The disorder that I chose for this week for my sleep wake disorder is Hypersomnolence Disorder. This disorder is characterized by recurrent episodes of excessive daytime sleepiness or prolonged night time sleep. Patients with excessive daytime sleepiness (EDS) have impaired function due to difficulty maintaining wakefulness or alertness at appropriate times during the day. Complaints of EDS, or related terms such as tiredness, fatigue, and lack of energy, constitute some of the most common issues presented to clinicians (American Psychiatric Association, 2014).
EDS is important to recognize because it can signal an undiagnosed sleep disorder or other treatable conditions such as Hypersomnolence. In addition, EDS can have a negative impact on a broad range of activities and raise safety risks while driving or operating other machinery. Sometimes individuals refer to this disorder as “hypersomnia”. However, this term does not capture its full signs and symptoms of the disorder (American Psychiatric Association, 2014). Symptoms of this disorder include, anxiety, increased irritation, restlessness, slow thinking, slow speech, hallucinations and problems with memory (American Psychiatric Association, 2014). Some individuals lose the ability to function in their family, social and occupational setting. There is a genetic predisposition to this disorder however, some people have an idiopathic meanings to this disorder. Research has shown that Hypersomnolence typically affects adolescents and young adults more frequently than older adults.
Diagnostic Criteria for Hypersomnolence Disorder
The DSM-5 states that the most prominent diagnostic criteria for this disorder is excessive sleepiness for at least one month (in acute conditions) or for at least three months (in persistent conditions). This is evidenced by prolonged sleeping episodes in night and/or daytime that occur at least three times a week (American Psychiatric Association, 2014). Other criteria listed in the DSM includes:
The excessive sleepiness causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (American Psychiatric Association, 2014).
The excessive sleepiness is not better accounted for by insomnia and does not occur exclusively during the course of another sleep disorder (e.g., narcolepsy, breathing-related sleep disorder, circadian rhythm sleep disorder, or a parasomnia) (American Psychiatric Association, 2014).
It cannot be accounted for by an inadequate amount of sleep.
The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (American Psychiatric Association, 2014).
Psychotherapy and Pharmacological Interventions
The recommended treatment for Hypersomnolence depends on the symptoms that are experienced. Medications such as stimulants such as dose controlled amphetamines are often used in the pharmacological treatment plan of this disorder. Some examples include d-amphetamine, methylphenidate (an ingredient in brand names, Ritalin and Concerta) and modafinil (Medina, 2018). Other drugs used to treat Hypersomnolence include clonidine, levodopa, bromocriptine, activating antidepressants, and monoamine oxidase inhibitors (Medina, 2018). Antidepressants, such as fluoxetine (Prozac), citalopram (Celexa), paroxetine (Paxil), sertraline (Zoloft) Sodium oxybate (Xyrem) is used to treat excessive daytime sleepiness associated with narcolepsy (American Psychiatric Association, 2014).
Evidence based practice has shown that stimulants help the individual by sustaining a higher alertness from day to day activities and different functional settings (Medina, 2018). Psychotherapy behavioral techniques that are used with this disorder include learned behaviors such as avoiding late night work or activities (Medina, 2018). Alcohol and caffeine should also be avoided close to bedtime in individuals who suffer from this disorder (Medina, 2018).
When to Refer to a Specialist
As a future PMHNP it is essential to know when a patient should be referred to a physician who specializes in sleep medicine. A decision on referral of a patient with Hypersomnolence will depend on the experience, subspecialty training, and comfort level of the practitioner, as well as local availability of appropriate specialists. When the signs and symptoms have not been resolved and are becoming a safety issues, such as operating a care and also decrease in social, everyday functioning the patient should be referred out to a sleep specialist (Bodkin & Machanda, 2011). The sleep medicine physician often directs treatment efforts as well as needed when different procedures and studies are tested such as a sleep study.
American Psychiatric Association. (2014). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Revised.
Bodkin CL, Manchanda (2011). Office evaluation of the “tired” or “sleepy” patient. Semin Neurol ; 31:42.
Medina, J. (2018). Treatments for Hypersomnolence. Psych Central. Retrieved on January 23, 2019, from https://psychcentral.com/disorders/treatments-for-hypersomnolence
Young (2004) Epidemiology of daytime sleepiness: definitions, symptomatology, and prevalence. J Clin Psychiatry; 65 Suppl 16:12.