Clinical and psychological aspects of hypersomnia and narcolepsy

Hypersomnias (hypersomnolence) are a group of neurological diseases with the main manifestations in the form of pathological daytime sleepiness and/or excessive need for sleep. Most sleep disorders are also accompanied by increased sleepiness during the day, which requires differential diagnosis of various causes of hypersomnia and identification of central hypersomnolence, which are rare diseases. There are difficulties both with the determination of the pathology of drowsiness and the subjective assessment of the duration of sleep. High sleepiness disrupts daytime functioning and reduces performance, the ability to drive a car, and can cause accidents and injuries. Hypersomnia is often comorbid with psychiatric disorders such as bipolar disorder, depression, and seasonal affective disorder. Depressive thoughts, aggressiveness, as well as comorbidity of hypersomnia with hysterical personality disorder are noted. Clinical and psychological aspects of hypersomnia at this stage have not been studied enough. The presented psychological consequences, as a rule, were described from the point of view of doctors’ observation of the behavior of patients, while a targeted study of the psychological characteristics of the personality of patients in most cases was not carried out. In the framework of future research, it seems relevant to study the clinical and psychological characteristics of patients with various forms of hypersomnia and to determine the targets of psychocorrectional work.

1. Sateia MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest. 2014;146(5):1387–1394. DOI: 10.1378/chest.14-0970.

2. Kalinkin AL. Prevalence of the excessive daytime sleepiness in Russian Federation. Nervno-myshechnye bolezni = Neuromuscular Diseases 2018;8(4):43–8. In Russian [Калинкин А.Л. Распространенность избыточной дневной сонливости в Российской Федерации. Нервно-мышечные болезни. 2018;8(4):43–8]. DOI: 10.17650/2222-8721-2018-8-4-43-48.

3. Bochkarev MV, Korostovtseva LS, Filchenko IA, et al. Social-demographic aspects of insomnia in the Russian population according to ESSE-RF study. Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova. 2018;118(4–2):26–34. In Russian DOI: 10.17116/jnevro20181184226.

4. Mahoney CE, Cogswell A, Koralnik I, et al. The neurobiological basis of narcolepsy. Nature reviews. Neuroscience. 2019: 20 (2): 83–93. DOI: 10.1038/s41583018-0097-x.

5. Miner B, Gill TM, Yaggi HK, et al. The Epidemiology of Patient-Reported Hypersomnia in Persons with Advanced Age. Journal of the American Geriatrics Society. 2019; 67(12):2545–2552. DOI: 10.1111/jgs.16107.

6. American Academy of Sleep Medicine. International classification of sleep disorders. 3rd ed.: Diagnostic and coding manual. Chicago, Illinois: American Academy of Sleep Medicine. 2014.

7. Ranjith KM, Manjari T, Biswaroop C, et al. Sleep Abnormalities and Polysomnography profile in children with drug-resistant epilepsy, Seizure. 2020; 82: 59–64. DOI: 10.1016/j.seizure.2020.09.016.

8. Laura B, Alice N, Giovanna V, et al. Impact of sleep disorders on the risk of seizure recurrence in juvenile myoclonic epilepsy. Epilepsy & Behavior. 2018; 80: 21–24. DOI: 10.1016/j.yebeh.2017.11.023.

9. Tandberg E, Larsen JP, Karlsen K. Excessive daytime sleepiness and sleep benefi in Parkinson’s disease: A community-based study. Mov. Disord. 1999 Nov; 14 (6): 922–927. DOI: 10.1002/1531-8257(199911)14:6<922::aidmds1003>3.0.co;2-7.

10. Nodel MR, Yahno NN, Ukrainceva UV. Hypersomnia in Parkinson’s disease. Nevrologicheskiy zhurnal. 2014;19(6): 9–16. In Russian

11. DGSM. S3-Leitlinie. Somnologie Schlafforsch und Schlafmedizin. 2009; 13 (S1):1–160.

12. Lammers GJ, Bassetti CLA, Dolenc-Groselj L, et al. Diagnosis of central disorders of hypersomnolence: A reappraisal by European experts. Sleep Med Rev. 2020; 52:101306. DOI:10.1016/j.smrv.2020.101306.

