Table 6.
Therapeutic strategies for excessive daytime sleepiness with increased sleep need in adolescents.
| Causes | Therapeutic strategies | Approved interventions for adolescents | |
|---|---|---|---|
| Central hypersomnia | Narcolepsy with severe excessive daytime sleepiness | • First-line treatments: Psychostimulant medications | Yes (only for modafinil in adolescents aged over 16 years) |
| • Alternative treatment: Sodium oxybate | Yes (only in adolescents aged over 16 years) | ||
| • Complementary treatments: Adequate sleep hygiene and programmed naps | Yes | ||
| Narcolepsy with moderate excessive daytime sleepiness | • First-line treatment: Sodium oxybate | Yes (only in adolescents aged over 16 years) | |
| • Alternative treatments: Psychostimulant medications | Yes (only for modafinil in adolescents aged over 16 years) | ||
| • Complementary treatments: Adequate sleep hygiene and programmed naps | Yes | ||
| Narcolepsy with refractory excessive daytime sleepiness | • First-line treatment: Pitolisant | No (off-label prescription) | |
| • Complementary treatments: Adequate sleep hygiene and programmed naps | Yes | ||
| Idiopathic hypersomnia | • First-line treatments: Psychostimulant medications | No (off-label prescription) | |
| Recurrent hypersomnia | Kleine-Levin syndrome | • Acute episodes: Psychostimulant medications or amantadine | No (off-label prescription) |
| • Prevention of relapses: prolonged-release lithium or valproic acid | No (off-label prescription) | ||
| • Complementary treatments: Consistent sleep-wake schedules, avoidance of alcohol, absence of contact with infectious individuals and home surveillance | Yes | ||
| Mild depression | • First-line treatment: Cognitive-behavioral or interpersonal psychotherapy | Yes | |
| Moderate to severe depression | • First-line treatment: Psychotherapy combined to fluoxetine | Yes | |
| Resistant depression | • Specialized psychiatric consultations for adolescents with resistant depression | Yes | |
| Menstrual-associated | • First-line treatment: Hormone therapy | No (off-label prescription) | |
| Use of sedative medications | • Adjustment of the dosage if necessary | Yes | |
| Misuse of sedative medications/drugs | Individual measures | • Cognitive-behavioural therapy and/or motivational interviewing | Yes |
| • Management of psychiatric co-morbidities | |||
| Family measures | • Family therapy | Yes | |
| Hypersomnia secondary to other disorders | • Establishment of targeted management for these specific aetiologies | Yes |