HELPING YOUR PATIENTS GET THE SLEEP OF THEIR DREAMS OCFP 51ST ANNUAL SCIENTIFIC ASSEMBLY NOVEMBER 2013 Dr. CAROLE LAMARCHE, C. Psych.

PRESENTER’S DECLARATION REGARDING CONFLICT OF INTEREST I DO NOT HAVE AN AFFILIATION (FINANCIAL OR OTHERWISE) WITH A PHARMACEUTICAL, MEDICAL DEVICE OR COMMUNICATIONS ORGANIZATION. I HAVE NOT RECEIVED FINANCIAL OR IN-KIND SUPPORT FROM ANY SUCH ORGANIZATION. copyright Dr. Carole Lamarche, C. Psych.

Program: 51st Annual Scientific Assembly Faculty/Presenter Disclosure Faculty: Dr. Carole Lamarche, C. Psych. Program: 51st Annual Scientific Assembly Relationships with commercial interests: N/A 3

Disclosure of Commercial Support This program has NOT received financial support This program has NOT received in-kind support Potential for conflict(s) of interest: N/A Dr. Carole Lamarche has NOT received payment/funding, etc. from any organization supporting this program AND/OR organization whose product(s) are being discussed in this program. [Supporting organization name] [developed/licenses/distributes/benefits from the sale of, etc.] a product that will be discussed in this program: N/A. 4

Mitigating Potential Bias N/A 5

OBJECTIVES OF TODAY’S SEMINAR PROVIDE A BRIEF OVERVIEW OF COMMON SLEEP DISORDERS INCLUDING INSOMNIA, OBSTRUCTIVE SLEEP APNEA, AND RESTLESS LEGS SYNDROME. UNDERSTAND THE COMPONENTS OF COGNITIVE-BEHAVIOURAL TREATMENT FOR INSOMNIA PROVIDE EXAMPLES OF BRIEF ASSESSMENT AND INTERVENTION STRATEGIES FOR SLEEP DISORDERS UNDERSTAND WHEN TO REFER TO A SLEEP CLINIC OR PSYCHOLOGIST copyright Dr. Carole Lamarche, C. Psych.

DSM-5: INSOMNIA DISORDER THE PREDOMINANT COMPLAINT OF DISSATISFACTION WITH SLEEP QUANTITY OR QUALITY, ASSOCIATED WITH: DIFFICULTY INITIATING SLEEP MAINTAINING SLEEP EARLY MORNING AWAKENING WITH INABILITY TO RETURN TO SLEEP copyright Dr. Carole Lamarche, C. Psych.

DSM-5 INSOMNIA DISORDER THE SLEEP DISTURBANCE CAUSES CLINICALLY SIGNIFICANT DISTRESS OR IMPAIRMENT IN SOCIAL, OCCUPATIONAL, EDUCATIONAL, ACADEMIC, BEHAVIOURAL OR OTHER IMPORTANT AREAS OF FUNCTIONING copyright Dr. Carole Lamarche, C. Psych.

DSM-5 INSOMNIA DISORDER THE SLEEP DIFFICULTY OCCURS AT LEAST 3 NIGHTS PER WEEK THE SLEEP DIFFICULTY IS PRESENT FOR AT LEAST 3 MONTHS THE SLEEP DIFFICULTY OCCURS DESPITE ADEQUATE OPPORTUNITY TO SLEEP copyright Dr. Carole Lamarche, C. Psych.

DSM-5 INSOMNIA DISORDER THE INSOMNIA IS NOT BETTER EXPLAINED BY AND DOES NOT OCCUR EXCLUSIVELY DURING THE COURSE OF NARCOLEPSY, BREATHING-RELATED SLEEP DISORDER, CIRCADIAN RHYTHM DISORDER OR A PARASOMNIA THE INSOMNIA IS NOT ATTRIBUTABLE TO THE PHYSIOLOGICAL EFFECTS OF A SUBSTANCE COEXISTING MENTAL DISORDERS AND MEDICAL CONDITIONS DO NOT ADEQUATELY EXPLAIN THE PREDOMINANT COMPLAINT OF INSOMNIA copyright Dr. Carole Lamarche, C. Psych.

