Modern Management of Sleep Disorders. If Only I Could Sleep Like I Did Before

Size: px
Start display at page:

Download "Modern Management of Sleep Disorders. If Only I Could Sleep Like I Did Before"

Transcription

1 Modern Management of Sleep Disorders Douglas C. Bauer, MD University of California, San Francisco No Disclosures If Only I Could Sleep Like I Did Before

2 Sleep Case 52 yr. old WF with >4 yr. of poor sleep Difficulty with both initiation and maintenance of sleep. Few daytime symptoms Bedtime 10PM, up between 7-10 depending upon her sleep that night. Naps intermittently. Denies depression, anxiety, bad habits Previous MD prescribed valium 5-10mg 3-5 times per week. What else would want to know and what do you want to do? Topics Covered Prevalence and potential consequences Sleep physiology Insomnia evaluation and treatment Sleep disordered breathing and parasomnias

3 Question: Which of the following statements is false? 1) Average duration of sleep in the US is 6.9 hours 2) The most common frequency of insomnia is almost every night 3) 95% of sleep disorders are never diagnosed and treated 4) The prevalence of sleep disorders increase with age Sleep Disorders Sleep per night: 9 hr in 1910, 6.9 hr now 40 million in US suffer from sleep disorders 95% are undiagnosed and untreated Sleep disorders 30% more common in women Prevalence of sleep disorders increases with age Frequent complaint in primary care

4 35% Percent Reporting Symptoms of Insomnia 30% 25% 20% 15% 10% 5% 0% Almost Every Night Few times/week Few times/month Rarely/Never 2002 Sleep in America poll, National Sleep Foundation Definitions Insomnia (insufficient or poor quality sleep) Latency (time to fall asleep) Efficiency (proportion of time in bed asleep) Hypersomnia (excessive daytime sleepiness) - Sleep disordered breathing/sleep apnea - Narcolepsy Parasomnia (coordinated motor activity) -Restless leg syndrome

5 Sleep Architecture REM (Rapid Eye Movement) - Characteristic eye movement - EEG resembles wakefulness Non REM - 75% of sleep - Four stages: correlate with depth of sleep - Progressive cortical inactivity Sleep architecture changes over age 65 - Reduced stage 3 and 4, phase advancement - total time, latency, efficiency Special Populations: Insomnia in the Elderly High prevalence (> 50%) Often secondary to a primary sleep disorder Commonly associated with psychiatric disorders or depression

6 Special Populations: Older Women Which of the Following is True? 1) Perimenopausal insomnia is primarily difficulty maintaining sleep 2) Insomnia is more common in perithan postmenopausal women 3) Correlates with frequency of vasomotor symptoms 4) HRT fully relieves perimenopausal insomnia Special Populations: Perimenopausal Women Prospective study of >3000 women followed for 7 yr (SWAN) Sleep complaints worse in both peri and postmenopausal women (40% vs. 22%) Both initiation and maintenance of sleep impaired Partly attributable to hot flushes Improved but not fully reversed with HRT Other neurocognitive effects? Kravitz et al, Sleep, 2008

7 Presentation and Screening for Insomnia Typical presentation Difficulty initiating or maintaining sleep Wake after sleep onset Early morning awakening Awakening not rested Recommended screening question: Do you have trouble falling asleep or staying asleep? If positive, consider sleep questionnaire

8 Medical Conditions That Cause Insomnia Hyperthyroidism Arthritis Chronic renal failure Chronic lung disease Heart failure Neurological disorders Dementia/AD Parkinson s disease Drugs That Cause Insomnia Alcohol CNS stimulants Beta-blockers Bronchodilators Calcium channel blockers Corticosteroids Decongestants Stimulating antidepressants Thyroid hormones Nicotine

9 Evaluation of Insomnia: History, Exam and Labs General history and exam Sleep pattern (patient and bedroom partner) - Insufficient sleep time - Delayed onset, frequent/early awakening - Associated nocturnal symptoms and daytime symptoms Consider thyroid function, glucose, UA Formal sleep study rarely indicated Insomnia Therapies Which of following is superior to benzodiazepine receptor agonists for primary insomnia? 1) sleep hygiene 2) cognitive behavioral therapy 3) anti-histamines 4) anti-depressants (TCA, SSRI, and trazadone)

10 Treatment of Insomnia: Non-Pharmacologic Treat underlying disorders Begin with non-pharmacologic treatment* - Sleep education (changes with aging) - Sleep hygiene (diet, exercise, habits, environment) - Establish optimal sleep pattern * Relief from Insomnia by Charles Morin Non-Pharmacologic Therapy: Cognitive Behavioral Therapy Cognitive therapy Change maladaptive thought processes Behavioral therapy (stimulus control, sleep restriction, relaxation, good sleep hygiene) RCT of 46 adults with chronic insomnia Superior short and long-term (6 mo) outcomes with CBT compared to zopiclone or placebo Sivertsen et al, Jama 2006 Buysse et al, Arch Intern Med, 2011

11 Suggested Approach to Insomnia In Primary Care Acute <4 wks Insomnia Chronic >4 wks Assess trigger Consider brief tx Hypersomia or parasomnia? Evaluate and treat Primary? Sleep hygiene CBT Refer if persists Secondary cause? Treat and reassess Treatment of Insomnia: Pharmacologic Depression - TCA, trazadone, SSRI, combinations (suppress REM) - Not recommended if not depressed Anxiety, panic - Benzodiazepines (suppress REM and non REM stage 3 and 4) - Not recommended if not anxious Primary insomnia: what to use?

12 Treatment of Insomnia: Pharmacologic Problems with anti-histamines: anticholinergic, sedation, cognitive dysfunction Problems with benzodiazepines: habit forming, tachyphylaxis, suppression of REM sleep, cognitive dysfunction, falls Short-term benzodiazepine use (<2 wk) may be helpful in some patients Alternatives to benzodiazepines?

