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Hypersomnolence Disorder

According to American Psychiatric Association (2013), hypersomnolence Disorder is characterized by the self-reported excessive sleepiness lasting for 3 months as evidenced by a prolonged sleep episode of more than 9 hours per day or day time sleep episode occurring at least 3 times a week.

1. The hypersomnolence is accompanied by significant distress or impairment in cognitive, social, occupational, or other important areas of functioning.
2. The hypersomnolence is not better explained by and does not occur exclusively during another sleep disorder such as sleep apnea or narcolepsy
3. The hypersomnolence is not attributable to the physiological effects of a substance e.g. drug abuse or medication.
4. Coexisting mental and medical disorders do not adequately explain the chief complaint of hypersomnolence.

Psychotherapy

In patients with hypersomnolence disorders, the goal of treatment is to curtail daytime sleepiness. Nonpharmacologic measures may help reduce tiredness in some patients (Khan, & Trotti, 2015). The use of cognitive-behavioral therapy can be very helpful in the treatment of hypersomnolence disorders. CBT can be conducted in group or individual sessions and its modality consists of CBT modules that include behavioral, cognitive and educational components. The behavioral part begins with specific techniques aimed at changing sleep-disordered behaviors such as scheduled naps, sleep hygiene, and regularizing sleep schedules at night. The cognitive component is aimed at modifying beliefs, motivations, and emotions that might play an essential role in maintaining hypersomnolence that intensifies symptoms. The educational features include education about hypersomnia, coping skills training, the mechanism of drug action, drug interaction, and perceived limitations of living with chronic hypersomnia (Agudelo et al., 2014).

Psychopharmacology

Modafinil is a non-stimulant medication, wakeful promoting agent, approved by FDA as the first-line intervention to treat hypersomnolence. It acts by blocking norepinephrine and dopamine reuptake transporters. Its plasma concentration normally reaches peak values within 2-4 hours after intake. Modafinil is safe and well-tolerated. Some of the side effects of the medication include headache, nausea, loss of appetite, and nervousness (Sonka & Susta, 2012). Modafinil is a long-acting non-stimulant medication and can provide all-day benefits following morning administration. However, stimuli with a short duration of action such as methylphenidate can be used in combination to achieve alertness quickly on an as-needed basis (Gabbard, 2014).

Referring patients to their primary care physician

Hypersomnolence causes many significant impacts on the quality of life and psychosocial well-being of an individual. Excessive sleepiness can be problematic because it affects the person’s abilities at work, school. It can cause safety issues while driving and also affects other everyday activities. The PMHNP can play an essential role by referring these and patients who present with excessive daytime sleepiness and whose quality of life has been significantly impacted by the condition to their primary physician.  Referring to these patients on time is essential for an early diagnosis and intervention and also to be able to determine any underlying medical disorder that can be causing the excessive sleepiness. Also, an early referral is needed because when hypersomnolence is left untreated, it can lead to social isolation and interfere with daily patient functioning (Khan, & Trotti, 2015).

References

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.). Washington, DC: American Psychiatric Publications

Khan, Z., & Trotti, L. M. (2015). Central Disorders of Hypersomnolence: Focus on the Narcolepsies and Idiopathic Hypersomnia. Chest, 148(1), 262–273. https://doi.org/10.1378/chest.14-1304

Marín Agudelo, H. A., Jiménez Correa, U., Carlos Sierra, J., Pandi-Perumal, S. R., & Schenck, C. H. (2014). Cognitive-behavioral treatment for narcolepsy: can it complement pharmacotherapy? Sleep Science, 7(1), 30–42. https://doi-org.ezp.waldenulibrary.org/10.1016/j.slsci.2014.07.02

Sonka, K., & Susta, M. (2012). Diagnosis and management o