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CME

Perspectives on Insomnia in the New Millennium

  • Authors: Michael Sateia, MD; Sonia Ancoli-Israel, PhD; Karl Doghramji, MD; Daniel J. Buysse, MD
  • THIS ACTIVITY HAS EXPIRED FOR CREDIT
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Target Audience and Goal Statement

This activity was developed for sleep specialists and other healthcare providers with an interest in sleep disorders.

Upon completion of this activity, participants will be able to:

  1. List the physiologic, psychological, pharmacologic, and environmental risk factors that increase vulnerability to insomnia.
  2. Explain the clinical implications of insomnia with regard to its impact on physical and cognitive impairment, psychosocial functioning, and health-related quality of life.
  3. Recognize insomnia as an independent risk factor for medical and psychiatric comorbidities.
  4. Design an effective and individualized management plan for patients with insomnia, utilizing appropriate pharmacologic and nonpharmacologic treatment strategies.


Author(s)

  • Karl Doghramji, MD

    Professor of Psychiatry, Jefferson Medical College, Philadelphia, Pennsylvania; Director, Sleep Disorders Center, Thomas Jefferson University, Philadelphia, Pennsylvania

    Disclosures

    Disclosure: Grants/research support: Bristol-Myers Squibb, GlaxoSmithKline, Orphan Pharmaceuticals, Sanofi; Consultant: Pfizer Inc, Takeda; Speakers bureau: Forest Laboratories, Inc., GlaxoSmithKline, King, Sanofi, Sepracor; Stock shareholder: Cephalon, DuPont, Forest Laboratories, Inc., Merck & Co., Inc., Pfizer Inc.

  • Sonia Ancoli-Israel, PhD

    Professor of Psychiatry; Director, Gillin Laboratory of Sleep and Chronobiology, University of California, San Diego

    Disclosures

    Disclosure: Grants/research support: National Institutes of Health; Consultant: Acadia, Cephalon, King, Neurocrine Biosciences, Inc., Pfizer Inc, Sanofi-Aventis, Sepracor, Takeda; Stock shareholder: Cephalon, Neurocrine Biosciences, Inc., Pfizer Inc; Honoraria: Acadia, Cephalon, King, Neurocrine Biosciences, Inc., Pfizer Inc, Sanofi-Aventis, Sepracor, Takeda.

  • Daniel J. Buysse, MD

    Professor of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Director, Clinical Neuroscience Research Center, Pittsburgh, Pennsylvania; Medical Director, Sleep and Chronobiology Program, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania

    Disclosures

    Disclosure: Grants/research support/honoraria: Pfizer Inc, Sanofi-Aventis, Sepracor, Takeda; Consultant: Actelion, Cephalon, Eli Lilly and Company, Merck & Co., Inc, Neurocrine Biosciences, Inc., Pfizer Inc, Respironics, Sanofi-Aventis, Servier, Sepracor, and Takeda.

  • Michael Sateia, MD, Chair

    Professor of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire; Director, Dartmouth-Hitchcock Sleep Disorders Center, Lebanon, New Hampshire

    Disclosures

    Disclosure: Consultant: Pfizer Inc, Takeda.


Accreditation Statements

    For Physicians

  • This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the University of Wisconsin School of Medicine and Public Health and CME Enterprise. The University of Wisconsin School of Medicine and Public Health is accredited by the ACCME to provide continuing medical education for physicians.

    The University of Wisconsin Medical School designates this educational activity for a maximum of 2.0 Category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]


Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. In addition, you must complete the Activity Evaluation to provide feedback for future programming.
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 5 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

*The credit that you receive is based on your user profile.

CME

Perspectives on Insomnia in the New Millennium

Authors: Michael Sateia, MD; Sonia Ancoli-Israel, PhD; Karl Doghramji, MD; Daniel J. Buysse, MDFaculty and Disclosures
THIS ACTIVITY HAS EXPIRED FOR CREDIT

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Welcome and Introduction , Presented by Michael Sateia, MD

Introduction: Perspectives on Insomnia

  • I thought it would be helpful if I defined a few general issues and challenges that face us.

  • Slide 1. Welcome and Introduction

    Slide 1.

    Welcome and Introduction

    (Enlarge Slide)
  • The first issue that came to my mind was regarding the plethora of biologic data that are emerging about insomnia these days. It's unclear from these data as to what extent some of these physiologic changes represent predispositions vs complications of the condition. Ultimately, the challenge is that we need to translate these emerging biologic data into more effective treatment interventions and perhaps even prevention.

  • Slide 2. Perspectives on Insomnia in the New Millennium

    Slide 2.

    Perspectives on Insomnia in the New Millennium

    (Enlarge Slide)
  • Another issue that I think is familiar to many of you is that we now have a great deal of epidemiologic data that indicate connection and association between chronic insomnia and a variety of health-related problems, particularly development of new psychiatric disorders, especially mood disorders. The challenge that we face still is to demonstrate that by effectively intervening in chronic insomnia, we can lower the risk for complications of these various health problems. And in doing so, I think we add to the attention to insomnia and underscore the importance of identifying and treating the problem.

  • Slide 3. Perspectives on Insomnia in the New Millennium

    Slide 3.

    Perspectives on Insomnia in the New Millennium

    (Enlarge Slide)

Other Issues in Insomnia

  • We know that there are still major shortcomings in the identification and assessment of the insomnia population. In the Academy, we've been working on a public education program that includes insomnia; you'll see more coming out about this. But we really need to understand more about ways of promoting effective identification and evaluation of patients, and we also need to understand more about how to lead those patients into effective treatment.

  • Slide 4. Perspectives on Insomnia in the New Millennium

    Slide 4.

    Perspectives on Insomnia in the New Millennium

    (Enlarge Slide)
  • Increasingly we're seeing and we will continue to see much more data that suggest safety and effectiveness in long-term use of nonbenzodiazepine hypnotics. The question I think that remains open is exactly what to do with that information about safety and efficacy and long-term use; how do we incorporate that into our treatment approach for chronic insomnia?

  • Slide 5. Perspectives on Insomnia in the New Millennium

    Slide 5.

    Perspectives on Insomnia in the New Millennium

    (Enlarge Slide)
  • There are data, and we know about effectiveness of combined pharmacologic and nonpharmacologic treatments; we understand cognitive behavioral treatments to be quite effective in the management of chronic insomnia. But we still have yet to answer the question of how we can best integrate pharmacotherapy and cognitive behavioral therapy (CBT) into effective long-term management for individuals with chronic insomnia.

  • Slide 6. Perspectives on Insomnia in the New Millennium

    Slide 6.

    Perspectives on Insomnia in the New Millennium

    (Enlarge Slide)
  • An enormous challenge that interests me considerably is that nonpharmacologic therapies, although effective, simply are unavailable to the vast majority of individuals with chronic insomnia. Behavioral sleep medicine specialists are relatively small in number, and we have an enormous challenge to try to find ways of training additional people to deliver effective CBT and to be able to offer this form of treatment to a much larger number of people with this problem. Give those issues some thought.

  • Slide 7. Perspectives on Insomnia in the New Millennium

    Slide 7.

    Perspectives on Insomnia in the New Millennium

    (Enlarge Slide)