Sleep Disorders and Insomnia
|
|
- Allyson Davidson
- 5 years ago
- Views:
Transcription
1 7:45 8:45 am Management of Insomnia and Other Disorders SPEAKER Alon Y. Avidan, MD, MPH, FAAN, FAASM Presenter Disclosure Information The following relationships exist related to this presentation: Alon Y. Avidan, MD, MPH, FAAN, FAASM: Speakers Bureau for Merck & Co., Inc. and XenoPort, Inc. Off-Label/Investigational Discussion In accordance with pmicme policy, faculty have been asked to disclose discussion of unlabeled or unapproved use(s) of drugs or devices during the course of their presentations. Disorders and Insomnia What is Insomnia? Difficulties Falling Asleep Difficulties Maintaining Early Morning Awakenings Alon Y. Avidan, M.D., M.P.H, Professor, UCLA Department of Neurology Director, UCLA Disorders Center Next Day Consequences: Fatigue Attention, concentration, or memory impairment Social/vocational dysfunction Mood disturbance/irritability Proneness for errors/accident at work or while driving Tension headaches, and/or GI symptoms in response to sleep loss Concerns or worries about sleep ICSD III Despite adequate opportunity for sleep. Prevalence of Insomnia by Age Group DSM-5 INSOMNIA nights/wk 3 months Initiation Maintaining Waking early Percent Trouble falling asleep Frequent awakening or trouble returning to sleep after awakening Waking earlier than desired Age Group Mellinger GD et al. Arch Gen Psychiatry. 1985;42: APA Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: DSM-5
2 Causes of Insomnia Primary / psychophysiologic 20% Periodic limb movement 10% Circadian rhythm ( DSPS / shift ) 10% Breathing related 5% Psychiatric 40% Other 10% Substances 5% Ohayon MM. Med Rev. 2002;6: Insomnia According to Timing at Night Difficulties Initiating RLS Anxiety Drugs Difficulties Maintaining Primary Disorder: OSA, Nocturia Poor sleep environment Early morning awakening ASPS Depression Drugs Approach to the Management of Insomnia Cognitive & Behavioral Therapy This technique Targets these symptoms Diagnosis 1,2 restriction Excessive time spent in bed; fragmented sleep Education, including good sleep practices 1,2 Stimulus control Relaxation Techniques Associating bed with wakefulness High physiologic, cognitive, or emotional arousal Nonpharmacologic and/or pharmacologic therapy 1,2 Cognitive Misconceptions about sleep and insomnia hygiene education Behaviors that undermine good quality sleep Referral to sleep specialist (in cases of treatment failure) 1 1. Kupfer DJ, Reynolds CF III. N Engl J Med. 1997;336: [Evidence Level C]; 2. Consensus Conference. Drugs and insomnia. JAMA ;251: [Evidence Level C] 1. Spielman AJ et al. Psychiatr Clin North Am. 1987;10: ; 10: Walsh JK et al. NIH Publication No Morin CM. Principles and Practice of Medicine. 2005: Ringdahl EN et al. J Am Board Fam Pract. 2004;17:
3 14 What Do People Take to Try to Improve Their? Alcohol 1,2,3 Herbals 3,4 Dietary supplements 1,4 Homeopathic preparations 4 Melatonin 1,3,4 OTC sleep aids 2 Sedating antidepressants 1 Sedative-hypnotics 1,5 Melatonin receptor agonist Hypocretin Receptor Antagonist 1. Neubauer DN. Clinical Cornerstone. 2003;5: Ancoli-Israel S, Roth T ;22(suppl 2):S347-S Wagner J et al. Neuro 4. Larzelere MM, Wiseman P.Prim Care Clin Office Pract. 2002;29: Mitler MM ;23(suppl 1):S39-S47. What Do People Take to Try to Improve Their? 28% use alcohol Characteristics of the Ideal Hypnotic No memory deficits No respiratory depression No interaction with ethanol No tolerance Rapid absorption Ideal Hypnotic Address underlying pathophysiology Rapid sleep induction Minimal adverse effect on sleep physiology Optimal duration of action No physical dependence No rebound insomnia No residual effects No formation of active metabolites Adapted from Mendelson et al. Med Rev 2004;8: Drug classes Hypnotics: Mechanism of Action & Labeling Class 1 Drugs 1,2 Acts on:1 Controlled Substance Schedule 2 Barbiturates Phenobarbital, mephobarbital, amobarbital, secobarbital Non-selective CNS depressants II, III, IV Antipsychotics Quetiapine, risperidone, aripiprazole Dopamine, serotonin Not scheduled Histamine Receptor Antagonist BZA Receptor Agonists Melatonin Receptor Agonist Hypocretin Receptor Antagonist Antidepressants Tradozone, amitriptyline Serotonin/histamine Not scheduled Benzodiazepines Temazepam, estazolam, GABA IV flurazepam, quazepam, triazolam Antihistamines Diphenhydramine 5 Histamine Not scheduled Doxepin Zolpidem Eszopiclone Zaleplon Triazolam Ramelteon Suvorexant Nonbenzodiazepines Zolpidem, eszopiclone, zaleplon GABA IV Melatonin receptor agonist Ramelteon Melatonin Not scheduled Selective H 1 receptor antagonist 3 Doxepin Histamine H 1 Not scheduled Orexin receptor antagonist 4 Suvorexant Orexin IV 1. Roth T, Culpepper L. Clinical Symposia. 2008;58:1-32; 2. Controlled Substances Act. Accessed June 9, 2015; 3. SILENOR (doxepin) [package insert]. Morristown, NJ: Pernix Therapeutics; 2014; 4. Belsomra (suvorexant) [package insert]. Whitehouse Station, NJ; Merck and Co. 2014; 5. Richardson GS et al. J Clin Psychopharmacol. 2002;22:
4 DRUGS INDICATED FOR INSOMNIA Generic Brand T 1/2 (Hours) Dose (mg) Drug Class Flurazepam Dalmane BZD Temazepam Restoril BZD Triazolam Halcion BZD Estazolam Prosom BZD Quazepam Doral BZD Zolpidem Ambien non-bzd Zaleplon Sonata non-bzd Eszopiclone Lunesta non-bzd Zolpidem Ex Rel Ambien CR * non-bzd Ramelteon Rozerem MT agonist Silenor Doxepin , 6 H 1 Antagnonist Suvorexant Belsomra 12 5, 10, 15, 20 Hcrt Antagonist Agent Initiates Maintains with limited opportunity Required Inactivity (hr) Dose (mg) Eszopiclone 8+ 1,2,3 Zaleplon 4 5,10 Zolpidem 7-8 5,10 Extended release , 12.5 Intermezzo (Sublingual) (4 hrs) , , 10 Zolpimist (oral spray) Elduar (Sublingual) 4 5, 10 Silenor 7-8 3, 6 Ramelteon - 8 Suvorexant 7 5, 10, 15, 20 * Modified formulation. No short-term use limitation. BZRA Hypnotics: Possible Adverse Effects OREXIN MELATONIN HISTAMIN 25 26
5 27 OBSTRUCTIVE SLEEP APNEA SYNDROME THE ANATOMY OF SLEEP APNEA Obesity Trends in the US: CDC Dataset Prevalence of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2014 Prevalence estimates reflect BRFSS methodological changes started in These estimates should not be compared to prevalence estimates before *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) 30%.