COMMON PHYSICAL HEALTH FACTORS THAT CONTRIBUTE TO INSOMNIA CHRONIC PAIN CONDITIONS (I.E. ARTHRITIS PULMONARY DISEASE CANCER FIBROMYALGIA DEMENTIA HEART FAILURE STROKE GASTROINTESTINAL CONDITIONS (I.E. GERD) GENITO-URINARY CONDITIONS HYPERTHYROIDISM MENOPAUSE copyright Dr. Carole Lamarche, C. Psych.

COMMON PSYCHOLOGICAL HEALTH FACTORS THAT CONTRIBUTE TO INSOMNIA MOOD DISORDERS ANXIETY DISORDERS SUBSTANCE USE DISORDERS GRIEF REACTIONS RELATIONSHIP DIFFICULTIES WORK STRESS LIFE TRANSITIONS copyright Dr. Carole Lamarche, C. Psych.

copyright Dr. Carole Lamarche, C. Psych. MOOD DISORDERS Major Depressive Disorder Bipolar Disorder Dysthymic Disorder Cyclothymia copyright Dr. Carole Lamarche, C. Psych.

copyright Dr. Carole Lamarche, C. Psych. ANXIETY DISORDERS PANIC DISORDER SIMPLE PHOBIA SOCIAL ANXIETY DISORDER GENERALIZED ANXIETY DISORDER OBSESSIVE-COMPULSIVE DISORDER POST-TRAUMATIC STRESS DISORDER copyright Dr. Carole Lamarche, C. Psych.

HEALTHY ALCOHOL CONSUMPTION GUIDELINES AMERICAN GUIDELINES: 2 DRINKS PER DAY FOR MEN 1 DRINK PER DAY FOR WOMEN CANADIAN GUIDELINES: 15 DRINKS PER WEEK FOR MEN, NO MORE THAN 3 PER DAY 10 DRINKS PER WEEK FOR WOMEN, NO MORE THAN 2 PER DAY copyright Dr. Carole Lamarche, C. Psych.

SLEEP DISORDERS DISGUISED AS INSOMNIA SLEEP APNEA PERIODIC LIMB MOVEMENT DISORDER RESTLESS LEGS SYNDROME CIRCADIAN RHYTHM DISORDERS copyright Dr. Carole Lamarche, C. Psych.

LINKS BETWEEN INSOMNIA AND FUTURE HEALTH RISKS DEPRESSION HEART FAILURE DIABETES HIGH BLOOD PRESSURE OBESITY IMMUNE DYSFUNCTION copyright Dr. Carole Lamarche, C. Psych.

copyright Dr. Carole Lamarche, C. Psych. THE SLEEP DIARY WILL ASSIST IN CORRECTLY ASSESSING THE PROBLEM WILL DEMONSTRATE PRESENCE OF SLEEP INCOMPATIBLE BEHAVIOURS WILL ASSIST IN MONITORING PATIENT’S PROGRESS copyright Dr. Carole Lamarche, C. Psych.

copyright Dr. Carole Lamarche, C. Psych. THE SLEEP DIARY TOTAL SLEEP TIME NUMBER OF AWAKENINGS SLEEP ONSET LATENCY LENGTH OF AWAKENINGS TIME OF AWAKENINGS ALCOHOL USE CAFFEINE USE PHYSICAL ACTIVITY NAPS MEDICATION USE RATINGS OF: ENERGY MOOD SLEEP QUALITY copyright Dr. Carole Lamarche, C. Psych.

A BRIEF HISTORY OF COGNITIVE-BEHAVIOURAL THERAPY COGNITIVE THERAPY DEVELOPED BY DR. AARON BECK, PSYCHIATRIST IN THE 70S FOR THE TREATMENT OF DEPRESSION RATIONAL-EMOTIVE THERAPY DEVELOPED BY ALBERT ELLIS copyright Dr. Carole Lamarche, C. Psych.

copyright Dr. Carole Lamarche, C. Psych. BEHAVIOUR THERAPY BEHAVIOUR THERAPY DEVELOPED IN THE 50S FROM THE EXPERIMENTAL TRADITION IN CLINICAL PSYCHOLOGY REFERS TO PSYCHOTHERAPEUTIC TECHNIQUES DERIVED FROM EMPIRICAL RESEARCH AND BASED ON CONDITIONING GOAL IS TO INCREASE ADAPTIVE BEHAVIOUR THROUGH REINFORCEMENT AND DECREASING MALADAPTIVE BEHAVIOUR THROUGH EXTINCTION OR PUNISHMENT copyright Dr. Carole Lamarche, C. Psych.