13. Ruoff C, Rye D. The ICSD-3 and DSM-5 guidelines for diagnosing narcolepsy: clinical relevance and practicality. Curr Med Res Opin. 2016;32:1–12. DOI: 10.1080/03007995.2016.1208643.

14. Loktionova AI, Muhamedzyanova RI, Shishkina AI et al. Hypersomnia: problems of diagnosis. Astrahanskij medicinskij zhurnal. 6(2)2011. P. 205–208. In Russian

15. Strygin KN. Contemporary Classification of Hypersomnias: its Diagnosis and Treatment. Effektivnaya farmakoterapia. 2015; 53: 64–71. In Russian

16. Trishin LS. Gipersomnia kak bolezni I yeyo kliniko-psihologucheskaya harakteristika. Voennaya medicina. 2009: 2(11): 30–33. In Russian http://rep.bsmu.by/handle/BSMU/5612

17. Bollu PC, Manjamalai S, Thakkar M, et al. Hypersomnia. Missouri medicine. 2018; 115(1): 85–91. PMID: 30228690

18. Murer T, Imbach LL, Hackius M, et al. Optimizing MSLT specificity in narcolepsy with cataplexy. Sleep. 2017; 40(12). DOI: 10.1093/sleep/zsx173.

19. Kritikou I, Vgontzas AN, Rapp MA, et al. Anti-Ma1and Anti-Ma2-associated encephalitis manifesting with rapid eye movement sleep disorder and narcolepsy with cataplexy: a case report. Biol Psychiatry. 2018;83:e39–e40. DOI: 10.1016/j.biopsych.2016.12.014.

20. Billiard M, Sonka K. Idiopathic hypersomnia. Sleep Med Rev. 2016;29:23–33. DOI: 10.1016/j.smrv.2015.08.007.

21. Coelho FMS, Pradella-Hallinan M, Predazzoli Neto M, et al. Prevalence of the HLA-DQB1*0602 allele in narcolepsy and idiopathic hypersomnia patients seen at a sleep disorders outpatient unit in São Paulo. Rev Bras Psiquiatr. 2009;31:10–14. DOI: 10.1590/s151644462009000100004.

22. Liblau RS, Vassalli A, Seifinejad A, et al. Hypocretin (orexin) biology and the pathophysiology of narcolepsy with cataplexy. Lancet Neurol. 2015;14:318–328. DOI: 10.1016/S1474-4422(14)70218-2.

23. Mayer G, Benes H, Young P, et al. Modafinil in the treatment of idiopathic hypersomnia without long sleep time — a randomized, double-blind, placebo-controlled study. J Sleep Res. 2015;24:74–81. DOI: 10.1111/jsr.12201.

24. Rocca FL, Finotti E, Pizza F, et al. Psychosocial Profile and Quality of Life in Children with Type 1 Narcolepsy: A Case-Control Study. Sleep. 2016; 39(7): 1389– 1398. DOI: 10.5665/sleep.5970.

25. Pancheri C, Verdolini N, Pacchiarotti I, et al. A systematic review on sleep alterations anticipating the onset of bipolar disorder. European Psychiatry. 2019; 58: 45–53. DOI: 10.1016/j.eurpsy.2019.02.003.

26. Chiang H-L, Shur-Fen Gau S, Ni H-C, et al. Association between symptoms and subtypes of attention-deficit hyperactivity disorder and sleep problems/ disorders. 2010; 19(4): 535–545. DOI:10.1111/j.13652869.2010.00832.x.

27. Walters AS, Zucconi M, Chandrashekariah R, et al. Review of the possible relationship and hypothetical links between attention defi hyperactivity disorder (ADHD) and the simple sleep related movement disorders, parasomnias, hypersomnias, and circadian rhythm disorders. J. Clin. Sleep Med., 2008, 4: 591– 600. PMID: 19110891.

28. Neikrug AB, Crawford MR, Ong JC. Behavioral sleep medicine Services for Hypersomnia Disorders: A survey study. Behavioral Sleep Medicine. 2017; 15(2), 158–171. DOI: 10.1080/15402002.2015.1120201.

