Efficacy of Modafinil for Dissociative Identity Disorder with Hypersomnia

We report the case of a 22-year-old female victim of childhood sexual abuse with dissociative identity disorder and hypersomnia who remitted from both clinical conditions with the use of modafinil 400 mg/day. We review the literature supporting the sleep-dissociation theory, where trauma-related memories induce a labile sleep-wake cycle allowing dreamlike mentation to intrude into waking consciousness and precipitate dissociative symptoms. The studies examined here found high correlations between dissociation and unusual sleep experiences. This may explain why in our case report modafinil, a medication with wake-promoting properties, improved both excessive daytime sleepiness and dissociation. Future studies are needed to determine which alterations in the sleep-wake cycle are most associated with dissociative disorders. We suggest a new perspective on the use of medications for comorbid hypersomnia, such as modafinil, in the treatment of dissociation.