13 Benzodiazepine Receptor Agonists Zolpidem (generic), zaleplon (Sonata), eszopiclone (Lunesta) - Activate 1 of 3 benzodiazepine receptors - No anxiolytic or muscle relaxing effects - No tolerance (studies up to one year) - Preserves REM, less withdrawal, little abuse - Rapid onset, half life 2-3 hours Longer and shorter half-life versions available CR zolpidem if awakens too early with generic Sublingual zolpidem (Intermezzo) for middle of the night awakening. Note women 1.75 mg, men 3.5 mg An unexpected side effect

14 Other Drugs Melatonin (OTC) - From pineal gland, receptors in hypothalamus - Low serum levels = poor sleep - Poor evidence for insomnia, maybe for jet lag or phase delay - Not regulated; long term safety? Ramelteon (Rozerem) Melatonin receptor agonist. FDA approved but no long-term safety data AHRQ Evidence Report #108, 2011 What s the Diagnosis?

15 Hypersominas: Sleep Apnea Obstructive more common than central Apnic episodes, loud snoring, choking, gasping during sleep Key feature: insomnia not common but usually associated with daytime sleepiness Risk factors include: Older age Male sex Obesity Craniofacial structure Definition of Sleep Apnea Apnea = cessation of respiration Hypopnea = partial decrease (>50%) of respiration Duration 10 seconds Respiratory Disturbance Index (RDI): # apneas + hypopneas / hour while asleep Normal RDI < 5, severe apnea 15

16 Prevalence of Sleep Disordered Breathing Heavily dependent on definition used 2-4% in younger adults (20-60 yrs) > 10% in elderly Consequences of Sleep Disordered Breathing Impaired QOL (as with insomnia) Increased risk of accidents & injuries Mild cognitive impairment/dementia 85% increased risk if RDI>15 in older women Increased risk of hypertension and cardiovascular events Sleep Heart Study Yaffe et al Jama, 2011

17 Sleep Heart Study: HTN by Quartiles of RDI 45% 40% 35% 30% 25% 20% 15% P(trend)<.001 in both men and women Men Women 10% 5% 0% < < < Shahar, Am J Respir Crit Care Med (1):19-25 Sleep Heart Study: CVD by Quartiles of RDI* P< Q1 (ref) Q2 Q3 Q4 *Both sexes, all ages

18 Evaluation of Sleep Disorders: Sleep Studies Polysomnography (oximetry, EEG, EKG, EMG, observation) Home monitoring (oximetry others) if not medically complicated Indications - Unexplained hypersomnia (esp. with snoring) - Unexplained sleep-related CV abn (pulm HTN) - Abnormal complex sleep behavior - Unremitting chronic insomnia that does not respond to therapy Flemons et al, Chest, 2003 Other Causes of Hypersomnia: Narcolepsy - Extreme daytime sleepiness, frequent brief naps, cataplexy - Rare, familial, presents in 20s and 30s - Requires sleep study and daytime Multiple Sleep Latency Test (MSLT) - Treatment: stimulants, anticholinergics

19 Parasomnias: Restless Leg Syndrome Intense dysesthesias, repetitive jerking - Worse at bedtime, frequently awakens patient - Often familial, progresses with age Etiology unknown, associated with iron deficiency Treatment - Sinemet 25/100 qhs (70% respond) - Clonazepam mg qhs - Dopamine agonists (rotingotine, pergolide, etc) effective but intolerance common Scholz et al, Cochrane Database, 2011 Conclusions Sleep disorders are common Associated with significant morbidity Primary care providers can diagnose and treat most patients with insomnia Drug treatments over utilized, nonpharmacologic treatment often successful Specialty referral (sleep study) for selected patients with unexplained hypersomnia or severe insomnia

20 Case 52 yr. old WF with >4 yr. of poor sleep Difficulty with both initiation and maintenance of sleep. Few daytime symptoms Bedtime 10PM, up between 7-10 depending upon her sleep that night. Naps intermittently. Denies depression, anxiety, bad habits Previous MD prescribed valium 5-10mg 3-5 times per week. What else would want to know and what do you want to do?

Modern Management of Sleep Disorders. Case. Introduction. Topics Covered. Douglas C. Bauer, MD University of California, San Francisco

Modern Management of Sleep Disorders. Case. Introduction. Topics Covered. Douglas C. Bauer, MD University of California, San Francisco Modern Management of Sleep Disorders Douglas C. Bauer, MD University of California, San Francisco No Disclosures Case 68 yr. old WF with >15 yr. of poor sleep Difficulty with both initiation and maintenance

More information

Modern Management of Sleep Disorders

Modern Management of Sleep Disorders Modern Management of Sleep Disorders Douglas C. Bauer, MD University of California, San Francisco No Disclosures Case 68 yr. old WF with >15 yr. of poor sleep Difficulty with both initiation and maintenance

More information

Insomnia. Dr Terri Henderson MBChB FCPsych

Insomnia. Dr Terri Henderson MBChB FCPsych Insomnia Dr Terri Henderson MBChB FCPsych Plan Basics of insomnia Pharmacology Medication CBT Details of insomnia Unsatisfactory sleep that impairs daytime well-being Starts with specific problem or change

More information

INSOMNIA IN THE GERIATRIC POPULATION. Shannon Bush, MS4

INSOMNIA IN THE GERIATRIC POPULATION. Shannon Bush, MS4 INSOMNIA IN THE GERIATRIC POPULATION Shannon Bush, MS4 CHANGES IN SLEEP ARCHITECTURE 2 Reduction in slow wave sleep (stage 3 and 4) Increase in lighter stages of sleep (stage 1 and 2) Decrease in REM sleep

More information

Insomnia. Learning Objectives. Disclosure 6/7/11. Research funding: NIH, Respironics, Embla Consulting: Elsevier

Insomnia. Learning Objectives. Disclosure 6/7/11. Research funding: NIH, Respironics, Embla Consulting: Elsevier Insomnia Teofilo Lee-Chiong MD Professor of Medicine National Jewish Health University of Colorado Denver School of Medicine Learning Objectives Learn about the causes of transient and chronic Learn how

More information

Index. sleep.theclinics.com. Note: Page numbers of article titles are in boldface type.

