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Respond  to your  colleagues by comparing the differential diagnostic features of the  disorder you were assigned to the diagnostic features of the disorder  your colleagues were assigned.   

NOTE: Positive comment (bellow is attached the sleep disorder assigned to me)

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Treatment of Sleep/Wake Disorders

Narcolepsy  is a chronic sleep disorder categorized by overwhelming daytime  drowsiness and sudden attacks of sleep. Individuals with narcolepsy  often find it challenging to stay awake for long periods. At times  narcolepsy can be accompanied by a hurried muscle tone (cataplexy)  triggered by strong emotion. Narcolepsy that happens with cataplexy is  known as type one narcolepsy, and without cataplexy is called type two.  The average sleep process starts with a phase called non-rapid eye  movement (NREM) sleep, where a person’s brain waves slow considerably.  An hour or so of NREM sleep, an individual’s brain activity changes, and  rapid eye movement sleep begins. In narcolepsy, a person can suddenly  go into rapid eye movement without first experiencing non-rapid eye  movement sleep. The cause of narcolepsy is unknown; however, individuals  with type one narcolepsy have low levels of the chemical hypocretin, a  neurochemical in the brain that helps regulate wakefulness and rapid eye  movement sleep. Narcolepsy starts in an individual between 10and 30  years old and has no cure. However, a psychiatric mental health nurse  practitioner can help the individual manage the symptoms (Sadock et al., 2014).

Diagnostic Criteria for Narcolepsy

Recurrent  periods of uncontainable sleep lasting or napping happening within the  same day at least three times per week over the last three months. The  presence of at least one of the following: people with long-standing  disease brief (seconds to minutes) episodes of sudden bilateral loss of  muscle tone with sustained consciousness that are triggered by joking or  laughter. Hypocretin deficiency, as measured by cerebrospinal fluid  hypocretin -1 immunoreactivity values of less than or equal to 110  pg/ml, must not be due to brain injury, inflammation, or infection.  Nocturnal sleep polysomnography revealing rapid eye movement sleep  latency less than or equal to 15 minutes (American Psychiatric Association, 2013).

Psychotherapy Treatment

In  combination with pharmacology treatments, various behavioral approaches  are also frequently recommended by psychiatric mental health nurse  practitioners for narcolepsy symptom management. Cognitive-behavioral  therapy for narcolepsy has increasingly been identified as a crucial  supplement for treatment. Cognitive-behavioral therapy focuses on  managing clients’ behaviors with narcolepsy, such as sticking to  medication regimens and engaging in acceptable nocturnal sleep hygiene  practices. Providing relevant education is vital, especially when  clients are first diagnosed with narcolepsy for effective symptom  management and treatment. Establishing good sleep hygiene is a powerful  approach that is key in successfully managing symptoms. Sleep hygiene  includes reoccurring habits and behaviors that contribute to a high  quality of sleep. Naps ranging from 15 to 20 minutes scheduled about two  to three times a day are particularly useful in treating excessive  daytime sleepiness and improving alertness. A sleep diary is another  beneficial tool when treating and diagnosing narcolepsy (Bhattarai

& Sumerall, 2017).

Psychopharmacologic Treatment

Current  medications have been developed to target symptoms, yet most  individuals continue to experience the adverse effects of their symptoms  despite receiving standard treatment. Stimulants, such as  amphetamines/dextroamphetamine and methylphenidate, are the conventional  medications prescribed for symptom indication, particularly excessive  daytime sleepiness. Modafinil and armodafinil are not as addictive as  older stimulants and do not produce the highs and lows often associated  with older stimulants. Side effects are headache, nausea, or anxiety.  Sodium oxybate is a more recent medication effective in treating  narcolepsy. It is the only medication effective and recommended by the  Food and Drug Administration (FDA) to treat cataplexy and excessive  daytime sleepiness. The FDA does not approve antidepressants for  narcolepsy treatment, and further testing is required to determine their  efficacy in treating cataplexy. However, practitioners commonly  prescribe antidepressants due to their clinical effectiveness. More  specifically, an antidepressant that inhibits norepinephrine reuptake  (SNRIs), such as venlafaxine, has been reported as effective in treating  cataplexy (Bhattarai & Sumerall, 2017).

Additional Referral

After  an initial diagnosis, the psychiatric mental health nurse practitioner  refers the client to a sleep specialist for further evaluation. Formal  diagnosis demands staying overnight at a sleep center for an in-depth  sleep analysis by the sleep specialist. Polysomnography measures a  variety of signals during sleep using electrodes placed on the scalp.  For this test, a person must spend a night at a medical facility. The  test measures the electrical activity of the individual’s brain and  heart and his or her muscle’s movement. It also monitors breathing (Mayo  Clinic, 2020).

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders 

(5th ed.). Washington, DC

Bhattarai, J., & Sumerall, S. (2017). Current and Future Treatment Options for Narcolepsy: A 

Review. Sleep Science (Sao Paulo, Brazil)10(1), 19–27. https://doi-org.ezp.waldenulibrary.org/10.5935/1984-0063.20170004

Mayo Clinic. (2020, November 6). Narcolepsy.

https://www.mayoclinic.org/diseases-conditions/narcolepsy/diagnosis-treatment/drc-20375503

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: 

Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia, PA

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