Bhanu Prakash Kolla, MBBS, MD: Treating Sleep with Psychiatric Illness

At SLEEP 2024, the 38th annual meeting of the Associated Professional Sleep Societies in Houston, Bhanu Prakash Kolla, MBBS, MD, from the Mayo Clinc, presented the topic, “Practical Management of Sleep Disorders in Patients with Psychiatric Illnesses.” HCPLive sat down with Kolla to discuss the relationship between sleep disorders and psychiatric illnesses, as well as recommendations how to treat patients with both.

He stated about 70% to 80% of patients with major depressive disorder complain about insomnia symptoms, and 10% complain about hypersomnia. People with the mood disorder, bipolar disorder, also complain about tiredness following a manic episode where they sleep very little but experience insomnia after. Insomnia is common in psychotic illnesses—like schizophrenia—and generalized anxiety disorders.

However, it is not always the psychiatric illness itself creating tiredness—it could be the medication.

“One thing I would really caution clinicians about is making sure that the medications [for [psychiatric illnesses] are not the cause for either the insomnia or excessive sleepiness, to rule that out, or at least consider that as a possibility,” Kolla said.

He added how many of these medications cause weight gain, which can worsen or cause obstructive sleep apnea, so Kolla said it is important to watch out for that as well.

“One final thing is, there is this assumption sometimes, that if you treat the primary psychiatric illness, the sleep disorder will go away, usually addressing both at the same time,” Kolla said. “So, treating the underlying psychiatric illness but also paying attention to the sleep problems and treating those, we get more traction.”

Integration care between sleep specialists and mental health professionals is important for managing sleep disorders in patients with psychiatric illnesses. He described a patient of his with treatment-resistant depression. After trying antidepressant after antidepressant, he considered adding an augmentation medication to the antidepressant.

Around the same time, the patient was referred to a sleep center for his obstructive sleep apnea associated with headaches and daytime somnolence. The patient started with CPAP treatment, and afterward, antidepressants started to show signs of an effect—and the patient no longer needed an augmented agent.

“Being quite mindful of this, having a high index of suspicion in patients with depression, especially when they're not responding to the antidepressants, referral appropriately to sleep specialist in treating the underlying sleep condition, which is what happened in this case, really led to a good outcome,” Kolla said.

References

^{Kolla, B, Plante, D, Sylvia, L. Practical Management of Sleep Disorders in Patients with Psychiatric Illnesses. Session presented at SLEEP 2024. Houston, TX. June 4, 2024.}