Index. sleep.theclinics.com. Note: Page numbers of article titles are in boldface type. Note: Page numbers of article titles are in boldface type. A Actigraphy, 475, 485, 496 Adolescents, sleep disorders in, 576 578 Adults, sleep disorders in, 578 580 Advanced sleep phase disorder, 482 Age,

More information

Pharmacological Help for a Good Night s s Sleep. Thomas Owens, MD

Pharmacological Help for a Good Night s s Sleep. Thomas Owens, MD Pharmacological Help for a Good Night s s Sleep Thomas Owens, MD Objectives 1. Define insomnia and characterize the symptoms and array of causes. 2. Describe traditional and new pharmacologic approaches

More information

Diagnosis and treatment of sleep disorders

Diagnosis and treatment of sleep disorders Diagnosis and treatment of sleep disorders Normal human sleep Sleep cycle occurs about every 90 minutes, approximately 4-6 cycles occur per major sleep episode NREM (70-80%) slow wave sleep heart rate,

More information

Insomnia Agents (Sherwood Employer Group)

Insomnia Agents (Sherwood Employer Group) Insomnia Agents (Sherwood Employer Group) BCBSKS will review Prior Authorization requests Prior Authorization Form: https://www.bcbsks.com/customerservice/forms/pdf/priorauth-6058ks-st-ippi.pdf Link to

More information

TOP 10 LIST OF SLEEP QUESTIONS. Kenneth C. Sassower, MD Sleep Disorders Unit Massachusetts General Hospital for Children

TOP 10 LIST OF SLEEP QUESTIONS. Kenneth C. Sassower, MD Sleep Disorders Unit Massachusetts General Hospital for Children TOP 10 LIST OF SLEEP QUESTIONS Kenneth C. Sassower, MD Sleep Disorders Unit Massachusetts General Hospital for Children QUESTION #1: ARE SLEEP ISSUES IN CHILDREN THE SAME AS IN ADULTS? Distinctive Features

More information

Sleep Science: better sleep for you and your patients CHUNBAI ZHANG, MD MPH UW MEDICINE VALLEY MEDICAL CENTER

Sleep Science: better sleep for you and your patients CHUNBAI ZHANG, MD MPH UW MEDICINE VALLEY MEDICAL CENTER Sleep Science: better sleep for you and your patients CHUNBAI ZHANG, MD MPH UW MEDICINE VALLEY MEDICAL CENTER Disclosure: Financial - none Non-Financial - none Selected Topics Sleep epidemiology Sleep

More information

Parkinson s Disease Associated Sleep Disturbance Ehsan M. Hadi, MD, MPH. Dignity Health Neurological Institute

Parkinson s Disease Associated Sleep Disturbance Ehsan M. Hadi, MD, MPH. Dignity Health Neurological Institute Parkinson s Disease Associated Sleep Disturbance Ehsan M. Hadi, MD, MPH. Dignity Health Neurological Institute Parkinson s Disease 2 nd most common neurodegenerative disorder Peak age at onset is 60 years

More information

SLEEP DISORDERS. Kenneth C. Sassower, MD Division of Sleep Medicine; Department of Neurology Massachusetts General Hospital for Children

SLEEP DISORDERS. Kenneth C. Sassower, MD Division of Sleep Medicine; Department of Neurology Massachusetts General Hospital for Children SLEEP DISORDERS Kenneth C. Sassower, MD Division of Sleep Medicine; Department of Neurology Massachusetts General Hospital for Children Distinctive Features of Pediatric Sleep Daytime sleepiness uncommon

More information

노인병원에서 Light Therapy 의 활용 박 기 형 진주삼성병원 송도병원 신경과

노인병원에서 Light Therapy 의 활용 박 기 형 진주삼성병원 송도병원 신경과 Light Therapy 1 : 15 / 63 (23.8%) 1 : 7 2 : 8 : 6 / 86 (7%) 1, : 48 / 205 (23.4%) 1 : 43 2 : 5 Sleep in Geriatrics Prevalence NIH survey of 9000 american senior above age 65 ; 88% had sleep disturbances

More information

Sleep Dysfunction in Multiple System Atrophy DR CALLUM DUPRE NEUROLOGY/SLEEP MEDICINE CAPITAL HEALTH SYSTEM

Sleep Dysfunction in Multiple System Atrophy DR CALLUM DUPRE NEUROLOGY/SLEEP MEDICINE CAPITAL HEALTH SYSTEM Sleep Dysfunction in Multiple System Atrophy DR CALLUM DUPRE NEUROLOGY/SLEEP MEDICINE CAPITAL HEALTH SYSTEM Categories of Disturbance Sleep Breathing Disorders Parasomnias Sleepiness Insomnia Breathing?

More information

Sleep and Parkinson's Disease

Sleep and Parkinson's Disease Parkinson s Disease Clinic and Research Center University of California, San Francisco 505 Parnassus Ave., Rm. 795-M, Box 0114 San Francisco, CA 94143-0114 (415) 476-9276 http://pdcenter.neurology.ucsf.edu

More information

AGING CHANGES IN SLEEP

AGING CHANGES IN SLEEP OBJECTIVES: Understand the common age-related changes in sleep Discuss the evaluation of the older person with sleep complaints Identify sleep apnea, PLMS, RLS, and REM sleep disorders and their treatments

More information

Index SLEEP MEDICINE CLINICS. Note: Page numbers of article titles are in boldface type. Cerebrospinal fluid analysis, for Kleine-Levin syndrome,

Index SLEEP MEDICINE CLINICS. Note: Page numbers of article titles are in boldface type. Cerebrospinal fluid analysis, for Kleine-Levin syndrome, 165 SLEEP MEDICINE CLINICS Index Sleep Med Clin 1 (2006) 165 170 Note: Page numbers of article titles are in boldface type. A Academic performance, effects of sleepiness in children on, 112 Accidents,

More information

Managing Insomnia Disorder A Review of the Research for Adults

Managing Insomnia Disorder A Review of the Research for Adults Managing Insomnia Disorder A Review of the Research for Adults e Is This Information Right for Me? This information is right for you if: Your health care professional said you have insomnia disorder (said

More information

SLEEP UPDATE 2008 SLEEP HYPNOGRAM. David Claman, MD UCSF Sleep Disorders Center

SLEEP UPDATE 2008 SLEEP HYPNOGRAM. David Claman, MD UCSF Sleep Disorders Center SLEEP UPDATE 2008 SLEEP HYPNOGRAM David Claman, MD UCSF Sleep Disorders Center Insomnia Case A 40 year old man c/o insomnia at sleep onset. He worries about sleep at night, and takes 2-3 hrs to fall asleep.

