
In modern life conditions, the subject has to compensate a chronic failure in order not to suffer from sleep insufficiency and excessive daytime sleepiness. Yet, the subject often prefers to avoid the naps because waking up is particularly difficult here, with sensations of sleep drunkenness and confusion which sometimes last a long time. The excessive sleepiness mostly appears in going to sleep early and getting up late.
If the handicap justifies it (the subject has the feeling of being « stoned » all the time), arousing molecules like cafeine, amphetamine or amphetamine-related (modafinil) can sometimes be resorted to in order to help the subject to live more normally (but troubles with waking up remain).
In 2005, a ministerial project which consisted in 3 colour level pictograms has been announced by the Afssaps (French health product safety agency) and starts (late) to be distributed in doctors’ consultations.
It foresaw one colour meaning that driving is forbidden, one colour which meant that a medical opinion was necessary and one colour to draw the attention on a potential risk.
There are few medications for which it is possible to exclude any risk for sleep.
Beta-blockers (used in hypertension, sometimes because of their anti-stress effect) must be particularly avoided in the evening because they inhibit the synthesis of melatonin, which gives the signal « night » to the organism.
Despite its very ancient traditional use (the sect of the « Hashishin » which drugged its members to give them a foretaste of paradise), the effect of cannabinoids on sleep has not been studied very much.
Yet, some recent publications show properties which could reveal interesting. They seem to increase slow and REM sleep and might present numerous applications in food balance, pain mechanisms and the immune system.
That type of disturbance responds favourably to a well-conduced anti-depressant treatment and, in that case, the normalisation of the hypnogram precedes that of the mood.
It is thus possible to consider the EEG diagram like a predictive marker of the efficiency of the medication.
A promising path for the future of somnology...
Some psychiatry units proceed to (under control) sleep deprivations (combined with an antidepressant) in subjects who suffer from severe depression and meet a lot of success doing so.