6 THE ANATOMY OF SLEEP APNEA Phenotypic Features Consistent with OSA 39 EKG Airflow Exhale Airway obstructs Airway opens Thorac ic effort Abd. effort Inhale Effort gradually increases Paradoxin g Paradoxing Ends SAO2 Blood oxygen levels reduce to < 3% of baseline value Obstructive Apnea A complete blockage of the airway despite efforts to breath. Notice the effort gradually increasing ending in airway opening. Kryger: Principles and Practice of Medicine, 5th ed. Nuchton, TJ et al Jul;29(7): Treatment of OSA Weight loss CPAP/BiPAP Positional Tx Oral Appliances UPPP LAUP Bimax Advancement Trach Drugs Avoidance of Rx/Etoh
7 CPAP SLEEP HYPNOGRAM Splint the airway open Gold Standard Tx for OSA Courtesy Richard Schwab, M.D. UPENN OXYGEN SATURATION CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) Restless Legs Syndrome Nasal Pillows Nasal Aire Willis Ekbom Disease Willis-Ekbom Disease Differential Diagnosis of RLS Essential Criteria* Supportive Features* disturbances Urge to move the legs usually accompanied or caused by uncomfortable leg Periodic leg movements sensations Positive family history for RLS Getting up: Temporary relief with movement partial or total relief from discomfort by walking or stretching Positive response to dopaminergic therapy Rest: Onset or worsening of symptoms at rest or inactivity, such as when lying or sitting Evening: Worsening or onset of symptoms in the evening or at night * Diagnostic criteria developed by the International RLS (IRLS) Study Group in collaboration with the National Institutes of Health (NIH). Allen et al. Med. 2003;4:
8 RLS RLS is a symptom based Dx PLMS PLMS are an EMG finding Management of RLS Conservative Tx Pharmacotehrapy RLS is Dx in the physician s office PLM s are Dx in the sleep lab Alerting activities Iron state Ferritin <45 ug/l 80% of people who have RLS will have PLM s 30% of individuals who have PLM s have RLS symptoms Avoid Etoh, Caffeine Nicotine Review Medications 1. Ropinirole, 2. Pramipexole, 3. Rotigotine 4. Gabapentin Enacarbil FDA-approved medication for the treatment of moderate-tosevere primary RLS. Hypnotics Levodopa, Opioids Silber, M, et al September 2013;88(9): Narcolepsy Disorder of unknown etiology Consists of: Excessive sleepiness REM sleep phenomena (i.e cataplexy) PARASOMNIAS Undesirable motor, or verbal phenomena that arise from sleep or sleep - wake transition Case WAKE A 64 y/o man presented to the ER with a broken wrist experienced during a fighting dream. For the last 6m, he has been sleeping in a separate room than his wife after he had punched her during one of these dreams. What is the most likely diagnosis? REM NREM NREM
9 REM Behavior Disorder RBD is most commonly associated with neurodegenerative disease, particularly ɑ-synucleinopathies: RBD Rates of Phenoconversion Parkinson s disease Dementia with Lewy Bodies Multiple System Atrophy Barcelona GroupIranzo A, Fernandez-Arcos A, Tolosa E et al, PLOS ONE 2014;9:e89741 Drug (*) Dose Level of Special considerations Recommendation Clonazepa m Melatonin Pharmacologic treatment of RBD Environmental Safety mg QHS 3 mg to 12 mg before bedtime. Suggested ( ) Suggested ( ) (*) Not FDA approved for the treatment of RBD. ( ) Supported by sparse high grade evidence data, or a substantial amount of low-grade data and/or clinical consensus. ( ) Supported by low grade data. Use with caution in patient s with dementia, gait disorders, or concomitant OSA. Side effect include sedation, impotence, motor incoordination, confusion and memory dysfunction. Effective in patients with alphasynucleinopathies, memory problems, and sleep-disordered breathing. Side effects include headaches, sleepiness and delusions/hallucinations. Summary: Treatments of Disorders Condition Nonpharmacologic Pharmacologic Insufficient Syndrome Obstructive Apnea Increase total sleep time, e.g., naps Positive Pressure Therapy Airway surgery (CPAP) Not recommended Modafinil* (for residual sleepiness with CPAP compliance) Insomnia Behavioral Tx BZA *, non-bza agonists*, H1 antidepressants*, melatonin agonist, Hcrt antagonist* Narcolepsy Prophylactic power naps Modafinil,* dexamphetamine,* methylphenidate* RLS Hot bath, massage Dopaminergic agents, Dopamine agonist*, α2 delta ligand. Parasomnias Safety, Avoid exacerbating factors BZA
14. Percent Mellinger GD et al. Arch Gen Psychiatry. 1985;42: ICSD III
4:45 5:45 pm Management of Insomnia and Other Disorders Presenter Disclosure Information The following relationships exist related to this presentation: Alon Y. Avidan, MD, MPH, FAAN, FAASM: Speakers Bureau
More information14. Percent
4:30 5:45 pm Management of Insomnia and Other Disorders Presenter Disclosure Information The following relationships exist related to this presentation: Alon Y. Avidan, MD, MPH, FAAN, FAASM: Speakers Bureau
More informationDSM-5 INSOMNIA. Maintaining. Maintaining Sleep. Difficulty Falling Asleep: Difficulty. Early AM awakenings: (> 30 minutes before desired wake time)
DSM-5 INSOMNIA 3 nights/wk 3 months Difficulty Falling Asleep: > 30 minutes Difficulty Maintaining Sleep Next Day Consequences Early AM awakenings: (> 30 minutes before desired wake time) Initiation Trouble
More informationDefinitions. Prevalence. Chronic Insomnia DSM-5 INSOMNIA. Insomnia Is a Distinct Disorder That Should Be Treated ~10% 3 nights/wk 3 months
Chronic Definitions Alon Y. Avidan, M.D., M.P.H UCLA Sleep Disorders Center Is a Distinct Disorder That Should Be Treated NIH (1983) 1 NIH (2005) 2 is a symptom, is a disorder not a disorder DSM-5 INSOMNIA