More information

Pharmacy Benefit Determination Policy

Pharmacy Benefit Determination Policy Policy Subject: CNS Stimulant Medications Policy Number: SHS PBD06 Category: CNS Drugs Policy Type: Medical Pharmacy Department: Pharmacy Product (check all that apply): Group HMO/POS ASO PPO Individual

More information

Polysomnography (PSG) (Sleep Studies), Sleep Center

Polysomnography (PSG) (Sleep Studies), Sleep Center Policy Number: 1036 Policy History Approve Date: 07/09/2015 Effective Date: 07/09/2015 Preauthorization All Plans Benefit plans vary in coverage and some plans may not provide coverage for certain service(s)

More information

CPT David Shaha, MC US Army

CPT David Shaha, MC US Army CPT David Shaha, MC US Army None Thoughts and comments are my own and do not represent the official policy of the Department of the Army, Department of Defense, or United States Government. Clinical Case

More information

Insomnia. Arturo Meade MD

Insomnia. Arturo Meade MD Insomnia Arturo Meade MD Goals Definition Prevalence Pathophysiology The role of Orexin Orexin receptor blockers Consequences: Daily Functioning Insomnia: Consequences Decreased quality of life

More information

Treating Insomnia in Primary Care. Judith R. Davidson Ph.D., C. Psych. Kingston Family Health Team

Treating Insomnia in Primary Care. Judith R. Davidson Ph.D., C. Psych. Kingston Family Health Team Treating Insomnia in Primary Care Judith R. Davidson Ph.D., C. Psych. Kingston Family Health Team jdavidson@kfhn.net Disclosure statement Nothing to disclose A ruffled mind makes a restless pillow. ~ Charlotte

More information

Disclosures. Speaker: Teva, UCB, Purdue Advisory Board: Welltrinsic Sleep Network Consultant: Vapotherm, Inc. National Interpretor: Novasom

Disclosures. Speaker: Teva, UCB, Purdue Advisory Board: Welltrinsic Sleep Network Consultant: Vapotherm, Inc. National Interpretor: Novasom So PAP Doesn t Work Rochelle Goldberg, MD, FAASM, FCCP Diplomat, American Board of Sleep Medicine Director Sleep Medicine Services Main Line Health Systems Lankenau Medical Center and Paoli Hospital Disclosures

More information

Facts about Sleep. Circadian rhythms are important in determining human sleep patterns/ sleep-waking cycle

Facts about Sleep. Circadian rhythms are important in determining human sleep patterns/ sleep-waking cycle Sleep Sleep is described as a state of unconsciousness or partial consciousness from which a person can be roused by stimulation Period of rest and recovery People spend about a third of their lives sleeping

More information

Chronic Insomnia: DSM - V. Insomnia DSM - V. Patient Symptoms. Insomnia: Assessment and Overview of Management. Insomnia Management in the Digital Age

Chronic Insomnia: DSM - V. Insomnia DSM - V. Patient Symptoms. Insomnia: Assessment and Overview of Management. Insomnia Management in the Digital Age Insomnia Management in the Digital Age Dr Anup Desai Sleep & Respiratory Medicine MBBS (syd), PhD (syd), FRACP Senior Staff Specialist, POW Hospital Medical Director, Sydney Sleep Centre Senior Lecturer,

More information

Insomnia. St. Joseph s Annual Family Practice Refresher March 1, Robert J. Ostrander, M.D

Insomnia. St. Joseph s Annual Family Practice Refresher March 1, Robert J. Ostrander, M.D St. Joseph s Annual Family Practice Refresher March 1, 2018 Robert J. Ostrander, M.D If in bed I say, When shall I arise? then the night drags on; I am filled with restlessness until the dawn. Job 7:4

More information

Sweet Dreams: The Relationship between Sleep Health and Your Weight

Sweet Dreams: The Relationship between Sleep Health and Your Weight Sweet Dreams: The Relationship between Sleep Health and Your Weight Jason C. Ong, PhD Associate Professor Department of Neurology Center for Circadian and Sleep Medicine Northwestern University Feinberg

More information

Treating sleep disorders

Treating sleep disorders Treating sleep disorders Sue Wilson Centre for Neuropsychopharmacology Imperial College London sue.wilson@imperial.ac.uk Suggested algorithm for treatment of insomnia Diagnosis of insomnia Associated with

More information

SLEEP-WAKE DISORDERS: INSOMNIA. Prof. Paz Gía-Portilla

SLEEP-WAKE DISORDERS: INSOMNIA. Prof. Paz Gía-Portilla SLEEP-WAKE DISORDERS: INSOMNIA Prof. Paz Gía-Portilla SLEEP-WAKE DISORDERS AND ICD-10 Chapter V: Mental and Behavioural Disorders F51. Non-organic sleep disorders Chapter VI: Nervous System Illnesses G47.

More information

Question #1. Disclosures. CAPA 2015 Annual Conference. All of the following occur as we get older EXCEPT: Evaluating Patients with Insomnia

Question #1. Disclosures. CAPA 2015 Annual Conference. All of the following occur as we get older EXCEPT: Evaluating Patients with Insomnia Evaluating Patients with Roger D. Seheult, M.D. Pulmonary Critical Care Physician - Beaver Medical Group, Redlands California Assistant Clinical Professor of Medicine - Loma Linda University School of

More information

May 27, Gosia Eve Phillips, MD

May 27, Gosia Eve Phillips, MD May 27, 2015 Gosia Eve Phillips, MD Diplomate, American Board of Psychiatry and Neurology Assistant Professor of Medicine, Dalhousie University Medical Director, MedSleep Atlantic >50% of MS patients suffer

More information

Insomnia treatment in primary care

Insomnia treatment in primary care Insomnia treatment in primary care Daniel J. Buysse, MD UPMC Professor of Sleep Medicine Professor of Psychiatry and Clinical and Translational Science University of Pittsburgh School of Medicine buyssedj@upmc.edu

More information

HEALTHY LIFESTYLE, HEALTHY SLEEP. There are many different sleep disorders, and almost all of them can be improved with lifestyle changes.

