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Insomnia in the Context of Comorbidity

Insomnia is the most commonly occurring of all sleep disorders, yet it frequently goes unrecognized and untreated. New and growing evidence reveals that chronic sleep deprivation may have as its consequence a variety of significant health problems including cardiovascular diseases such as myocardial infarction and stroke; obesity, glucose intolerance and diabetes; and increased age-specific mortality. Despite this increase in scientific knowledge, many clinicians fail to treat insomnia and other sleep disorders as complex chronic conditions requiring long-term management approaches.

This activity from the National Sleep Foundation, in joint sponsorship with the Atlanta School of Sleep Medicine, is intended to provide a knowledge-based educational format focusing on the aforementioned topics related to the assessment and treatment of insomnia in the context of medical and psychiatric conditions.

This program was presented at a satellite symposium at the American College of Physicians’ Internal Medicine 2009 meeting on April 22, 2009 in Philadelphia, PA. This program is now available online, free of charge to registered participants and should take approximately one hour to complete.

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Target Audience

This activity has been designed specifically for physicians.

Learning Objectives

Upon completion of this activity, health care providers will be able to:

  • Discuss the relationship between insomnia and its common comorbidities and the dis/advantages of different treatment approaches.
  • Discuss the influence of comorbid medical and psychiatric conditions in the development of insomnia.
  • Apply the newest behavioral and pharmacological treatment approaches in insomnia.
  • Identify the latest treatment targets for insomnia and their potential advantages in comorbid populations.

Faculty

David N. Neubauer, MDDavid N. Neubauer, MD

Associate Director, Johns Hopkins Sleep Disorders Center

Assistant Professor, Department of Psychiatry

Johns Hopkins University School of Medicine

David N. Neubauer, MD is Associate Director of the Johns Hopkins Sleep Disorders Center and Assistant Professor in the Department of Psychiatry at the Johns Hopkins University School of Medicine in Baltimore, Maryland. He is a Fellow of the American Psychiatric Association and a Diplomate of the American Board of Sleep Medicine, and he is a member of several professional organizations, including the American Academy of Sleep Medicine, the Sleep Research Society, and the Society for Light Treatment and Biological Rhythms. He is on the editorial board of the journals SLEEP and Postgraduate Medicine. He contributes a quarterly column on sleep-related topics to Primary Psychiatry and he writes a consumer-oriented mental health blog for the Yahoo! Health web site. Dr. Neubauer is the author of the 2004 insomnia and the 2007, 2008, and 2009 sleep disorders chapters in Conn's Current Therapy, and a book, Understanding Sleeplessness: Perspectives on Insomnia, published in 2003 by the Johns Hopkins University Press.

 

Allison Harvey, PhDAllison Harvey, PhD

Associate Professor of Clinical Psychology

Director of the Sleep and Psychiatric Disorders Laboratory

University of California, Berkeley

Allison Harvey, PhD is Associate Professor of Clinical Psychology and Director of the Sleep and Psychiatric Disorders Laboratory at the University of California, Berkeley.  Her clinical training and PhD were completed in Sydney, Australia. Dr. Harvey then moved to England as faculty in the Department of Experimental Psychology, University of Oxford. She was also a Fellow of St. Anne's College. In 2004 she moved to UC Berkeley.  Dr. Harvey's research interests focus on chronic insomnia, on understanding the role of sleep disturbance across psychiatric disorders (particularly bipolar disorder) and on sleep across development (particularly during adolescence). The editorial boards on which Dr. Harvey serves include the journal SLEEP and Behavioral Sleep Medicine.  Dr. Harvey has been the recipient of numerous awards including The Queen's Trust Award, the Chaim Danielle Award for Traumatic Stress Studies, an award from the American Association for Behavior Therapy and from 2005-2006 she was a Scholar at the Beck Institute for Cognitive Therapy and Research.  Dr. Harvey has received research funding from various sources including the Australian Research Council, Royal Society, Wellcome Trust, Jules Thorn Charitable Trust, Economic and Social Research Council and NARSAD. Currently her research is funded by the National Institutes of Mental Health.

 

Andrew D. Krystal, MD, MSAndrew D. Krystal, MD, MS

Director, Sleep Research Laboratory and Insomnia Program

Associate Professor of Psychiatry and Behavioral Sciences

Duke University Medical Center

Andrew Krystal, MD, MS is Professor of Psychiatry and Behavioral Sciences in the Duke University School of Medicine.  There he directs the Sleep Research Laboratory, the Insomnia Clinic, and the Quantitative EEG Laboratory. He attended the Massachusetts Institute of Technology where he completed Bachelor's and Master's Degrees in Biomedical Engineering. He earned his doctorate in medicine from Duke University in 1987. He subsequently completed psychiatry residency training at Duke along with fellowships in Clinical Neurophysiology and Clinical Research Methodology. He is Board Certified in Psychiatry, Sleep Medicine, and Clinical Neurophysiology. Dr. Krystal currently serves as an Associate Editor of the Journal SLEEP, he is Clinical Editor of the International Journal of Sleep and Wakefulness, and is the Chairman of the Research Committee of the Sleep Research Society.  His primary areas of clinical work are in sleep disorders, EEG, and mood disorders.  His primary research is related to the pathophysiology and treatment of sleep disorders and mood disorders.