29. Ozaki A, Inoue Y, Hayashida K, et al. Quality of life in patients with narcolepsy with cataplexy, narcolepsy without cataplexy, and idiopathic hypersomnia without long sleep time: Comparison between patients on psychostimulants, drug-naive patients and the general Japanese population. Sleep Medicine. 2012; 13(2), 200–206. DOI: 10.1016/j.sleep.2011.07.014.

30. Ong JC, Fox RS, Brower RF, et al. How does narcolepsy impact health-related quality of life? A mixedmethods study. Behavioral Sleep Medicine. 2020; 1–14. DOI: 10.1080/15402002.2020.1715411.

31. Massie J. Medical conditions revealed in fairy tales, folklore and literature. J Paediatr Child Health. 2019 Nov;55(11):1295–1298. DOI: 10.1111/jpc.14615.

32. Kales A, Soldatos CR, Bixler EO, et al. Narcolepsy-cataplexy. II. Psychosocial consequences and associated psychopathology. Archives of Neurology. 1982; 39(3): 169–171. DOI: 10.1001/archneur.1982.00510150039009.

33. Ford DE, Kamerow DB. Epidemiologic study of sleep disturbances and psychiatric disorders. An opportunity for prevention? JAMA. 1989; 262(11), 1479–1484. DOI: 10.1001/jama.262.11.1479.

34. Ohayon MM. Narcolepsy is complicated by high medical and psychiatric comorbidities: A comparison with the general population. Sleep Medicine. 2013; 14(6), 488–492. DOI: 10.1016/j.sleep.2013.03.002.

35. Baglioni C, Battagliese G, Feige B, et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord. 2011; 135(1–3):10–9. DOI: 10.1016/j.jad.2011.01.011.

36. Grigolon RB, Trevizol AP, Cerqueira RO, et al. Hypersomnia and bipolar disorder: A systematic review and meta-analysis of proportion. Journal of affective disorders. 2019; 246: 659–666. DOI: 10.1016/j.jad.2018.12.030.

37. Franklin JC, Ribeiro JD, Fox KR, et al. Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychol Bull. 2017; 143(2):187–232. DOI: 10.1037/bul0000084.

38. Black J, Reaven NL, Funk SE, et al. The burden of narcolepsy disease (BOND) study: Health-care utilization and cost findings. 2014; Sleep Medicine. 15(5): 522–529. doi.org/10.1016/j.sleep.2014.02.001.

39. Kollar B, Siarnik P, Valovičová K, et al. Mood disorders in patients with hypersomnia: comparison of sleep-related breathing disorders versus narcolepsy. Neuro Endocrinol Lett. 2021; 42(6):395–402. PMID: 34713691.

40. Dauvilliers Y, Paquereau J, Bastuji H, et al. Psychological health in central hypersomnias: The French harmony study. Journal of Neurology, Neurosurgery, and Psychiatry. 2009; 80(6), 636–641. https://doi. org/10.1136/jnnp.2008.161588.

41. Littlewood D, Kyle SD, Pratt D, et al. Examining the role of psychological factors in the relationship between sleep problems and suicide. Clin Psychol Rev. 2017; 54:1–16. DOI: 10.1016/j.cpr.2017.03.009.

42. Ong JC, Schuiling MD. CBT-I for patients with hypersomnia disorders. Adapting Cognitive Behavioral Therapy for Insomnia. Academic Press. 2022; 115–133. doi.org/10.1016/B978-0-12-822872-2.00018-9.

43. Ong JC, Dawson SC, Mundt JM, et al. Developing a cognitive behavioral therapy for hypersomnia using telehealth: a feasibility study. J Clin Sleep Med. 2020; 16(12):2047–2062. DOI: 10.5664/jcsm.8750.

44. Tsai CW, Tai Y-M, Yang S-N. Suicidal Ideation, Quality of Life, and Psychometric Outcomes in Taiwanese Military Personnel with Subjective Hypersomnia or Insomnia. Taiwanese Journal of Psychiatry. 2020; 34 (4): 162. DOI: 10.4103/TPSY.TPSY_34_20