HEALTHY LIFESTYLE, HEALTHY SLEEP. There are many different sleep disorders, and almost all of them can be improved with lifestyle changes. HEALTHY LIFESTYLE, HEALTHY SLEEP There are many different sleep disorders, and almost all of them can be improved with lifestyle changes. HEALTHY LIFESTYLE, HEALTHY SLEEP There are many different sleep

More information

Get on the Road to Better Health Recognizing the Dangers of Sleep Apnea

Get on the Road to Better Health Recognizing the Dangers of Sleep Apnea Get on the Road to Better Health You Will Learn About The importance and benefits of sleep Sleep deprivation and its consequences The prevalence, symptoms, and treatments for major sleep problems/ disorders

More information

OBJECTIVES. The psychiatric, medical, and neurologic causes of sleep problems. Office-based and objective methods of evaluating sleep

OBJECTIVES. The psychiatric, medical, and neurologic causes of sleep problems. Office-based and objective methods of evaluating sleep SLEEP ISSUES 1 OBJECTIVES 2 Know and understand: Age-related changes in sleep The psychiatric, medical, and neurologic causes of sleep problems Office-based and objective methods of evaluating sleep Appropriate

More information

Milena Pavlova, M.D., FAASM Department of Neurology, Brigham and Women's Hospital Assistant Professor of Neurology, Harvard Medical School Medical

Milena Pavlova, M.D., FAASM Department of Neurology, Brigham and Women's Hospital Assistant Professor of Neurology, Harvard Medical School Medical Milena Pavlova, M.D., FAASM Department of Neurology, Brigham and Women's Hospital Assistant Professor of Neurology, Harvard Medical School Medical Director, Faulkner EEG and Sleep Testing Center Course

More information

Sleep disorders. Norbert Kozak

Sleep disorders. Norbert Kozak Sleep disorders Norbert Kozak About the sleep Each of us will spend about 1/3 of our lifetime sleeping....and 1/3 part of the population has sleep complain Sleep is an essential biological function, but

More information

Individual Planning: A Treatment Plan Overview for Individuals Sleep Disorder Problems.

Individual Planning: A Treatment Plan Overview for Individuals Sleep Disorder Problems. COURSES ARTICLE - THERAPYTOOLS.US Individual Planning: A Treatment Plan Overview for Individuals Sleep Disorder Problems. Individual Planning: A Treatment Plan Overview for Individuals Sleep Disorder Problems.

More information

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Note: Page numbers of article titles are in boldface type. A Abuse sleep physiology effects of, 880 882 substance, in adolescents, sleep problems and, 929 946. See also Substance use and abuse, in adolescents,

More information

Insomnia: habits, help, and hazards

Insomnia: habits, help, and hazards Insomnia: habits, help, and hazards Balanced data about medications www.rxfacts.org Copyright 2010 by The Alosa Foundation www.rxfacts.org November 2010 2 www.rxfacts.org Author: Leslie Jackowski, B.Sc.,

More information

WHY CAN T I SLEEP? Deepti Chandran, MD

WHY CAN T I SLEEP? Deepti Chandran, MD WHY CAN T I SLEEP? Deepti Chandran, MD Sleep and Aging How does sleep change as we age? Do we need less sleep as we get older? Can a person expect to experience more sleep problems or have a sleep disorder

More information

Sleep This factsheet is available in a downloadable PDF here. Table of Contents Introduction Insomnia How Long does Insomnia Last? How much Sleep should You get? Symptoms of Insomnia Causes of Insomnia

More information

Index. sleep.theclinics.com. Note: Page numbers of article titles are in boldface type.

Index. sleep.theclinics.com. Note: Page numbers of article titles are in boldface type. Note: Page numbers of article titles are in boldface type. A Accidents, risk of, with insufficient sleep, 318 Acquired immunodeficiency syndrome (AIDS), comorbid with narcolepsy, 298 299 Actigraphy, in

More information

Sleep Complaints and Disorders in Epileptic Patients 순천향의대천안병원순천향의대천안병원신경과양광익

Sleep Complaints and Disorders in Epileptic Patients 순천향의대천안병원순천향의대천안병원신경과양광익 Sleep Complaints and Disorders in Epileptic Patients 순천향의대천안병원순천향의대천안병원신경과양광익 Introduction The global physical, social and economic consequence of epilepsy are high. WHO 2000 study Improving QoL is increasingly

More information

Insomnia Disorder A Journey to the Land of No Nod

Insomnia Disorder A Journey to the Land of No Nod Insomnia Disorder A Journey to the Land of No Nod JACQUELINE D. KLOSS, PH.D. P S Y C H O L O G I S T B R Y N M A W R P S Y C H O L O G I C A L A S S O C I A T E S B E H A V I O R A L S L E E P M E D I

More information

Sleep Disorders. Guidance for Primary Care. National Advisory Group for Respiratory Managed Clinical Networks

Sleep Disorders. Guidance for Primary Care. National Advisory Group for Respiratory Managed Clinical Networks Sleep Disorders Guidance for Primary Care National Advisory Group for Respiratory Managed Clinical Networks Presentation Patient complaining of difficulty sleeping, ongoing fatigue, poor concentration

More information

INTRINSIC SLEEP DISORDERS. Excessive daytime sleepiness (EDS) is a common complaint. Causes of EDS are numerous and include:

INTRINSIC SLEEP DISORDERS. Excessive daytime sleepiness (EDS) is a common complaint. Causes of EDS are numerous and include: INTRINSIC SLEEP DISORDERS Introduction Excessive daytime sleepiness (EDS) is a common complaint. Causes of EDS are numerous and include: Intrinsic sleep disorders (e.g. narcolepsy, obstructive sleep apnoea/hypopnea

More information

Sleep and Epilepsy. Nancy Foldvary-Schaefer, DO, MS

Sleep and Epilepsy. Nancy Foldvary-Schaefer, DO, MS Sleep and Epilepsy Nancy Foldvary-Schaefer, DO, MS Burden of epilepsy Affects over 50 million people worldwide; 2 million new cases/yr Estimated 30-40% continue to have seizures despite anti-seizure medications

More information

How to Help Your Clients Get Better Sleep

How to Help Your Clients Get Better Sleep How to Help Your Clients Get Better Sleep Bonus Video 1 10-Point Checklist for Getting Better Sleep with Rubin Naiman, PhD How to Help Your Clients Get Better Sleep 2 10-Point Checklist for Getting Better

More information

Sleep Hygiene. William M. DeMayo, M.D. John P. Murtha Neuroscience and Pain Institute Conemaugh Health System Johnstown, PA

Sleep Hygiene. William M. DeMayo, M.D. John P. Murtha Neuroscience and Pain Institute Conemaugh Health System Johnstown, PA Sleep Hygiene William M. DeMayo, M.D. John P. Murtha Neuroscience and Pain Institute Conemaugh Health System Johnstown, PA Why Is Sleep Important? Symptoms of Sleep Deprivation: Irritability / Poor Stress