NATURE OF COGNITIVE BEHAVIOURAL THERAPY (CBT) COLLABORATIVE RELATIVELY SHORT-TERM, MOSTLY PRESENT-FOCUSED ACTIVE STANCE OF THERAPIST EMPIRICALLY SUPPORTED PROBLEM-FOCUSED HOMEWORK BASED copyright Dr. Carole Lamarche, C. Psych.

THE COGNITIVE-BEHAVIOURAL MODEL PHYSICAL ENVIRONMENT BEHAVIOUR MOOD COGNITION copyright Dr. Carole Lamarche, C. Psych.

COMPONENTS OF COGNITIVE-BEHAVIOURAL THERAPY FOR INSOMNIA PSYCHOEDUCATION ABOUT SLEEP SLEEP HYGIENE STIMULUS CONTROL SLEEP RESTRICTION COGNITIVE RESTRUCTURING copyright Dr. Carole Lamarche, C. Psych.

PSYCHOEDUCATION SLEEP 101: THE BASICS SLEEP STAGES SLEEP ARCHITECTURE SLEEP NEED SLEEP ACROSS THE LIFESPAN copyright Dr. Carole Lamarche, C. Psych.

copyright Dr. Carole Lamarche, C. Psych. SLEEP HYGIENE INSUFFICIENT TO TREAT CHRONIC INSOMNIA BEDTIME ROUTINE ENVIRONMENT: COOL, DARK, QUIET AVOID ALCOHOL AVOID CAFFEINE AVOID NICOTINE copyright Dr. Carole Lamarche, C. Psych.

SLEEP HYGIENE (cont’d) AVOID EATING A LARGE MEAL BEFORE BED LEARN STRESS MANAGEMENT EXERCISE IN THE AFTERNOON AVOID NAPS copyright Dr. Carole Lamarche, C. Psych.

PSYCHOLOGICAL TREATMENT OF INSOMNIA STIMULUS CONTROL THERAPY SLEEP RESTRICTION THERAPY COGNITIVE THERAPY copyright Dr. Carole Lamarche, C. Psych.

copyright Dr. Carole Lamarche, C. Psych. STIMULUS CONTROL DEVELOPED BY PSYCHOLOGIST R. BOOTZIN IN THE EARLY 70s BASED ON PSYCHOLOGICAL CONDITIONING PRINCIPLES GOAL IS TO RECONDITION BED WITH SLEEP RATHER THAN WAKEFULNESS copyright Dr. Carole Lamarche, C. Psych.

copyright Dr. Carole Lamarche, C. Psych. STIMULUS CONTROL GO TO BED ONLY WHEN SLEEPY IF UNABLE TO FALL ASLEEP OR STAY ASLEEP WITHIN 20 MINUTES, LEAVE BEDROOM RETURN TO BED WHEN SLEEPY REPEAT AS OFTEN AS NECESSARY MAINTAIN REGULAR WAKETIME DO NOT NAP USE BEDROOM ONLY FOR SLEEP AND SEX copyright Dr. Carole Lamarche, C. Psych.

copyright Dr. Carole Lamarche, C. Psych. SLEEP RESTRICTION DEVELOPED BY A. SPIELMAN IN THE LATE 80s GOAL IS TO INCREASE HOMEOSTATIC SLEEP NEED BY RESTRICTING TIME IN BED CREATES MILD SLEEP DEPRIVATION copyright Dr. Carole Lamarche, C. Psych.

copyright Dr. Carole Lamarche, C. Psych. SLEEP RESTRICTION ESTIMATE TOTAL SLEEP TIME FROM SLEEP DIARY PRESCRIBE ESTIMATED TOTAL SLEEP TIME AS NEW TIME TO STAY IN BED AS SLEEP IMPROVES, ADD 15 ADDITIONAL MINUTES TO TIME IN BED copyright Dr. Carole Lamarche, C. Psych.

copyright Dr. Carole Lamarche, C. Psych. COGNITIVE THERAPY PRINCIPLES OF COGNITIVE THERAPY APPLIED TO INSOMNIA DEVELOPED BY C. MORIN HE WAS ALSO THE FIRST PSYCHOLOGIST TO COMBINE COGNITIVE AND BEHAVIOURAL PRINCIPLES INTO A COMPREHENSIVE PSYCHOLOGICAL TREATMENT PACKAGE FOR INSOMNIA copyright Dr. Carole Lamarche, C. Psych.

copyright Dr. Carole Lamarche, C. Psych. COGNITIVE THERAPY IDENTIFY MALADAPTIVE THOUGHTS, PREDICTIONS AND BELIEFS ABOUT SLEEP CHALLENGE THESE WITH FACTS ABOUT SLEEP AND EVIDENCE FROM PATIENT’S LIFE copyright Dr. Carole Lamarche, C. Psych.

