David Gregory is a 78-year-old male who presents with excessive daytime sleepiness (EDS) for the past year.
He shares with you, “I experience sudden onset of sleepiness without any preceding tiredness. I could be reading the newspaper, working on the computer, watching television, talking on the phone, and suddenly feel drowsy and more often than not I just fall asleep. In order to stay awake, I’m engaging in various activities like painting walls at home, exercising, or dancing. This happens even when I am driving and so I listen to loud music in the car.
“I started having what I think are cataplexy attacks two months ago. I looked this up on the internet. The frequency of cataplexy episodes varied depending on my emotional state and ranged between five a day to more than fifteen in five minutes. These episodes commonly happen while I am watching emotionally laden television shows and are triggered by sharing jokes, anger, unexpectedly meeting a relative, being the center of attention, or when excited… like during football games. They last for five to six seconds on average, with a maximum duration of around 20 seconds. During such episodes, my face and shoulders droop, I appear emotionless, and become immobile with a sense of weakness in my legs. I can’t resist a cataplexy attack once it starts but I learned to prevent it by avoiding emotional situations.
“I also have visual hallucinations where I see snakes while awakening from sleep; however, I do not have sleep paralysis. Although I do not have any difficulty initiating sleep, I wake up several times through the night.”
His past medical history included a few episodes of generalized seizures, each lasting for seconds. They were associated with fever at eight years of age, which is suggestive of febrile seizures. He does not have any history of head injury nor does he report flu-like illness, immunization, sleep apnea, or restless legs syndrome. He does not have any history of current or previous substance abuse and does not report any recent life stressors.
Questions
From your perspective as David’s psychiatric nurse practitioner, answer the following questions in a two page double-spaced paper (not including the reference and tittle page) and in APA format. Include at least three peer-reviewed, evidence-based references.
1-What scale or screening tool would be most appropriate for David?
2-What diagnosis would you give David and what are some differential diagnoses?
3-What medication would you start him on? Please include the starting dose and medication education instructions for this David.
4-What non-pharmacological treatments would you recommend and why?
5-What referrals would you make for David?