More information

How to Manage Insomnia with and without medications

How to Manage Insomnia with and without medications How to Manage Insomnia with and without medications Tatyana Gurvich, Pharm.D. USC School of Pharmacy UC Irvine SeniorHealth Center Insomnia: How common is it? 26-50% of adult population complain of insomnia

More information

OUTLINE SLEEP UPDATE 2011 DISCLOSURES. David Claman, MD. Formerly on Lunesta Speakers Bureau Resigned 2011

OUTLINE SLEEP UPDATE 2011 DISCLOSURES. David Claman, MD. Formerly on Lunesta Speakers Bureau Resigned 2011 SLEEP UPDATE 2011 David Claman, MD Professor of Medicine UCSF Sleep Disorders Center DISCLOSURES Formerly on Lunesta Speakers Bureau Resigned 2011 Former Consultant for Provent Consulting activity was

More information

ATHLETES & PRESCRIBING PHYSICIANS PLEASE READ

ATHLETES & PRESCRIBING PHYSICIANS PLEASE READ ATHLETES & PRESCRIBING PHYSICIANS PLEASE READ USADA can grant a Therapeutic Use Exemption (TUE) in compliance with the World Anti- Doping Agency International Standard for TUEs. The TUE application process

More information

Article printed from

Article printed from What Are Sleep Disorders? Sleep disorders are conditions that affect how much and how well you sleep. The causes range from poor habits that keep you awake to medical problems that disrupt your sleep cycle.

More information

Diana Corzine, MD ABMS Sleep Chief MT VA Sleep Medicine Common Sleep Disorders

Diana Corzine, MD ABMS Sleep Chief MT VA Sleep Medicine Common Sleep Disorders Diana Corzine, MD ABMS Sleep Chief MT VA Sleep Medicine 2018 Common Sleep Disorders Objectives: Understand Understand how Sleep Disorders affects health. Describe Describe some Common Sleep Disorders.

More information

Healthy Sleep Tips Along the Way!

Healthy Sleep Tips Along the Way! Women and Sleep What You Will Learn The Benefits and Importance of Sleep States and Stages of the Sleep Cycle Unique Physiology of Women s Sleep Common Disorders in Women that Affect Sleep Women s Role

More information

RETT SYNDROME AND SLEEP

RETT SYNDROME AND SLEEP 2015 A good night s sleep promotes learning, improved mood, general good health, and a better quality of life for both your child and the whole family. This article written for Rettsyndrome.org by Dr Daniel

More information

Sleep and Traumatic Brain Injury (TBI)

Sleep and Traumatic Brain Injury (TBI) Sleep and Traumatic Brain Injury (TBI) A resource for individuals with traumatic brain injury and their supporters This presentation is based on TBI Model Systems research and was developed with support

More information

SLEEP STUDY. Nighttime. 1. How many hours of sleep are you now getting in a typical night?

SLEEP STUDY. Nighttime. 1. How many hours of sleep are you now getting in a typical night? SLEEP STUDY Patient Name: Date of Birth: Date of Study: This questionnaire involves a broad range of sleep and sleep-related behaviors. Your answers enable us to develop a clearer picture of your sleep/wake

More information

Sleep and Ageing. Siobhan Banks PhD. Body and Brain at Work, Centre for Sleep Research University of South Australia

Sleep and Ageing. Siobhan Banks PhD. Body and Brain at Work, Centre for Sleep Research University of South Australia Sleep and Ageing Siobhan Banks PhD Body and Brain at Work, Centre for Sleep Research University of South Australia Health and Active Ageing, 22 nd September 2015 Sleep and Aging How does sleep change as

More information

6/3/2015. Insomnia An Integrative Approach. Objectives. Why An Integrative Approach? Integrative Model. Definition. Short-term Insomnia

6/3/2015. Insomnia An Integrative Approach. Objectives. Why An Integrative Approach? Integrative Model. Definition. Short-term Insomnia Insomnia An Integrative Approach Jeffrey S. Jump, M.D. Medical Director CHI Memorial Integrative Medicine Associates Objectives Understand the importance of sleep to health Identify patients with insomnia

More information

Assessment of Sleep Disorders DR HUGH SELSICK

Assessment of Sleep Disorders DR HUGH SELSICK Assessment of Sleep Disorders DR HUGH SELSICK Goals Understand the importance of history taking Be able to take a basic sleep history Be aware the technology used to assess sleep disorders. Understand

More information

Sleep Studies: Attended Polysomnography and Portable Polysomnography Tests, Multiple Sleep Latency Testing and Maintenance of Wakefulness Testing

Sleep Studies: Attended Polysomnography and Portable Polysomnography Tests, Multiple Sleep Latency Testing and Maintenance of Wakefulness Testing Portable Polysomnography Tests, Multiple Sleep Latency Testing and Maintenance of Wakefulness Testing MP9132 Covered Service: Yes when meets criteria below Prior Authorization Required: Yes as indicated

More information

Ambien vs Rozerem There are people out there who have trouble falling asleep at night. Â Often, this would be considered as a disease that

Ambien vs Rozerem There are people out there who have trouble falling asleep at night. Â Often, this would be considered as a disease that 22-10-2013 Ambien vs Rozerem There are people out there who have trouble falling asleep at night. Â Often, this would be considered as a disease that can be treated with Ambien vs Rozerem. Ambien:. Ramelteon

More information

Sleep - Definition. Slide 1 Sleep & Developmental Disabilities: Lessons for All Children. Slide 2 Importance of Sleep. Slide 3. Lawrence W.

