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居眠り男
居眠り男

日中の激しい睡魔を引き起こす反復性過眠症とは

居眠りする男

 
過眠症という言葉を聞いたことがありますか?日中に耐え難い睡魔が襲ってきて、授業中、仕事中、会議中に居眠りしてしまう。このような人は、怠け者、精神がたるんでいる、やる気がない、夜遊びばかりしている、などの悪いレッテルを貼られてしまうことが多いでしょう。

しかし夜更かしをせず規則正しい生活を送っているのに、日中に耐え難い眠気に襲われる。そんな病気があるのです。

こちらでは、あまり耳にしないが知っておきたい過眠症という病気についてご紹介します。

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過眠症とは

過眠症の主なタイプ

眠い男

過眠症とは、夜眠っているにもかかわらず、日中に強い眠気が生じ起きているのが困難になる状態です。原因としては、脳内の覚醒維持機能の異常、何らかの原因で夜間の睡眠障害があるためなどが想定されています。

以下の3つが挙げられます。

  • ナルコレプシー
  • 特発性過眠症
  • 反復性過眠症

ナルコレプシー

世界的には1000人から2000人に1人にみられる病気で、10歳代で発症することが多い疾患です。

症状
日中の耐え難い眠気と居眠りが繰り返し生じる。居眠りは長くても30分以内と短く、目覚めたあとは一時的にすっきりする。笑ったり怒ったりすると、突然体の力が入らなくなり、ひどいときにはへたり込んでしまう。寝入りばなに金縛りにあったり、現実と区別がつかないような夢を体験したりする。

特発性過眠症

発症は10~20歳代で、有病率はナルコレプシーよりやや少ないと推測されています。

症状
昼間の眠気と居眠りを主症状とする。居眠りは、1時間以上続き、目覚め後はすっきりと覚醒できずに眠気が持続し、リフレッシュ感が乏しい場合が多い。夜間睡眠が10時間以上と著しく長い場合がある。

反復性過眠症

非常にまれな疾患です。初発は、ほとんど10歳代で、女性よりも男性で頻度が高いとされています。

症状
強い眠気を呈する時期(傾眠期)が3日から3週間持続し、自然に回復してまったく症状がなくなるが、その後、不定の間隔で傾眠期が繰り返し出現する。

反復性過眠症について

比較的まれな疾患であり、正確な有病率は不明です。この病気について詳しく見ていきましょう。

症状

反復性過眠症は周期性傾眠症とも呼ばれる非常に珍しい睡眠障害のひとつです。普段は健常者と何ら変わることのない日常生活を送りますが、1年に数回程度~もう少し頻繁に、ある日突然、非常に強い眠気に襲われるようになり、かなりの日数のあいだ毎日16~18時間も眠ってしまうようになります。  

このような時期は「傾眠期」と呼ばれていて昼夜を問わず過眠状態が続き、常に意識がもうろうとした状態となります。すぐに眠り込んでしまいがちで、睡眠中は強い刺激には多少反応するものの、その反応はとても鈍く注意力も集中力も持続しません。傾眠期にも食事や排泄行為はでき人と話すこともありますが、その間の記憶はほとんど残らないか、まったく残らないのが普通です。

このような傾眠期が3日~3週間ほど続いた後、自然に症状がなくなり回復しますが、何日~何週間かすると、また不定期に傾眠期がやってきて、同様な症状が繰り返されます。傾眠期と次の傾眠期の間は、普通の日常生活を送ることができるけれど、傾眠期になると過食症状や攻撃性が高まりイライラしやすくなる人もいます。

クライネ・レビン症候群
傾眠期に過食、ときにそれに加えて性欲完進や攻撃性などの精神症状を伴うものはクライネ・レビン症候群と呼ばれ、男性に圧倒的に多いです。次第に午後に目覚めている時間が増え(回復期)、間欠期に至る。傾眠期の出来事について、程度の差はあれほとんど覚えていないことが多いでしょう。

月経関連過眠症
月経の1週間ほど前から傾眠が始まり、月経時になると急速に症状が改善するというように月経周期と一致して繰り返されるものを月経関連過眠症といいます。これも反復性過眠症の一種とされています。

反復性過眠症の原因

この病気は、非常に稀な病気であるために病態に関する研究は進んでおらず、発症原因はほとんど解明されていません。間脳下垂体系の機能に異常があるために、傾眠期になると覚醒物質であるオレキシンの髄液中濃度低下が見られるとの報告もありますが、未だ研究段階であり病気の原因と特定されてはいません。しかし、風邪などでの急性の発熱や強いストレス、疲労、深酒などに誘発されることが多いとされています。

反復性過眠症の診断

3日~3週間持続する傾眠期が反復して出現すること、傾眠期にも食事と排泄を自力で行えること、および、問欠期には完全に無症状であることが確認されれば診断してよいでしょう。うつ病との判別が問題になりますが、傾眠期の持続はうつ病に比べ著しく短い点が判別に役立ちます。

反復性過眠症の治療方法

治療は難しく、この病気の傾眠にはメチルフェニデートのような精神賦活薬の効果はあまり期待できません。反復性の病気であり、次の傾眠期が来ないような予防対策として、リチウムや気分安定薬が有効な場合があります。加齢に伴い、次第に傾眠期の生じる頻度が減少することが一般的です。発症に関してはストレスが誘因となることがあるので、家族や周囲の人々の理解と協力が必要となります。また、傾眠期の傾眠症状に対しては有効な治療法はありません。

ただし月経関連過眠症の場合には、月経周期と連動することから、ホルモンのアンバランスが原因となっている可能性があると考えられていて、経口避妊薬の使用によって症状が改善することがあるとされています。

9割の不眠は「夕方」の習慣で治る (SB新書)
白濱 龍太郎
SBクリエイティブ
売り上げランキング: 92,314

まとめ:過眠症について知っておこう

過眠症は、睡眠が異常に多くなる睡眠障害の総称です。日中の仕事中や食事中、あるいは会話中、車の運転中など眠るべきではない場面において突然眠り込んでしまうような疾患です。知らないでこの病気にかかっていると危険な場合があります。過眠症についておさらいしておきましょう。

  • ナルコレプシー:日中におこる 居眠り病として知られる
  • 特発性過眠症:日中におこる 夜の睡眠は正常
  • 反復性過眠症:昼夜を問わず過眠 食事と排泄は自力でできる

少しでも自覚のある方、運転中に症状が出たりすると危険ですので、早急に専門医にかかってくださいね。

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