COMMON MALADAPTIVE THOUGHTS ABOUT SLEEP “ I absolutely need __ hours of sleep to function” “ Because my partner is able to fall asleep quickly, I SHOULD be able to do the same” “When I have trouble falling asleep, I should stay in bed and try harder” copyright Dr. Carole Lamarche, C. Psych.

ADDITIONAL PSYCHOLOGICAL INTERVENTIONS RELAXATION TRAINING PROGRESSIVE MUSCLE RELAXATION DIAPHRAGMATIC BREATHING IMAGERY AND VISUALIZATION AUTOGENICS copyright Dr. Carole Lamarche, C. Psych.

FACTORS AFFECTING TREATMENT ADHERENCE AND OUTCOME MOTIVATION PAIN MOOD DISORDERS ANXIETY DISORDERS SUBSTANCE USE DISORDERS OTHER PSYCHOLOGICAL HEALTH ISSUES copyright Dr. Carole Lamarche, C. Psych.

copyright Dr. Carole Lamarche, C. Psych. ADHERENCE FACTORS THESE TREATMENTS LOOK EASY ON PAPER BUT THEY ARE A CHALLENGE FOR MOST PATIENTS TO IMPLEMENT ALTHOUGH MANY PATIENTS HAVE EXPERIENCED YEARS OF INSOMNIA, MANY WILL BE FEARFUL OF MAKING THE PROBLEM WORSE BY CHANGING WHAT THEY ARE DOING copyright Dr. Carole Lamarche, C. Psych.

copyright Dr. Carole Lamarche, C. Psych. APPLICATION OF COGNITIVE-BEHAVIOURAL TREATMENT PRINCIPLES TO IMPROVE ADHERENCE COLLABORATION NEGOTIATION VALIDATION TIMING EXPERIMENTS PATIENCE NEUTRAL STANCE copyright Dr. Carole Lamarche, C. Psych.

BRIEF ASSESSMENT STRATEGIES FOR THE PHYSICIAN REVIEW HEALTH HISTORY FOR COMMON COMORBID DISORDERS: DEPRESSION ANXIETY SUBSTANCE USE PHYSICAL PAIN HEART AND LUNG PROBLEMS copyright Dr. Carole Lamarche, C. Psych.

BRIEF ASSESSMENT STRATEGIES FOR THE PHYSICIAN HAVE PATIENT KEEP A SLEEP DIARY OBTAIN COLLATERAL INFORMATION FROM BEDPARTNER ASK ABOUT RECENT LIFE EVENTS ASK ABOUT PHYSICAL PAIN ASK ABOUT MOOD AND INTEREST copyright Dr. Carole Lamarche, C. Psych.

BRIEF ASSESSMENT STRATEGIES FOR THE PHYSICIAN ASK PATIENTS HOW MUCH ALCOHOL THEY USE PER DAY ASK PATIENTS ABOUT CAFFEINE USE ASK PATIENTS ABOUT NAPPING copyright Dr. Carole Lamarche, C. Psych.

INTERVENTIONS FOR INSOMNIA MEDICATIONS BENZODIAZEPINES BENZODIAZEPINE RECEPTOR AGONITSTS ANTI-DEPRESSANTS ANTI-PSYCHOTICS copyright Dr. Carole Lamarche, C. Psych.

WHAT ABOUT MEDICATIONS? MEDICATIONS ARE APPROPRIATE FOR SHORT-TERM OR INTERMITTENT USE BUT NOT FOR CHRONIC USE MANY IMPACT SLEEP ARCHITECTURE, HAVE ADDICTION POTENTIAL, CAN CAUSE DAYTIME SLEEPINESS AND CREATE REBOUND INSOMNIA UPON WITHDRAWAL copyright Dr. Carole Lamarche, C. Psych.