Sleep - Definition. Slide 1 Sleep & Developmental Disabilities: Lessons for All Children. Slide 2 Importance of Sleep. Slide 3. Lawrence W. 1 Sleep & Developmental Disabilities: Lessons for All Children March 28, 2012 Lawrence W. Brown, MD Pediatric Neuropsychiatry Program Sleep Disorders Center The Children s Hospital of Philadelphia 2 Importance

More information

PORTABLE OR HOME SLEEP STUDIES FOR ADULT PATIENTS:

PORTABLE OR HOME SLEEP STUDIES FOR ADULT PATIENTS: Sleep Studies: Attended Polysomnography and Portable Polysomnography Tests, Multiple Sleep Latency Testing and Maintenance of Wakefulness Testing MP9132 Covered Service: Prior Authorization Required: Additional

More information

Insomnia. F r e q u e n t l y A s k e d Q u e s t i o n s

Insomnia. F r e q u e n t l y A s k e d Q u e s t i o n s Insomnia Q: What is insomnia? A: Insomnia is a common sleep disorder. If you have insomnia, you may: Lie awake for a long time and have trouble falling asleep Wake up a lot and have trouble returning to

More information

Sleep: A Forgotten Component of Overall Health Demarcus Sneed Health and Human Sciences Educator Madison County October 5, 2016

Sleep: A Forgotten Component of Overall Health Demarcus Sneed Health and Human Sciences Educator Madison County October 5, 2016 Sleep: A Forgotten Component of Overall Health Demarcus Sneed Health and Human Sciences Educator Madison County October 5, 2016 Lesson Objectives Understand the importance of having consistent, quality

More information

Beyond Sleep Hygiene: Behavioral Approaches to Insomnia

Beyond Sleep Hygiene: Behavioral Approaches to Insomnia Beyond Sleep Hygiene: Behavioral Approaches to Insomnia Rocky Garrison, PhD, CBSM Damon Michael Williams, RN, PMHNP-BC In House Counseling Laughing Heart LLC 10201 SE Main St. 12 SE 14 th Ave. Suite 10

More information

WHEN SHOULD I USE SLEEP AIDS IN MY PATIENTS WITH SLEEP DISORDERS... (AND WHEN SHOULD I NOT?)

WHEN SHOULD I USE SLEEP AIDS IN MY PATIENTS WITH SLEEP DISORDERS... (AND WHEN SHOULD I NOT?) Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences WHEN SHOULD I USE SLEEP AIDS IN MY PATIENTS WITH SLEEP DISORDERS... (AND WHEN SHOULD I NOT?) CATHERINE MCCALL, MD

More information

Participant ID: If you had no responsibilities, what time would your body tell you to go to sleep and wake up?

Participant ID: If you had no responsibilities, what time would your body tell you to go to sleep and wake up? What does your sleep look like on a typical week? Total Sleep Time: Bedtime:, Sleep onset latency:, Number of Awakenings:, Wake time after sleep onset:, Rise time:, Out of bed:, Naps:? Notes: Is your sleep

More information

HOW TO DEAL WITH SLEEP PROBLEMS

HOW TO DEAL WITH SLEEP PROBLEMS The Handbook on Successful Ageing HOW TO DEAL WITH SLEEP PROBLEMS Up to 50% of the elderly complain of insomnia, but although such complaints are prevalent and are often accompanied by higher rates of

More information

Guideline for Adult Insomnia

Guideline for Adult Insomnia Guideline for Adult Insomnia Exclusions This guideline does not apply to: Children under the age of 18 Pregnant and lactating women Geriatric patients: While the general principles of the diagnosis and

More information

DRUGS THAT ACT IN THE CNS

DRUGS THAT ACT IN THE CNS DRUGS THAT ACT IN THE CNS Anxiolytic and Hypnotic Drugs Dr Karamallah S. Mahmood PhD Clinical Pharmacology 1 OTHER ANXIOLYTIC AGENTS/ A. Antidepressants Many antidepressants are effective in the treatment

More information

Insomnia: Updates in Medical Management. Michael Newnam M.D.

Insomnia: Updates in Medical Management. Michael Newnam M.D. Insomnia: Updates in Medical Management Michael Newnam M.D. Sleep Neurobiology Delicate balance of excitatory and inhibitory neurotransmitters that control the switch between wakefulness and sleep Circadian

More information

Overview of Sleep Medicine

Overview of Sleep Medicine Overview of Sleep Medicine Rodney Smith. New York Times 11-18-2007 James E. Mojica, MD, FAASM Pulmonary, Sleep, Critical Care Massachusetts General Hospital Sleep Reversible state Perceptual disengagement

More information

일차진료에서불면증치료 김종우. Primary Insomnia : DSM-IV criteria 경희대학교의과대학정신과학교실 MEMO. Diagnostic Criteria for Insomnia (ICSD-2) 개원의와함께하는임상강좌

일차진료에서불면증치료 김종우. Primary Insomnia : DSM-IV criteria 경희대학교의과대학정신과학교실 MEMO. Diagnostic Criteria for Insomnia (ICSD-2) 개원의와함께하는임상강좌 개원의와함께하는임상강좌 2011 일차진료에서불면증치료 경희대학교의과대학정신과학교실 김종우 Diagnostic Criteria for Insomnia (ICSD-2) International Classification of Sleep Disorders, 2nd Edition (ICSD-2) Primary Insomnia : DSM-IV criteria A. The

More information

Insomnia % of adults suffer from chronic and severe insomnia (Complaints of insomnia with daytime consequences)

Insomnia % of adults suffer from chronic and severe insomnia (Complaints of insomnia with daytime consequences) 10-15% of adults suffer from chronic and severe insomnia (Complaints of insomnia with daytime consequences) 30 40% of adults complain of insomnia symptoms only 95% experience insomnia at some time in their

More information

Sleep Disorders. Sleep. Circadian Rhythms

Sleep Disorders. Sleep. Circadian Rhythms Sleep Disorders Sleep The Sleep Wakefulness Cycle: Circadian Rhythms Internally generated patterns of bodily functions that vary over a ~24-hour period Function even in the absence of normal cues 2 Circadian

More information

Sleep Disorders. Anneka Rose ST5 Psychiatrist

Sleep Disorders. Anneka Rose ST5 Psychiatrist Sleep Disorders Anneka Rose ST5 Psychiatrist Agenda Basic overview of sleep structure Interactive case based discussions 5 min interventions MCQs Questions Hypnogram Actigraphy Common Scenario Patient

More information

What is sleep? o Sleep is a body s rest cycle.

What is sleep? o Sleep is a body s rest cycle. What is sleep? o Sleep is a state when our senses and motor actvity are relatively suspended; there is a total or partial unconsciousness and all voluntary muscles are inactive. o Sleep is a body s rest

More information

Sleep Medicine Questionnaire

Sleep Medicine Questionnaire Please bring this completed questionnaire with you to your sleep medicine appointment. Our sleep medicine staff strives to understand your sleep symptoms, which may be complex in nature. Thank you for

More information

Introduction. v Insomnia is very prevalent in acute (30-50%) and chronic forms (10-15%). v Insomnia is often ignored as a symptom of other disorders.

