P10#1 AND P10#2

Marianne Alfaro 

COLLAPSE

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Week 10: Hypersomnolence Disorder

 

            Hypersomnolence is asleep/wake disorder characterized by severe daytime sleepiness, which is present despite normal quality and timing of nocturnal sleep(Khan, 2015). According to the DSM-5 the diagnostic criteria is :

A. Self-reported excessive sleepiness (hypersomnolence) despite a main sleep period lasting at least 7 hours, with at least one of the following symptoms:

1-Recurrent periods of sleep or lapses into sleep within the same day.

2-A prolonged main sleep episode of more than 9 hours per day that is nonrestorative (i.e., unrefreshing).

3-Difficulty being fully awake after abrupt awakening.

B. The hypersomnolence occurs at least three times per week, for at least 3 months.

 

C. The hypersomnolence is accompanied by significant distress or impairment in cognitive, social, occupational, or other important areas of functioning.

D. The hypersomnolence is not better explained by and does not occur exclusively during the course of another sleep disorder (e.g., narcolepsy, breathing-related sleep disorder, circadian rhythm sleep-wake disorder, or a parasomnia).

F. Coexisting mental and medical disorders do not adequately explain the predominant complaint of hypersomnolence.

E. The hypersomnolence is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication)(American Psychiatric Association, 2013).

Pharmacological and psychotherapy Treatments 

            Behavior modifications such as scheduled napping can be an effective therapeutic approach before starting long-term medication regimen(Khan, 2015). Life-long therapy is the norm and involves initiating treatment usually with modafinil, armodafinil, or sodium oxybate, with methylphenidate, amphetamine-like stimulants, atomoxetine, or antidepressants used as second-line therapy(Khan, 2015). Pharmacologic therapy is usually done in concert with behavioral modifications (Cleare, et al., 2015).There is no effective cure for hypersomnia, and symptom treatment is current therapy methods. Although, behavioral approaches and sleep hygiene techniques are recommended, they have little overall positive impact on this disease(Khan, 2015).

Referrals

            Referring the patient to PCP would be appropriate when the hypersomnolence is due to a

medical condition not related to psychiatric condition. Because many neurologic disorders are associated with insomnia, either as a result of dysfunction in central nervous system pathways that regulate sleep or as a consequence of pain, immobility, or respiratory dysfunction collaboration is important(Cleare, et al., 2015).

 

 

Reference

 

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

 

Cleare, A., Pariante, C., Young, A.(2015).Evidence-based guidelines for treating   depressive       disorders with antidepressants: A revision of the 2008 British Association for   Psychopharmacology guidelines. Journal of Psychopharmacology. 29(5):459-525.             doi: 10.1177/0269881115581093

 

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

 

Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.