More informationInsomnia: 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 informationInsomnia treatment. Sleep hygiene education sleep hygiene teaches good sleeping habits. This includes:
Insomnia treatment INSOMNIA OVERVIEW insomnia is defined as difficulty falling asleep, difficulty staying asleep, or waking up early in the morning and not being able to return to sleep. In general, people
More informationInsomnia. 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 informationQuestion #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 informationInsomnia. 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 informationINSOMNIA 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 informationAvailable 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 informationPharmacological 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 informationThe Medical Letter. on Drugs and Therapeutics. Usual Adult Hypnotic Dose 1,2 Some Adverse Effects Comments Cost 3
The Medical Letter publications are protected by US and international copyright laws. Forwarding, copying or any other distribution of this material is strictly prohibited. For further information call:
More informationInsomnia 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 informationAddressing Pharmacologic Issues in. DSM-5 Sleep-Wake. Insomnia. Disorders. DSM-5 Insomnia Disorder. Insomnia. Disorder
Addressing Pharmacologic Issues in David N. Neubauer, MD Associate Professor of Psychiatry and Behavioral Sciences Johns Hopkins School of Medicine Baltimore, Maryland Restless Legs Syndrome Substance/
More informationInsomnia 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 informationLearning 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 informationSLEEP 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 informationManaging 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 informationOBJECTIVES. 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 informationParkinson 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 informationSleep Disorders: Assessment and Therapeutic Options
Sleep Disorders: Assessment and Therapeutic Options John W. Winkelman MD, PhD Chief, Sleep Disorders Clinical Research Program Departments of Psychiatry and Neurology Massachusetts General Hospital Professor
More informationAGING 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 informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: Non-Benzodiazepine Insomnia Reference Number: CP.PMA_10.11.23 Effective Date: 07.16 Last Review Date: 04.18 Line of Business: Medicaid- Arizona (AHCS, CIC) Revision Log See Important Reminder
More informationModern Management of Sleep Disorders. If Only I Could Sleep Like I Did Before
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 Sleep Case 52 yr. old WF with >4 yr. of poor sleep
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: Non-Benzodiazepine Insomnia Medications Reference Number: CP.HNMC.265 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Medicaid Medi-Cal Revision Log See Important Reminder
More informationSleep 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 informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: Non-Benzodiazepine Insomnia Medications Reference Number: CP.CPA.265 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Commercial Revision Log See Important Reminder at
More informationModern 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 informationInsomnia Treatment in Brief
Insomnia Treatment in Brief Project ECHO May 7, 2015 Jonathan Emens, M.D. Associate Professor, Departments of Psychiatry and Internal Medicine Oregon Health & Science University Staff Physician and Sleep
More informationSLEEP-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 informationOUTLINE 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 informationWHY 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 informationHow 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 informationDiagnosis 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 informationIndex. 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 informationModern 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 informationTreating 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 informationSedative Hypnotics. Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.60.11 Subject: Sedative Hypnotics Page: 1 of 8 Last Review Date: September 15, 2016 Sedative Hypnotics
More informationPsychopharmacology of Sleep Disorders
Psychopharmacology of Sleep Disorders John W. Winkelman MD, PhD Chief, Sleep Disorders Clinical Research Program Departments of Psychiatry and Neurology Massachusetts General Hospital Professor of Psychiatry
More informationSedative Hypnotics. Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.60.11 Subject: Sedative Hypnotics Page: 1 of 7 Last Review Date: December 8, 2017 Sedative Hypnotics
More informationSleep 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 informationSleep 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 informationManaging 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 informationDr 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 informationFacts 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 informationSleep 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 informationSEDATIVE-HYPNOTIC AGENTS
SEDATIVE-HYPNOTIC AGENTS Documentation A. FDA approved indications 1. Insomnia 2. Sedation for an agitated patient in an inpatient setting Documentation B. Non-FDA approved, commonly used indications 1.