Introduction. v Insomnia is very prevalent in acute (30-50%) and chronic forms (10-15%). v Insomnia is often ignored as a symptom of other disorders. Introduction v Insomnia is very prevalent in acute (30-50%) and chronic forms (10-15%). v Insomnia is often ignored as a symptom of other disorders. v Insomnia is a risk factor for psychiatric and medical

More information

Managing Sleep Disorders in Primary Care. Objectives. Disclosures. Nancy Nadolski, FNP, MSN, M.Ed Insomnia Medicine of Idaho Boise Counseling Center

Managing Sleep Disorders in Primary Care. Objectives. Disclosures. Nancy Nadolski, FNP, MSN, M.Ed Insomnia Medicine of Idaho Boise Counseling Center Managing Sleep Disorders in Primary Care Nancy Nadolski, FNP, MSN, M.Ed Insomnia Medicine of Idaho Boise Counseling Center www.sleeplessinidaho.com 1 Objectives 1) Identify stages and behaviors for normal

More information

Available Strengths Limits. 200 mg tablets PA. 50 mg, 150 mg, 200 mg, 250 mg tablets. 500 mg/ml solution PA

Available Strengths Limits. 200 mg tablets PA. 50 mg, 150 mg, 200 mg, 250 mg tablets. 500 mg/ml solution PA MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY Sleeping Disorders P&T DATE: 12/14/2016 THERAPEUTIC CLASS Psychiatric Disorders REVIEW HISTORY: 2/16, 5/15, 2/12 LOB AFFECTED

More information

Overview. Surviving shift work. What is the circadian rhythm? Components of a Generic Biological Timing System 31/10/2017

Overview. Surviving shift work. What is the circadian rhythm? Components of a Generic Biological Timing System 31/10/2017 Overview Surviving shift work Dr Claire M. Ellender Respiratory and Sleep Physician Princess Alexandra Hospital Conflicts nil relevant Circadian rhythm Impacts of shift work on health Case example Circadian

More information

Earl J. Soileau, MD, FSAHM Asst Professor, Family Medicine LSU HSC Medical School New Orleans at Lake Charles

Earl J. Soileau, MD, FSAHM Asst Professor, Family Medicine LSU HSC Medical School New Orleans at Lake Charles Earl J. Soileau, MD, FSAHM Asst Professor, Family Medicine LSU HSC Medical School New Orleans at Lake Charles Sleep Disorders Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD) Sleep

More information

Learning Objectives. Management of Insomnia. Impact of Chronic Insomnia. Insomnia: Definitions. Measurement of Goals. Goals of Therapy 9/29/2017

Learning Objectives. Management of Insomnia. Impact of Chronic Insomnia. Insomnia: Definitions. Measurement of Goals. Goals of Therapy 9/29/2017 Learning Objectives Characterize insomnia and its negative effects Management of Insomnia Discuss the goals of treatment Summarize guidelines of management of insomnia including non-pharmacologic and pharmacologic

More information

Dr Alex Bartle. Sleep Well Clinic

Dr Alex Bartle. Sleep Well Clinic Dr Alex Bartle Sleep Well Clinic Overview of Sleep Disorders Sleep: Why bother. Effect of Poor Quality or reduced Quantity of Sleep Common Sleep Disorders Management of Insomnia Medication vs CBTi Conclusion

More information

CBT for Insomnia: Past, Present, and Future Directions

CBT for Insomnia: Past, Present, and Future Directions CBT for Insomnia: Past, Present, and Future Directions J. Todd Arnedt, Ph.D. Associate Professor of Psychiatry and Neurology Director, Behavioral Sleep Medicine Program Acting Director, Sleep and Circadian

More information

Sleep Center. Have you had a previous sleep study? Yes No If so, when and where? Name of facility Address

Sleep Center. Have you had a previous sleep study? Yes No If so, when and where? Name of facility Address Patient Label For office use only Appt date: Clinician: Sleep Center Main Campus Highlands Ranch Location 1400 Jackson Street 8671 S. Quebec St., Ste 120 Denver, CO 80206 Highlands Ranch, CO 80130 Leading

More information

RECIPES FOR A GOOD NIGHT S SLEEP

RECIPES FOR A GOOD NIGHT S SLEEP RECIPES FOR A GOOD NIGHT S SLEEP Maribeth Gallagher, PMHNP-BC, MS Hospice of the Valley Objectives: Describe the most common changes in sleep that occur in older adults. Discuss the possible negative effects

More information

Sweet Dreams. Guide to Getting a Good Night s Sleep

Sweet Dreams. Guide to Getting a Good Night s Sleep Sweet Dreams Guide to Getting a Good Night s Sleep Objectives Learn sleep facts, common myths about sleep, and the consequences of sleep deprivation Discover how sleep works and what interferes with sleeping

More information

SLEEP DISORDERED BREATHING The Clinical Conditions

SLEEP DISORDERED BREATHING The Clinical Conditions SLEEP DISORDERED BREATHING The Clinical Conditions Robert G. Hooper, M.D. In the previous portion of this paper, the definitions of the respiratory events that are the hallmarks of problems with breathing

More information

SLEEP QUESTIONNAIRE. Please briefly describe your sleep or sleep problem:

SLEEP QUESTIONNAIRE. Please briefly describe your sleep or sleep problem: SLEEP QUESTIONNAIRE Your answers to the following questions will help us to obtain a better understanding of your sleep problems. Please answer every question to the best of your ability. It is helpful

More information

Dr Alex Bartle. Medical Director Sleep Well Clinic Christchurch

Dr Alex Bartle. Medical Director Sleep Well Clinic Christchurch Dr Alex Bartle Medical Director Sleep Well Clinic Christchurch 8:30-9:25 WS #191: Sleep Disorders in The Elderly 9:35-10:30 WS #203: Sleep Disorders in The Elderly (Repeated) REM - Rapid Eye Movement

More information

Sleep in the Patient with Diabetes

Sleep in the Patient with Diabetes Sleep in the Patient with Diabetes ANDREA RINN, DO SEPTEMBER, 2017 Learning Objectives 1. Recognize the correlation between sleep apnea and diabetes 2. Review potential relationships between sleep and

More information