Behavioral Sleep Medicine W 12:50p 3:50p, HPNP G103 CLP 7934 Section 03A4 Fall 2013 Instructor: Office hours: Christina McCrae, PhD, CBSM Department of Clinical & Health Psychology HPNP, Room 3139 csmccrae@phhp.ufl.edu 352.273.6053 by appointment WELCOME CLP 7934 Behavioral Sleep Medicine is a graduate seminar that will review normal and pathological sleep processes and the variety of sleep disorders. While this course will focus on behavioral interventions, medical interventions will also be covered. Course Objectives: Upon completing this course, you will be able to: 1. Describe normal human sleep, including its characteristics and how it is measured. 2. Discuss how human sleep develops from infancy to old age. 3. Describe the biological rhythms involved in regulating the human sleep/wake cycle. 4. Recognize the signs and symptoms of common sleep disorders, such as insomnia and sleep apnea. 5. Conduct a thorough sleep history interview, and generate a working diagnosis. 6. Describe the typical approaches to treating common sleep disorders (e.g., insomnia, sleep apnea). 7. Discuss practice and clinical research issues relevant to sleep psychologists and physicians.. 1
Required Readings: Mindell, J. A., & Owens, J. A. (2003). A clinical guide to pediatric sleep: diagnosis and management of sleep problems. Philadelphia, PA: Lippincott Williams & Wilkins. Perlis, M. L., Aloia, M., & Kuhn, B. (2011). Behavioral treatments for sleep disorders: A comprehensive primer of behavioral sleep medicine interventions. New York: Academic Press/Elsevier. Kryger, M. H., Roth, T., & Dement, W. C. (2011). Principles and practice of sleep medicine (5th ed.). St. Louis, MO: Saunders. Selected readings/articles (see below). Diagnostic Schemas/References: American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5 th ed., pp. 361-422). Washington, DC: Author. (DSM-5). American Sleep Disorders Association. (2005). International classification of sleep disorders: Diagnostic and coding manual, Second Edition. Rochester, MN: Author. REQUIREMENTS (details p. 4) Discussion Leadership Quizzes 150 points 150 points Total 300 points GRADES A = 93.0%+ 279+ points A- = 90.0%-92.9% 270-278 points B+ = 87.0%-89.9% 261-269 points B = 83.0%-86.9% 249-260 points B- = 80.0%-82.9% 240-248 points C+ = 77.0%-79.9% 231-239 points C = 73.0%-76.9% 219-230 points C- = 72.9% and below 218 points and below UNIVERSITY POLICIES Please review the University's honesty policy regarding cheating and use of copyrighted materials on the University web site. Academic dishonesty (plagiarism, cheating, etc.) will not be tolerated and will be handled according to UF policy. Students with disabilities or conditions requiring accommodation should contact the Office for Students with Disabilities, 392-1261, ext. 143. Students requesting classroom accommodation must first register with the Dean of Students Office. That office will provide documentation to the Instructor concerning accommodation of student needs. TIMETABLE (tentative) 2
