The assessment, diagnosis, and treatment of excessive sleepiness: practical considerations for the psychiatrist.

Excessive sleepiness occurs frequently in the general population and is a common feature of many psychiatric conditions. The reductions in quality of life associated with excessive sleepiness may be substantial, involving compromised cognitive performance and work productivity as well as possible harm to the individual and the public. Excessive sleepiness may be the result of a number of extrinsic and intrinsic causes. Although it is an established symptom of certain psychiatric illnesses, abnormal excessive sleepiness in psychiatric patients may be the result of a comorbid disorder of sleep or wakefulness. Underdiagnosis and undertreatment of sleep disorders are common in community psychiatric practices because clinicians may not be aware of the different causes and consequences of excessive sleepiness. It is essential to recognize and treat the underlying cause of this disorder. In cases where sleep disorders are suspected, a comprehensive treatment program might include nonpharmacologic approaches, pharmacologic approaches, or both may need to be initiated to encompass the complexity of sleep disorder treatments. Careful monitoring and follow-up of patients with excessive daytime sleepiness, including counseling and long-term support, are essential to ensure treatment compliance and to maintain improvements over time.