BRIEF INTERVENTIONS FOR THE PHYSICIAN ASK PATIENT TO MAKE TO-DO LIST ASK PATIENT TO JOURNAL HAVE PATIENT LEARN RELAXATION ASK PATIENT TO GET OUT OF BED WHEN AWAKE ASK PATIENT TO GO TO BED LATER/ WAKE UP EARLIER copyright Dr. Carole Lamarche, C. Psych.

BRIEF INTERVENTIONS FOR THE PHYSICIAN ENCOURAGE PATIENTS TO ONLY SLEEP AND HAVE SEX IN BED, NOTHING ELSE ENCOURAGE A REGULAR WAKE-UP TIME, REGARDLESS OF SLEEP QUANTITY OR QUALITY HAVE PATIENTS INCREASE AFTERNOON PHYSICAL ACTIVITY copyright Dr. Carole Lamarche, C. Psych.

DSM-5 BREATHING-RELATED DISORDERS OBSTRUCTIVE SLEEP APNEA HYPOPNEA CENTRAL SLEEP APNEA SLEEP-RELATED HYPOVENTILATION copyright Dr. Carole Lamarche, C. Psych.

OBSTRUCTIVE SLEEP APNEA HYPOPNEA A. EITHER 1 0R 2: 1. EVIDENCE BY POLYSOMNOGRAPHY OF AT LEAST FIVE OBSTRUCTIVE APEAS OR HYPOPNEAS PER HOUR OF SLEEP AND EITHER OF THE FOLLOWING SLEEP SYMPTOMS: copyright Dr. Carole Lamarche, C. Psych.

OBSTRUCTIVE SLEEP APNEA HYPOPNEA (CONT’D) A. NOCTURNAL BREATHING DISURBANCES: SNORING, SNORTING/GASPING, OR BREATHING PAUSES DURING SLEEP B. DAYTIME SLEEPINESS, FATIGUE, OR UNREFRESHING SLEEP DESPITE SUFFICIENT OPPOORTUNITY TO SLEEP THAT IS NOT BETTER EXPLAINED BY ANOTHER MENTAL DISORDER AND IS NOT ATTRIBUTABLE TO ANOTHER MEDICAL CONDITION. copyright Dr. Carole Lamarche, C. Psych.

OCTRUCTIVE SLEEP APNEA HYPOPNEA (CONT’D) 2. EVIDENCE BY POLYSOMNOGRAPHY OF 15 OR MORE OBSTRUCTIVE APNEAS AND/OR HYPOPNEAS PER HOUR OF SLEEP REGARDLESS OF ACCOMPANYING SYMPTOMS. copyright Dr. Carole Lamarche, C. Psych.

BRIEF ASSESSMENT STRATEGIES FOR THE PHYSICIAN: HISTORY SPECIFIC FACTORS: OBESITY CROWDED PHARYNGEAL AIRWAY AGE GENDER MENOPAUSE COMMON COMORBIDITIES: HYPERTENSION CORONARY ARTERY DISEASE HEART FAILURE STROKE DIABETES DEPRESSION copyright Dr. Carole Lamarche, C. Psych.

BRIEF ASSESSMENT STATEGIES FOR THE PHYSICIAN: HISTORY NON-SPECIFIC FACTORS: MORNING HEADACHES HEARTBURN NOCTURIA REDUCED LIBIDO DRY MOUTH ERECTILE DYSFUNCTION copyright Dr. Carole Lamarche, C. Psych.

BRIEF ASSESSMENT STRATEGIES FOR THE PHYSICIAN DO THEY SNORE? DOES A BEDPARTNER COMPLAIN OF SNORING OR OTHER LOUD NOISES? DO THEY FALL ASLEEP DURING THE DAY WITHOUT TRYING? ANY ACCIDENTS OR NEAR MISSES? copyright Dr. Carole Lamarche, C. Psych.

ASSESSMENT OF SLEEP APNEA PROPER DIAGNOSIS RELIES ON OVERNIGHT POLYSOMNOGRAPHY, POSSIBLE DAYTIME POLYSOMNOGRAPHY, INCLUDING OXYGEN DESATURATION copyright Dr. Carole Lamarche, C. Psych.

INTERVENTIONS FOR OBSTRUCTIVE SLEEP APNEA CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) BILEVEL POSITIVE AIRWAY PRESSURE (BiPAP) ORAL APPLIANCES POSITIONAL STRATEGIES (I.E. TENNIS BALL) copyright Dr. Carole Lamarche, C. Psych.