More informationCPT 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 informationHEALTHY 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 informationInsomnia. 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 informationTreating 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 informationINSOMNIA IN GERIATRICS. Presented By: Sara Kamalfar MD, Geriatrics Medicine Fellow
INSOMNIA IN GERIATRICS Presented By: Sara Kamalfar MD, Geriatrics Medicine Fellow Insomnia Insomnia is the inability to fall asleep, the inability to stay asleep, or waking up earlier than desired. To
More information노인병원에서 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 informationcontinuing education for pharmacists
continuing education for pharmacists General Insomnia Disorder in Adults and Treatment Guidelines Amanda R. Kriesen, R.Ph., PharmD Volume XXXV, No. 9 Dr. Amanda Kriesen has no relevant financial relationships
More informationAnxiolytic and Hypnotic drugs
Anxiolytic and Hypnotic drugs Anxiolytic and Hypnotic drugs Anxiety is unpleasant state of tension and fear that seems to arise from unknown source. The symptoms of severe anxiety are similar to those
More informationSLEEP 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 informationBasics of Restless Legs Syndrome (Willis-Ekbom Disease)
Basics of Restless Legs Syndrome (Willis-Ekbom Disease) Michael H. Silber, M.B.Ch.B. Professor of Neurology Mayo Clinic College of Medicine Objectives Understand how RLS is diagnosed Understand what we
More informationIndex. 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 informationSleep Disorders in the Psychiatric Context
Sleep Disorders in the Psychiatric Context John W. Winkelman MD, PhD Chief, Sleep Disorders Clinical Research Program Departments of Psychiatry and Neurology Massachusetts General Hospital Associate Professor
More informationAddressing the Multiple Causes and Lifestyle Impacts of Insomnia: A Guide for Patient Counseling
Addressing the Multiple Causes and Lifestyle Impacts of Insomnia: A Guide for Patient Counseling Educational Objectives: At the completion of this knowledge-based activity, participants will be able to:
More informationTOP 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 informationRestless Legs Syndrome: Is This a Pain Issue?
Restless Legs Syndrome: Is This a Pain Issue? Kathy Lattavo, RN, MSN, ACNS- BC, RN-BC Objectives Describe the pathophysiology of RLS. Evaluate treatment for RLS. Compare & contrast RLS & pain. Definitions
More informationACTIVITY DESCRIPTION Target Audience Learning Objectives
ACTIVITY DESCRIPTION Target Audience This activity is designed to meet the needs of primary care providers, including primary care physicians, doctors of osteopathy, physician assistants, nurse practitioners,
More informationDepression & Anxiety. What can I do? What are other possible treatments? What is this? Why does this happen? KEY POINTS
Depression & Anxiety One set of important protectors from depression is friends and family as much as you can, keep yourself active and engaged with others. Exercise, particularly while outside, may help.