 

Disclosures

It is the policy of the Atlanta School of Sleep Medicine to ensure balance, independence, objectivity, and scientific rigor in all its educational activities. All faculty participating in programs sponsored or jointly sponsored by Atlanta School of Sleep Medicine are expected to disclose to the program audience any real or apparent conflict(s) of interest related to the content of their presentation(s).  Having an interest in or affiliation with any corporate organization does not necessarily influence a speaker's presentation, but the relationship must be made known in advance to the audience in accordance with the standards of the Accreditation Council for Continuing Medical Education. It is the policy of the Atlanta School of Sleep Medicine that all faculty disclose the following information (1) if the CME content over which the speaker has control contains information about healthcare products or services, (2) if so, the financial relationship of individual and spouse/partner in the last 12 months with manufacturers of products or providers of services must be stipulated; and (3) attestation whether any identified relationship would cause information about healthcare products and services in the CME content to be commercially biased.

Allison Harvey, PhD (presenter) has disclosed that the CME content over which she has control does contain information about healthcare products or services but neither she nor her spouse/partner has had a financial relationship in any amount during the last 12 months with the manufacturers of the products or providers of the services that may be discussed.  Dr. Harvey discloses that she is a consultant for Actelion Pharmaceuticals and on the Speakers' Bureau of sanofi-aventis but attests that none of these relationships will cause the information about healthcare products and services in the CME content over which he has control to be commercially biased.

David N. Neubauer, MD (presenter) has disclosed that the CME content over which he has control does contain information about healthcare products or services and that he or his spouse/partner has had a financial relationship during the last 12 months with the manufacturers of the products or providers of the services. Dr. Neubauer discloses that he is a consultant for sanofi-aventis, McNeil Consumer Product and Takeda Pharmaceuticals but attests that none of these relationships will cause the information about healthcare products and services in the CME content over which he has control to be commercially biased.

Andrew Krystal, MD (presenter) has disclosed that the CME content over which he has control does contain information about healthcare products or services and that he or his spouse/partner has had a financial relationship during the last 12 months with the manufacturers of the products or providers of the services. Dr. Krystal discloses that he is a consultant for Actelion, Arena, Astellas, Axiom, Astra-Zeneca, BMS, Cephalon, Eli Lilly, GlaxoSmithKline, Jazz, Johnson and Johnson, King, Merck, Neurocrine, Neurogen, Novartis, Organon, Ortho-McNeil-Janssen, Pfizer, Respironics, Roche, sanofi-aventis, Sepracor, Somaxon, Takeda, Transcept, Research Triangle Institute and Kingsdown, Inc.  Dr. Krystal discloses that he has grants/research support from NIH, sanofi-aventis, Cephalon, GlaxoSmithKline, Merck, Neurocrine, Pfizer, Sepracor, Somaxon, Takeda, Transcept, Respironics, Neurogen, Evotec, Astellas, and Neuronetics. Dr. Krystal attests that none of these relationships will cause the information about healthcare products and services in the CME content over which he has control to be commercially biased.

Christopher Drake, PhD (planner) has disclosed that the CME content over which he has control does contain information about healthcare products or services and that he or his spouse/partner has had a financial relationship during the last 12 months with the manufacturers of the products or providers of the services.  Dr. Drake discloses that he is a consultant, speaker and researcher for Cephalon, a consultant for sanofi-aventis and has a research grant from Takeda but attests that none of these relationships will cause the information about healthcare products and services in the CME content over which he has control to be commercially biased.

Joseph Ojile, MD (planner) and Russell Rosenberg, PhD (planner) and staff planners David Cloud, Darrel Drobnich, Inne Barber, Jen Cowher, Trina Mercer, and Gail Reid have disclosed individually that the CME content over which they have control does not contain information about healthcare products or services.

Accreditation Statements

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Atlanta School of Sleep Medicine and the National Sleep Foundation. The Atlanta School of Sleep Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Designation of Credit
The Atlanta School of Sleep Medicine designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Credits valid from April 22, 2009 through April 22, 2010

Participant Resources

For further information, please visit www.sleepfoundation.org and the NSF store www.sleepfoundation.org/sleepshop.

Educational Resources for Physicians:

For further information, please visit www.sleepfoundation.org and the National Sleep Foundation's Education Store.

Educational Resources for Physicians' Patients:

  • National Sleep Foundation’s Sleep Sheet on Sleep Tips.

Commercial Support

This CME activity is supported by an independent educational grant from sanofi-aventis U.S.

Contact Information

For more information about this program, please email ibarber@sleepfoundation.org.

For technical questions or support, please email onlinecmehelp@sleepfoundation.org.

Technical Support

Minimum system requirements
For this activity, your computer needs to have Internet Explorer 6.0 (or higher) or Mozilla Firefox 2 (or higher) or Safari 2 (or higher) and Adobe Flash Player 9.0 (or higher). If you are using a modem to connect to the Internet, you will need a modem speed of at least 56K to view the pages of the site. Video content requires DSL and higher. Adobe Flash Player is required to view the video and Adobe Reader is required to print your certificate. You can download Adobe Reader for free. As you will be printing your CME certificate online, your computer must be connected to a printer.

Technical Questions
For technical questions or support, please contact us at: onlinecmehelp@sleepfoundation.org.