Novel Treatments for Patients with Excessive Daytime Sleepiness and Associated Sleep Disorders: Clinical Considerations for Patients with Co-Morbid Psychiatric Conditions

Excessive daytime sleepiness, or EDS substantially impacts individuals with psychiatric disorders, leading to heightened disability and mortality rates compared to the general population. In particular, patients with psychiatric disorders, especially those with major depressive disorder, or MDD, report remarkably high rates of EDS and related sleep disorders—patients often suffer more severe depressive episodes as a result. Unfortunately, many psychiatry and mental health clinicians struggle to understand the relationship between sleep and psychiatric disorders. Additionally, the underlying etiologies associated with EDS are often unrecognized by psychiatrists, and symptoms tend to overlap with common psychiatric disorders, leading to misdiagnoses and inappropriately prescribed psychotropic medications that do not address the primary cause(s) of the disorders. While pharmacologic agents have emerged for the effective management of EDS and associated conditions, these agents may have distinct clinical repercussions for patients with psychiatric disorders. Conversely, pharmaceuticals for the treatment of psychiatric disorders may negatively impact patients with EDS and complicate diagnosis. Thus, psychiatrists and allied mental healthcare professionals require education to identify, appropriately classify, and manage EDS within psychiatric populations in order to improve patient outcomes. This educational curriculum was designed to address learning objectives on EDS and associated sleep disorder identification and treatment. After participating in the education, clinician learners were expected to be able to • Describe the prevalence and impact of EDS and the burden that it places on patients suffering from psychiatric disorders; • Incorporate clinical strategies and diagnostic tools for the identification and assessment of EDS in patients with psychiatric disorders; • Develop an evidence-based strategy to manage EDS in the context of psychiatric practice utilizing general medical, cognitive/behavioral, and pharmacological techniques; and • And evaluate the safety and efficacy of current and emerging pharmacologic agents for the treatment of EDS, particularly in patients with psychiatric disorders. Throughout the curriculum, significant increases were demonstrated across survey questions designed to assess knowledge and competence in clinician behavior and practice.Nearly every surveyed learner indicated that these activities increased their knowledge on the topic of EDS and associated sleep disorders and noted that the activities increased their confidence. In particular, learners increased their knowledge on the safety and efficacy of current and emerging pharmacologic agents for the treatment of EDS. Learners were also able to better identify the prevalence and impact of EDS and the burden that it places on patients suffering from psychiatric disorders. Learners also provided insight into what their intended changes to practice would be following the education, including routinely initiating discussions about sleep issues in patients with psychiatric disorders, attempting to determine the root cause(s) of a given sleep disorder associated with a patient’s symptoms of EDS, utilizing validated screening tools to assess EDS symptoms; integrating non-pharmacological sleep disorder management strategies into practice, monitoring the effects of various treatments for EDS on comorbid psychiatric disorders and other potential side effects, and implementing pharmacologic management to treat EDS associated with central disorders of hypersomnolence. Overall, the most significant ongoing barriers to the optimal management of EDS in the context of psychiatric practice include unrecognized underlying EDS etiologies, symptom overlap with common psychiatric disorders, and limited knowledge of newer pharmacologic agents for the management of EDS. Prior to education, learners displayed very low levels of knowledge regarding the prevalence of sleep difficulty in patients with psychiatric disorders, as well knowledge regarding pharmaceutical agents for the management of EDS. However, further education on this topic is likely warranted.