Systematic Evaluation of Excessive Daytime Sleepiness Suggested to Uncover Comorbidities

Mental health clinicians treating patients with excessive daytime sleepiness (EDS) should perform a systematic evaluation to uncover comorbid sleep disorders that may be treated directly, according to a recent session presented at Psych Congress Elevate.

Karl Doghramji, MD, Thomas Jefferson University, Philadelphia, Pennsylvania, suggests patients with EDS may be experiencing or appear to be experiencing comorbid disorders. It is essential to treat them for the proper disorder. Excessive sleepiness, hypersomnia, and fatigue are commonly encountered in psychiatric disorders and are associated with significant impairment.

“What looked like a depression now you see turns out to be narcolepsy because sleepiness can often mimic affective instability and affective decline,” said Dr Doghrami when describing a recent patient to virtual attendees. “[It is] very difficult to separate these 2 from one another, but important to do so, because we need to treat these patients for the proper disorder.”

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Also, patients can appear to be depressed but be experiencing sleep apnea, said Dr Dogrami who is also the Medical Director at the Jefferson Sleep Disorders Center, Philadelphia, Pennsylvania. Sleep apnea causes similar symptoms such as memory impairment, decreased libido, refractory hypertension, among others.

“Treatment of sleep apnea is important, but sometimes these patients remain sleepy, so we need to also treat comorbid disorders that may cause sleepiness.”

If a patient has been appropriately managed for sleep apnea but remains sleepy without comorbidities that could cause the sleepiness, they are appropriate candidates for pharmacologic management, Dr Dogrami told virtual attendees.

“Novel wake-promoting agents for the treatment of sleepiness are available for narcolepsy as well as sleep apnea, and mental health professionals have an opportunity… to uncover and address sleepiness with the narcolepsy and obstructive sleep apnea in their patients,” Dr Doghrami concluded.

—Meagan Thistle

Reference

Doghramji, K. Management of excessive daytime sleepiness in patients with narcolepsy and psychiatric disorders. Presented at: Psych Congress Elevate; June 11–13, 2021; Virtual.