Recognizing and Treating Excessive Daytime Sleepiness in Patients With Narcolepsy
Sleep experts Drs Roth and Winkelman explore the differential diagnosis and treatment of narcolepsy in this CME journal activity.
Sleep disorders such as narcolepsy can cause excessive daytime sleepiness (EDS). The diagnosis of narcolepsy is often delayed by years. Clinicians can improve the recognition of EDS and diagnosis of sleep disorders using screening tools such as the Epworth Sleepiness Scale and other tests. By following up with patients who present with EDS and continuing to assess until a cause is found, clinicians can lessen the time to diagnosis and initiate appropriate treatment. 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. Clinicians must monitor EDS during ongoing treatment so that residual symptoms can be addressed. 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, Winkelman JW. Recognizing and treating excessive daytime sleepiness in patients with narcolepsy. J Clin Psychiatry. 2020;81(6):HB19045AH3C.
To share: https://doi.org/10.4088/JCP.HB19045AH3C
© Copyright 2020 Physicians Postgraduate Press, Inc.
Psychiatrists and other health care providers
- Use evidence-driven strategies for diagnosing and treating excessive daytime sleepiness and narcolepsy
Supported by an educational grant from Harmony Biosciences, LLC.
Articles are selected for credit designation based on an assessment of the educational needs of CME participants, with the purpose of providing readers with a curriculum of CME articles on a variety of topics throughout each volume. Activities are planned using a process that links identified needs with desired results.
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This Academic Highlights section of The Journal of Clinical Psychiatry presents the highlights of the teleconference series “Recognizing and Treating Excessive Daytime Sleepiness in Patients With Narcolepsy,” which was held in February and April 2020. This report was prepared and independently developed by the CME Institute of Physicians Postgraduate Press, Inc., and was supported by an educational grant from Harmony Biosciences, LLC.
The teleconference was chaired by 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. The faculty was John W. Winkelman, MD, PhD, Sleep Disorders Clinical Research Program and Departments of Psychiatry and Neurology, Massachusetts General Hospital; and Department of Psychiatry, Harvard Medical School, Boston.
After studying this article, you should be able to:
• Use evidence-driven strategies for diagnosing and treating excessive daytime sleepiness and narcolepsy
Release, Expiration, and Review Dates
This educational activity was published in November 2020 and is eligible for AMA PRA Category 1 Credit™ through December 31, 2022. The latest review of this material was November 2020.
The faculty members 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.
The opinions expressed herein are those of the faculty and do not necessarily reflect the opinions of the CME provider and publisher or the supporter.
Disclosure of off-label usage
To the best of their knowledge, the authors have determined that caffeine and selegiline are not approved by the US Food and Drug Administration for the treatment of narcolepsy.
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
John W. Winkelman, MD, PhD
Sleep Disorders Clinical Research Program and Departments of Psychiatry and Neurology, Massachusetts General Hospital, and Department of Psychiatry, Harvard Medical School, Boston
All individuals in a position to influence the content of this activity were asked to complete a statement regarding all relevant personal financial relationships between themselves or their spouse/partner and any commercial interest. The CME Institute has resolved any conflicts of interest that were identified. In the past year, Marlene P. Freeman, MD, Editor in Chief, has received research funding from JayMac and Sage; has been a member of the advisory boards for Otsuka, Alkermes, and Sunovion; has been a member of the Independent Data Safety and Monitoring Committee for Janssen; has been a member of the Steering Committee for Educational Activities for Medscape; and, as a Massachusetts General Hospital (MGH) employee, works with the MGH National Pregnancy Registry, which is sponsored by Teva, Alkermes, Otsuka, Actavis, and Sunovion, and works with the MGH Clinical Trials Network and Institute, which receives research funding from multiple pharmaceutical companies and the National Institute of Mental Health. No member of the CME Institute staff reported any relevant personal financial relationships.
Dr Roth is a consultant for and has received honoraria from Merck, Idorsia, Eisai, Alarion, Takeda, Jazz, Click Therapeutics, Avadel, GlaxoSmithKline, and SEQ; and is a member of the speaker/advisory board for Eisai. Dr Winkelman is a consultant for Avadel and CVS; has received grant/research support from Merck and RLS Foundation; is a member of the speaker/advisor board for Massachusetts General Hospital Psychiatry Academy; and has received financial or material support from Winston and Strawn and UpToDate.
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The CME Institute of Physicians Postgraduate Press, Inc., designates this enduring material for a maximum of 1 AMA PRA Category 1 Credits™. 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.
To obtain credit for this activity, study the material and complete the CME Posttest and Evaluation.
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, Recognizing and 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
- 1.00 AMA PRA Category 1 Credit™
- 1.00 Participation