Excessive Daytime Sleepiness Effects on Mental Health and Wellness

In this Q&A, Michael Grandner, PhD, MTR, CBSM, FAASM, Director of the Sleep and Heath Research Program at the University of Arizona, and Director of the Behavioral Sleep Medicine Clinic at the Banner-University Medical Center in Tucson, Arizona expands on his research study and discusses excessive daytime sleepiness in patients with obstructive sleep apnea and how it relates to mental health and wellness.

Dr Garndner and his colleagues will present their poster on this research, entitled “Health-related Burden of Illness Associated With Excessive Daytime Sleepiness in Patients With Obstructive Sleep Apnea Compliant With Continuous Positive Airway Pressure Treatment,” at the upcoming Psych Congress conference in San Antonio, Texas on Sunday, October 21, 2021.

Question:  What led you and your colleagues to investigate the burden of illness between excessive daytime sleepiness in obstructive sleep apnea?  

Answer:  Sleep apnea is a very common condition that impacts the health, mental health, and well-being of many people. And that number is growing! When you talk to people with sleep apnea, a lot of them will tell you that even after they are using their continuous positive airway pressure (CPAP) therapy, they still feel really sleepy during the day. This impacts people's lives in a very real way, standing in the way of them being able to do and accomplish what matters to them. Yet, the field mostly focuses on the respiratory aspects of sleep apnea while largely ignoring this important aspect of mental well-being. We thought that it was important to explore the degree to which excessive sleepiness in sleep apnea patients who are already using CPAP is related to important outcomes. If that is the case, then it is worth addressing sleepiness as a clinical concern on its own.

Q:  Please briefly describe the study method and participants.  

A:  These participants were recruited through an app that tracks health and well-being outcomes in many people. We restricted the survey to only include patients who had sleep apnea and were currently using their CPAP but still experienced excessive daytime sleepiness. 

Q:  Please briefly describe the most significant finding(s).  

A:  Those with excessive sleepiness had much more anxiety and depression than those without sleepiness, and they also had more functional impairments due to the consequences of sleepiness. In addition, physical activity was impacted, in that people with excessive sleepiness were not only more likely to report that sleepiness prevented them from engaging in physical activity, but they were also more likely to report that they need to keep moving to stay awake. It was also interesting to note that the reasons for caffeine use were different between sleep apnea patients who had sleepiness versus those who didn't. Those with excess sleepiness were more likely to use caffeine as a way to make it through the day, compared with the nonsleepy group, which was more likely to drink caffeine simply because they liked the taste or it was part of their routine.

Q:  Were any outcomes different than you expected?  

A:  We know sleep apnea is associated with psychiatric and functional problems, but the degree to which this residual, untreated sleepiness impacts functioning is not well known. It was surprising just how robust the mental health impact of daytime sleepiness was. In addition, it was really interesting to show that people who experience daytime sleepiness were more likely to have that impact their decision-making process regarding physical activity and caffeine use.

Q:  Are there any practical applications of your findings for clinicians treating patients with excessive daytime sleepiness (EDS) and obstructive sleep apnea (OSA)?  

A:  First of all, patients with EDS should talk to their doctor about this symptom, and doctors shouldn't ignore it. Often, patients feel like CPAP is the only solution and any residual issues are ones they will just have to live with. But doctors and therapists have many strategies for addressing daytime sleepiness, and this should be part of the clinical landscape. So, in summary, the most important take-home message here is that sleepiness in otherwise treated sleep apnea is a problem that should not be ignored.

Q:  Are you conducting any more research in this area, and are there any other studies you feel are needed?  

A: We are doing a few different studies in this area to carry this work forward. But what is really needed is research on how to identify mechanisms of this excessive sleepiness and develop strategies for reducing these symptoms so that we can improve quality of life.

Q:  Any final thoughts pertaining to this research? 

A:  There is a distinction between sleepiness and fatigue. Fatigue is a psychophysiologic experience of not feeling like you have the resources to meet demands. Sleepiness is less vague and much more specific — it is the inability to maintain consciousness when you otherwise should be able to stay awake. Many people struggle with sleepiness, whether from a sleep disorder like sleep apnea, or insufficient sleep, or shift work. It is an important problem!

Dr. Michael Grandner is a licensed clinical psychologist, Director of the Sleep and Heath Research Program at the University of Arizona, and Director of the Behavioral Sleep Medicine Clinic at the Banner-University Medical Center in Tucson, AZ. His work focuses on translational sleep research and Behavioral Sleep Medicine, including studies of sleep as a domain of health behavior and the development and implementation of behavioral interventions for insufficient sleep and sleep disorders. Specific areas of focus include: (1) Downstream cardiovascular, metabolic, and behavioral health outcomes associated with habitual sleep duration and/or insufficient sleep, (2) Upstream social, behavioral, and biological determinants of habitual sleep duration, insufficient sleep, and poor sleep quality, and (3) Development and implementation of behavioral interventions for sleep as a domain of health behavior. Learn more at sleephealthresearch.com or michaelgrandner.com.