Week 1 (8/21): Historical Perspectives Manber, R., & Harvey, A. (2005). Historical perspective and future directions in Cognitive Behavioral Therapy for insomnia and behavioral sleep medicine. Clin Psychol Rev, 25(5), 535-538. McCrae, C. S., Taylor, D. J., Smith, M. T., & Perlis, M. L. (2010). The future of Behavioral Sleep Medicine: A report on the presentations given at the Ponte Vedra Behavioral Sleep Medicine Consensus Conference, March 27-29, 2009. Behavioral Sleep Medicine, 8, 74-89. Stepanski, E. J., & Perlis, M. L. (2000). Behavioral sleep medicine. An emerging subspecialty in health psychology and sleep medicine. J Psychosom Res, 49(5), 343-347. Taylor, D. J., Perlis, M. L., McCrae, C. S., & Smith, M. T. (2010). The future of Behavioral Sleep Medicine: A report on consensus votes at Behavioral Sleep Medicine Consensus Conference, March 27-29, 2009. Behavioral Sleep Medicine, 8, 63-73. Week 2 (8/28): Normal Sleep and Its Variations; Methodology Aserinsky, E., & Kleitman, N. (1953). Regularly occurring periods of eye motility, and concomitant phenomena during sleep. Science, 118, 273-274. PPSM Ch 2 Normal human sleep PPSM Ch 3 Normal aging PPSM Ch 141 Monitoring and staging human sleep PPSM Ch 142 Monitoring techniques for evaluating suspected sleep-disordered breathing PPSM Ch 143 Evaluating sleepiness Week 3 (9/4): Impact, Presentation, and Diagnosis (Bring both the ICSD-2 and DSM-5 to class) PPSM Ch 56 Approach to the patient with disordered sleep PPSM Ch 57 Cardinal manifestations of sleep disorders PPSM Ch 59 Use of clinical tools and tests in sleep medicine PPSM Ch 60 Classification of sleep disorders Week 4 (9/11): Chronobiology PPSM Ch 31 Introduction: Master circadian clock and master circadian rhythm PPSM Ch 35 The human circadian timing system and sleep-wake regulation PPSM Ch 36 Melatonin and the regulation of sleep and circadian rhythms PPSM Ch 37 Sleep homeostasis and models of sleep regulation PPSM Ch 41 Circadian disorders of the sleep-wake cycle Morgenthaler, T.I, Lee-Chiong, T., Alessi, C., Friedman, L., Aurora, R.N., Boehlecke, B., Brown, T., Chesson, A.L., Kapur, V., Maganti, R., Owens, J., Pancer, J., Swick, T.J., Zak, R. (2007). Practice parameters for the clinical evaluation and treatment of circadian rhythm sleep disorders. An American Academy of Sleep Medicine report. Sleep, 30(11), 1445-1459. Week 5 (9/18): Chronobiology (cont.) & Occupational Sleep Medicine PPSM Ch 64 Occupational sleep medicine: Introduction PPSM Ch 67 Fatigue, performance, errors, and accidents PPSM Ch 70 Sleep and performance monitoring in the workplace PPSM Ch 71 Shift work, shift-work disorder, and jet lag Week 6 (9/25): Insomnia PPSM Ch 75 Insomnia: Recent developments and future directions PPSM Ch 76 Insomnia: Epidemiology and risk factors PPSM Ch 77 Insomnia: Diagnosis, assessment, and outcomes PPSM Ch 78 Models of insomnia Edinger, J. D., Bonnet, M. H., Bootzin, R. R., Doghramji, K., Dorsey, C. M., Espie, C. A., Jamieson, A. O., McCall, W. V., Morin, C. M., & Stepanski, E. J. (2004). Derivation of research diagnostic criteria for insomnia: Report of an American Academy of Sleep Medicine Work Group, Sleep, 27, 1567-96. Schutte-Rodin, S., Broch, L., Buysse, D., Dorsey, C., & Sateia, M. (2008). Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of Clinical Sleep Medicine, 4(5), 487-504. Week 7 (10/2): Insomnia (cont.) 3
PPSM Ch 79 PPSM Ch 80 PPSM Ch 81 PPSM Ch 82 Psychological and behavioral treatments for insomnia I: Approaches and efficacy Psychological and behavioral treatments for insomnia: Implementation and specific populations Pharmacologic treatment of insomnia: Benzodiazepine receptor agonists Pharmacologic treatment: Other medications Irwin, M.R., Cole, J.C., & Nicassio, PM. (2006). Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age. Health Psychology, 25(1), 3-14. Morin, C.M., Bootzin, R.R., Buysse, D.J., Edinger, J.D., Espie, C.A., & Lichstein, K.L. (2006). Psychological and behavioral treatment of insomnia: update of the recent evidence (1998-2004). Sleep, 29(11):1398-1414. Smith MT, Perlis ML, Park A, Smith MS, Pennington J, Giles DE, Buysse DJ. (2002). Comparative metaanalysis of pharmacotherapy and behavior therapy for persistent insomnia. American Journal of Psychiatry, 159, 5-11. Week 8 (10/9): Behavioral Sleep Medicine Interventions Perlis, Aloia, & Kuhn Ancoli-Israel, S. (2006). The impact and prevalence of chronic insomnia and other sleep disturbances associated with chronic illness. The American Journal of Managed Care, 12, S221-229 NIH State-of-the-Science Conference Statement on Manifestations and Management of Chronic Insomnia in Adults (June, 2005). Morgenthaler, T.I., Kramer, M., Alessi, C., Friedman, L., Boehlecke, B., Brown, T., Coleman, J., Kapur, V., Lee-Chiong, T., Owens, J., Pancer, J., & Swick, T. (2006). Practice parameters for the psychological and behavioral treatment of insomnia: an update. An American Academy of Sleep Medicine report. Sleep, 29(11), 1415-1419. Week 9 (10/16): Pediatric Sleep Disorders Mindell & Owens Fallone, G., Owens, J. A., & Deane, J. (2002). Sleepiness in children and adolescents: clinical implications. Sleep Med Rev, 6(4), 287-306. Mindell, J.A., Kuhn, B., Lewin, D.S., Meltzer, L.J., & Sadeh, A. (2006). Behavioral treatment of bedtime problems and night waking in infants and young children. SLEEP, 29(10), 1263-1276. Morgenthaler, T.I., Owens, J., Alessi, C., Boehlecke, B., Brown, T.M., Coleman, J., Friedman, L., Kapur, V.K., Lee-Chiong, T., Pancer, J., Swick, T.J. (2006). Practice parameters for behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep, 29(10), 1277-1281. Week 10 (10/23): Parasomnias PPSM Ch 94 Non-REM arousal parasomnias PPSM Ch 95 REM sleep parasomnias PPSM Ch 96 Other parasomnias PPSM Ch 98 Disturbed dreaming as a factor in medical conditions PPSM Ch 99 Sleep bruxism Week 11 (10/30): Sleep Breathing Disorders PPSM Ch 100 Central sleep apnea and periodic breathing PPSM Ch 101 Anatomy and physiology of upper airway obstruction PPSM Ch 106 Medical therapy for obstructive sleep apnea PPSM Ch 107 Positive airway pressure treatment for obstructive sleep apnea-hypopnea syndrome Week 12 (11/6): Neurological Disorders PPSM Ch 84 Narcolepsy: Pathophysiology and genetic predisposition PPSM Ch 85 Narcolepsy: Diagnosis and management PPSM Ch 87 Parkinsonism PPSM Ch 91 Alzheimer s disease and other dementias PPSM Ch 92 Epilepsy, sleep, and sleep disorders Week 13 (11/13): Medical Disorders PPSM Ch 117 Sleep-related cardiac risk 4
PPSM Ch 123 Sleep and fatigue in cancer patients PPSM Ch 124 Fibromyalgia and chronic fatigue syndromes Week 14 (11/20): Psychiatric Disorders & PPSM Ch 129 Anxiety disorders PPSM Ch 130 Mood disorders PPSM Ch 132 Medication and substance abuse Week 15 (12/4): Pharmacology PPSM Ch 41 Hypnotic medications: Mechanisms of action and pharmacologic effects PPSM Ch 42 Clinical pharmacologic effects of other drugs used as hypnotics PPSM Ch 45 Wake-promoting medications: Efficacy and adverse effects PPSM Ch 46 Drugs that disturb sleep and wakefulness COURSE REQUIREMENT DETAILS Required Readings: To be completed prior to class on the date of assignment. Discussion Leadership (dates vary by student): You will also be responsible for leading the seminar group in a discussion of the assigned readings three times over the course of the semester. [Total possible discussion leadership points: 50 points/ discussion X 3 discussions = 150]. Quizzes: You will be given a brief quiz at the end of each class [Total possible quiz points: 10-11 points/quiz X 14 quizzes = 150 points]. 5