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Treating Excessive Daytime Sleepiness in Patients With Narcolepsy
Individuals with narcolepsy may experience not only academic, social, and occupational consequences but also dangerous driving or other accidents, meaning that effective treatment is critical. Here, review the evidence on treatment strategies.
Abstract
Excessive daytime sleepiness (EDS) is a hallmark symptom of narcolepsy. The second major symptom, cataplexy, is present only in a subgroup of patients with narcolepsy. Fortunately, existing pharmacologic interventions are effective in reducing EDS for many patients, but elimination of EDS for most patients has not been achieved. Some interventions also show efficacy in cataplexy. Nonpharmacologic strategies should also be discussed with patients to provide optimal narcolepsy management. Clinicians must monitor EDS during ongoing treatment so that residual symptoms can be addressed with adjustment to the regimen. Research suggests a causative role for hypocretin deficiency in narcolepsy, and treatments ameliorating this deficiency are needed.
From the Series: Recognizing and Treating Excessive Daytime Sleepiness in Patients with Narcolepsy
To cite: Roth T. Treating EDS in patients with narcolepsy. J Clin Psychiatry. 2020;81(5):HB19045BR2C.
To share: https://doi.org/10.4088/JCP.HB19045BR2C
© Copyright 2020 Physicians Postgraduate Press, Inc.
Target Audience
Psychiatrists and other health care providers
Learning Objectives
- Select evidence-based treatments for narcolepsy
- Monitor residual EDS in patients being treated for narcolepsy
Support Statement
Supported by an educational grant from Harmony Biosciences, LLC.
Learning Objectives
After completing this educational activity, you should be able to:
- Select evidence-based treatments for narcolepsy
- Monitor residual EDS in patients being treated for narcolepsy
Release, Review, and Expiration Dates
This brief report activity was published in August 2020 and is eligible for AMA PRA Category 1 Credit™ through August 31, 2022. The latest review of this material was August 2020.
Statement of Need and Purpose
Sleep disorders such as narcolepsy can cause excessive daytime sleepiness (EDS). However, the diagnosis of narcolepsy is often delayed by years. Clinicians report that they lack knowledge about sleep disorders in general, and narcolepsy in particular, and they may not ask patients about sleep or document sleep histories. Therefore, increased awareness of the impact of EDS and narcolepsy is needed, as well as education on talking about sleep with patients and using tools to improve screening for and diagnosis of sleep disorders. Clinicians have also reported a lack of knowledge about treating sleep disorders such as narcolepsy. For patients who do receive treatment, many struggle with residual symptoms that affect work and daily living. Multiple types of health care providers need education to select pharmacologic and nonpharmacologic treatment for narcolepsy and to monitor for problems such as residual EDS. Clinicians also need education about the current understanding of the pathogenesis of narcolepsy and about emerging therapies. This activity was designed to meet the needs of participants in CME activities provided by the CME Institute of Physicians Postgraduate Press, Inc., who have requested information on narcolepsy.
Disclosure of Off-Label Usage
Dr Roth has determined that, to the best of his knowledge, caffeine, selegiline, and YNT-185 are not approved by the US Food and Drug Administration for the treatment of narcolepsy.
Review Process
The faculty member agreed to provide a balanced and evidence-based presentation and discussed the topics and CME objectives during the planning sessions. The faculty’s submitted content was validated by CME Institute staff, and the activity was evaluated for accuracy, use of evidence, and fair balance by the Chair and a peer reviewer who is without conflict of interest.
Acknowledgment
This activity is derived from the teleconference series “Recognizing and Treating Excessive Daytime Sleepiness in Patients With Narcolepsy,” which was held in February and April 2020 and supported by an educational grant from Harmony Biosciences, LLC. The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the commercial supporter.
Faculty Affiliation
Thomas Roth, PhD
Henry Ford Hospital Sleep Center and Department of Psychiatry, Wayne State University School of Medicine, Detroit, and Department of Psychiatry, University of Michigan College of Medicine, Ann Arbor
Financial Disclosure
The faculty for this CME activity and the CME Institute staff were asked to complete a statement regarding all relevant personal and financial relationships between themselves or their spouse/partner and any commercial interest. The Accreditation Council for Continuing Medical Education (ACCME) defines a commercial interest as any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The ACCME defines relevant financial relationships as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. The CME Institute has resolved any conflicts of interest that were identified. No member of the CME Institute staff reported any relevant personal financial relationships. Faculty financial disclosure is as follows:
Dr Roth is a consultant for and has received honoraria from Merck, Idorsia, Eisai, Alarion, Takeda, Jazz, Click Therapeutics, and Avadel.
Accreditation Statement
The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
Credit Designation
The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Note: The American Nurses Credentialing Center (ANCC) and the American Academy of Physician Assistants (AAPA) accept certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the ACCME.
MOC Approval Statement
Through the American Board of Medical Specialties (“ABMS”) ongoing commitment to increase access to practice relevant Continuing Certification Activities through the ABMS Continuing Certification Directory, Treating Excessive Daytime Sleepiness in Patients With Narcolepsy has met the requirements as a MOC Part II CME Activity (apply toward general CME requirement) for the following ABMS Member Boards:
MOC Part II CME Activity
Psychiatry and Neurology
Available Credit
- 0.50 AMA PRA Category 1 Credit™
- 0.50 Participation