![]() ![]() I do because I don’t think you can exclude those 2. ![]() Usually there’s a screener where patients fill out an extensive questionnaire, but I ask every psychiatric patient about sleep stuff and every sleep patient about psychiatric stuff. You can’t tease them out in the world that we live in. That’s what I tell the students who rotate with me. I’m pretty fixated on looking for sleep and psychiatric stuff from the very beginning. She continued to use her CPAP, and then getting on something like sodium oxybate or pitolisant made a big difference for her.ĭebra Stultz, MD: Right. It was subtle, it wasn’t happening, and eventually those medicines wore out and she really needed to get on something that was more tuned in to her cataplexy as well as her CPAP. But they were just missing the cataplexy that she had. I saw a patient the other day who was treated with modafinil and armodafinil for daytime sleepiness from OSA. They think it must be psychiatric, and that it’s something in their head, and it may be that the other medicines have helped with the excessive daytime sleepiness, but now the cataplexy is the most prominent thing. They may go to the neurologist or psychiatrist because they have these weird symptoms. Now we have patients presenting to us who have narcolepsy, and their sleepiness is fairly well controlled, but they have cataplexy. With some of these people who have coexisting disorders, we’ve treated a lot of their sleepiness. But I also think we’ve half-treated narcolepsy. Modafinil and armodafinil have especially moved us in the sleep world an incredible amount in helping people out. Haramandeep Singh, MD: With our patients who have sleep apnea, we often get tuned in to treating them with a CPAP machine and adjusting pressures, and we miss the fact that they’re not responding to treatment or they’re partially responding and they pull more to narcolepsy, which is so common.ĭebra Stultz, MD: I absolutely love modafinil, armodafinil, and Sunosi in the treatment of excessive daytime sleepiness of sleep apnea. Haramandeep Singh, MD: Thank you for bringing that up, because even in that Burden of Narcolepsy Disease study, we find that outside psychiatric comorbidities, the highest was sleep apnea. Once they’ve had 1 sleep study, it’s not 1 and done with your diagnosis or treatment. Sleep apnea is another place where we need to be sure and address if there are any narcolepsy symptoms present, because it’s estimated that about 30% of patients with narcolepsy can have coexisting sleep apnea, and 5%- some of the later studies say up to 30%-of patients with sleep apnea can have narcolepsy. When we look at the medical disorders, it’s associated with all our sleep disorders too, like sleep apnea, periodic limb movement disorder, and restless leg syndrome. We often find that they come to us already on stimulants for ADHD, when they actually have a sleep disorder.ĭebra Stultz, MD: Right, it’s not treated. Sometimes patients who have sleep disorders in general and narcolepsy because they’re not sleeping well, they can’t focus, they can’t concentrate, and they can’t remember. Haramandeep Singh, MD: I absolutely agree. They have a lot of anxiety about going to certain restaurants and around a lot of crowds or people they don’t know very well. There’s a lot of social anxiety in patients with narcolepsy, especially if they have a large component of cataplexy, because they’re fearful that they might get out and have an episode and would be embarrassed, or they go out to eat and get extremely sleepy, like can’t-hold-their-head-up sleepy. At least a third of the patients with narcolepsy had some kind of psychiatric illness, whether it was depression or anxiety or panic attacks. They looked at what kinds of illnesses are associated with narcolepsy, and psychiatric illness was at the top of the list at 31%, followed by GI disturbances and then neurological things. One of our landmark studies over the years has been the Burden of Narcolepsy Disease study by Dr Black and associates. A lot of the psychiatric disorders can have narcolepsy or narcolepsy-like signs and symptoms. Haramandeep Singh, MD: What are the other main common psychiatric comorbidities that you find with patients who have narcolepsy?ĭebra Stultz, MD: Depression and anxiety for sure, along with panic and PTSD.
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