psychosocial adjunctive treatment for hypersomnia (path)

Conditions: Narcolepsy; Idiopathic Hypersomnia

Summary: current pharmacological treatments for chronic hypersomnia (narcolepsy, idiopathic hypersomnia) can effectively reduce excessive daytime sleepiness but a high proportion of patients experience depressive symptoms and poor health-related quality of life. unfortunately, there are currently no psychosocial interventions that directly addresses this issue. therefore, the overall goal of this project is to gather initial outcome data and work out methodological issues to determine if a future pragmatic clinical trial is warranted.

chronic hypersomnia (ch) is a serious and debilitating condition involving persistent excessive daytime sleepiness (eds) and includes narcolepsy and idiopathic hypersomnia (ih). currently, pharmacotherapy is the only empirically-validated treatment for reducing eds in this patient population but the burden of long-term management and adverse effects of the medication lead to poor health-related quality of life (hrqol) and elevations in depressive symptoms evidence-based psychosocial interventions have been developed in other areas to improve hrqol related to chronic illnesses, such as cancer and chronic pain. these interventions typically involve a package of cognitive and behavioral techniques teaching coping skills (e.g., emotion-focused and problem-focused coping), behavioral management of the chronic illness symptoms (e.g., relaxation for pain management), and other strategies to improve psychosocial functioning (e.g., mindfulness). however, no such interventions have been developed or used for people with ch. therefore, a major research gap exists for an empirically-validated psychosocial intervention which is aimed directly at improving emotional functioning and hrqol for people with ch. the purpose of this project is to develop a cognitive-behavioral treatment for hypersomnia (cbt-h) and conducting a feasibility trial of cbt-h. the specific aims for this project are to: 1) develop and refine a treatment protocol for cbt-h; 2) identify the optimal delivery format of cbt-h; and 3) gather feasibility data on recruitment, retention, and selection criteria for a future clinical trial. the overall significance of this project is to improve the quality of care for people with ch by using a psychosocial intervention with medical management of hypersomnia.

Eligibility criteria:
inclusion criteria: 1. males and females age 18 and older. 2. meets criteria for narcolepsy (type i or ii) or idiopathic hypersomnia (ih). 3. moderate to severe symptoms of depression. 4. established standard care for ch at a sleep clinic. exclusion criteria: 1. hypersomnia not of central origin. 2. current suicidal ideation or intent. 3. uncontrolled medical conditions or physical limitations that require immediate medical treatment that would prevent ability to engage in the treatment protocol. 4. inability to engage in the treatment protocol due to a psychiatric or cognitive issue. 5. untreated moderate-to-severe sleep-related breathing disorder. 6. unable to attend intervention sessions due to accessibility or availability.

Keywords: hypersomnia narcolepsy idiopathic hypersomnia psychosocial cognitive-behavior therapy