Central disorders of hypersomnolence: a quick guide to evidence for the treating clinician

Central Disorders of Hypersomnolence (CDH) are conditions whose primary clinical characteristic is excessive sleepiness during waking hours, despite the main sleep period comprising adequate opportunity and duration of sleep. This excessive sleepiness is objectively demonstrated during daytime sleep studies, with rapid sleep onset, and other specific findings that differentiate each of the CDH focussed on in this review: Narcolepsy Type 1 and 2, and Idiopathic Hypersomnia. Historically conceptualised as psychosomatic conversion of psychological distress, modern understandings of CDH are that they are neurological conditions which intersect with the psychological, occupational and social contexts of the individual. While medications are commonly utilised for CDH, treatment response is often incomplete, and some patients are contraindicated or cannot tolerate side-effects. As such, the role of the psychologist in multidisciplinary management of CDH has burgeoned. This brief guide to evidence summarises current treatment/management approaches of CDH from a psychological perspective including napping/sleep scheduling, Cognitive Behaviour Therapy for Hypersomnia (CBT-H) and mindfulness-based interventions. In addition to covering the primary psychological interventions for excessive daytime sleepiness itself, this article discusses beneficial interventions for common ancillary symptoms of CDH, including Meditation-Relaxation therapy for sleep paralysis, and Imagery Rescripting Therapy (IRT) for nightmares.