More informationDiana 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 informationIndex 265. Feeding bottle, 37 methods, 37
Index 263 Index A Actigraphy delayed sleep phase syndrome, 66f Activity, 19 Adenoidectomy OSAHS, 121 Adolescents insomnia, 71 81 assessment and treatment, 76 78 etiology, 75, 76 female, 74, 75 sleep need
More informationSleep 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 informationOverview 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 informationRESTLESS LEGS SYNDROME IN CHILDREN AND ADOLESCENTS
RESTLESS LEGS SYNDROME IN CHILDREN AND ADOLESCENTS Tracy Carbone, MD Medical Director of Sleep Medicine Lee Health Golisano Children s Hospital of Southwest Florida Fort Myers, FL OVERVIEW Although the
More informationPharmacy 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 informationEarl 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 informationDRUGS 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 informationInsomnia 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 informationSleeping with PD. Jean Tsai, MD PhD September 27, 2014
Sleeping with PD Jean Tsai, MD PhD September 27, 2014 Evaluation of sleep Assessment at least annually recommended by Agency for Healthcare Research and Quality (AHRQ) of the US Dept of Health and Human
More informationThe Use of Sleep Aids in Our Society Today
The Use of Sleep Aids in Our Society Today Kathryn Hansen, BS, CPC, CPMA, REEGT Integration Consultants, LLC Sleep Education Partners Executive Director Kentucky Sleep Society Executive Director Society
More informationIndividual 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 informationWhat 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 informationHealthy 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 informationINTRINSIC 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 informationInsomnia % 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 informationCBT 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 informationA Review of Sleep Disorders in Cancer Patients: Finding the Dream Treatment
A Review of Sleep Disorders in Cancer Patients: Finding the Dream Treatment Jordan Pleskow, PharmD Roswell Park Cancer Institute Oncology Symposium 11/11/17 Objectives Evaluate the issues with sleep in
More informationIndex. 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 information일차진료에서불면증치료 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 informationChronic 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 informationAmbien 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 informationTreatment of sleep disorders in
Treatment of sleep disorders in Parkinson s s disease (PD) K. Ray Chaudhuri London, UK GPSRC CNS 176 0709 RTG 1 Managing insomnia in PD Onset/initiation Adjustment of anti-pd treatment Sleep hygiene Hypnotics
More informationSleep Problems in the Elderly
Emerging Challenges in Primary Care: 2017 Sleep Problems in the Elderly To Sleep, Perchance to Dream Ay There s The Rub MACBETH 1 Faculty Thomas Weiss, MD Researcher and Principle Investigator in Psychiatry
More informationSleep Clinic Case: History. Insomnia in Patients with Comorbid Psychiatric Disorders: Shared Neurobiology and Clinical Solutions
Sleep Clinic Case: History Insomnia in Patients with Comorbid Psychiatric Disorders: Shared Neurobiology and Clinical Solutions David N. Neubauer, MD Associate Professor Johns Hopkins University School
More informationInsomnia. 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 informationInsomnia: 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 informationDisclosure. Sleep Medications in Primary Care: How to choose, what to avoid
Sleep Medications in Primary Care: How to choose, what to avoid Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC, FNAP President, Fitzgerald Health Education Associates, North Andover,
More informationFaculty/Presenter Disclosure
A Little CBT I With My Tea Please: Cognitive Behavioural Therapy for insomnia (CBT I) and Its Use In the Treatment of Sleeplessness W. Jerome Alonso, MD Medical Director, Canadian Sleep Consultants Clinical
More informationParkinson s Founda.on
Parkinson s Founda.on PD ExpertBriefing: Sleep and Parkinson s Led By: Aleksandar Videnovic, M.D., M.Sc. Associate Professor of Neurology; Director, MGH Program on Sleep, Circadian Biology and NeurodegeneraDon
More informationDr 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 information9/13/17. Emerging Challenges in Primary Care: Sleep Problems in the Elderly. Faculty. Disclosures
Emerging Challenges in Primary Care: 2017 Sleep Problems in the Elderly To Sleep, Perchance to Dream Ay There s The Rub MACBETH 1 Faculty Thomas Weiss, MD Researcher and Principle Investigator in Psychiatry
More informationInsomnia Pearls in the Geriatric Population
Insomnia Pearls in the Geriatric Population September 9, 2016 Stephanie Loegering, PharmD, CGP Clinical Pharmacist VA Medical Center Thank You MPhA Wi-fi Information: NETWORK: EC-CTR PASSWORD: westgate252
More informationHARVARD PILGRIM HEALTH CARE RECOMMENDED MEDICATION REQUEST GUIDELINES. SEDATIVE HYPNOTIC AGENTS Generic Brand HICL GCN Exception/Other ZOLPIDEM
Generic Brand HICL GCN Exception/Other ZOLPIDEM AMBIEN 07842 GENERIC IS UNRESTRICTED TARTRATE AMBIEN CR EDLUAR INTERMEZZO ZOLPIMIST ESZOPICLONE LUNESTA 26791 GENERIC IS UNRESTRICTED RAMELTEON ROZEREM 33126
More informationOverview 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 What is Sleep? Reversible state Perceptual disengagement
More information