INTERVENTIONS FOR OBSTRUCTIVE SLEEP APNEA SURGERY OPTIONS: TISSUE REMOVAL (UPPP, TONSILS, ADENOIDS JAW REPOSITIONING NASAL SURGERY IMPLANTS INTO THE SOFT PALATE copyright Dr. Carole Lamarche, C. Psych.

ADDITIONAL BRIEF INTERVENTIONS FOR THE PHYSICIAN ENCOURAGE HEALTHY EATING AND PHYSICIAL ACTIVITY IN ORDER TO PROMOTE WEIGHT LOSS ENCOURAGE SMOKING CESSATION ENCOURAGE MODERATION WITH ALCOHOL USE TREAT COMORBID MENTAL AND PHYSICAL HEALTH CONDITIONS copyright Dr. Carole Lamarche, C. Psych.

DSM-5 RESTLESS LEGS SYNDROME A. AN URGE TO MOVE THE LEGS, USUALLY ACCOMPANIED BY OR IN RESPONSE TO UNCOMFORTABLE AND UNPLEASANT SENSATIONS IN THE LEGS, CHARACTERIZED BY ALL OF THE FOLLOWING: copyright Dr. Carole Lamarche, C. Psych.

DSM-5 RESTLESS LEGS SYNDROME 1. THE URGE TO MOVE THE LEGS BEGINS OR WORSENS DURING PERIODS OF REST OR INACTIVITY 2. THE URGE TO MOVE THE LEGS IS PARTIALLY OR TOTALLY RELIEVED BY MOVEMENT 3. THE URGE TO MOVE THE LEGS IS WORSE IN THE EVENING OR AT NIGHT THAN DURING THE DAY, OR OCCURS ONLY IN THE EVENING OR AT NIGHT copyright Dr. Carole Lamarche, C. Psych.

DSM-5 RESTLESS LEGS SYNDROME B. THE SYMPTOMS IN CRITERION A OCCUR AT LEAST 3 TIMES PER WEEK AND HAVE PERSISTED FOR AT LEAST 3 MONTHS C. THE SYMPTOMS ARE ACCOMPANIED BY SIGNIFICANT DISTRESS OR IMPAIRMENT IN SOCIAL, OCCUPATIONAL, EDUCATIONA, ACADEMIC, BEHAVIOURAL OR OTHER IMPORTANT AREAS OF FUNCTIONING copyright Dr. Carole Lamarche, C. Psych.

DSM-5 RESTLESS LEGS SYNDROME D. THE SYMPTOMS ARE NOT ATTRIBUTABLE TO ANOTHER MEDICAL DISORDER OR MEDICAL CONDITION AND ARE NOT BETTER EXPLAINED BY A BEHAVIOURAL CONDITION E. THE SYMPTOMS ARE NOT ATTRIBUTABLE TO THE PHYSIOLOGICAL EFFECTS OF A DRUG OF ABUSE OR MEDICATION copyright Dr. Carole Lamarche, C. Psych.

DSM-5 RESTLESS LEGS SYNDROME SENSATIONS ARE USUALLY DESCRIBED AS CREEPING, CRAWLING, TINGLING, BURNING, OR ITCHING CAN DELAY SLEEP ONSET OR CAUSE SIGNIFICANT FRAGMENTATION OF SLEEP MAY REPORT DAYTIME SLEEPINESS copyright Dr. Carole Lamarche, C. Psych.

BRIEF ASSESSMENT STRATEGIES FOR THE PHYSICIAN RULE OUT OTHER CAUSES OF MOVEMENTS: ARTHRITIS LEG EDEMA LEG CRAMPS PERIPHERAL ISCHEMIA HABITUAL FOOT TAPPING POSITIONAL DISCOMFORT MEDICATION EFFECTS copyright Dr. Carole Lamarche, C. Psych.

BRIEF ASSESSMENT STRATEGIES FOR THE PHYSICIAN: HISTORY SPECIFIC FACTORS: FEMALE GENDER PREGNANCY AGE FAMILY HISTORY IRON DEFICIENCY GENETIC RISK FACTORS copyright Dr. Carole Lamarche, C. Psych.

BRIEF ASSESSMENT STRATEGIES FOR THE PHYSICIAN: HISTORY COMMON COMORBIDITIES: DEPRESSION ANXIETY DISORDERS ATTENTIONAL DIFFICULTIES CARDIOVASCULAR DISEASE CHRONIC RENAL FAILURE PERIODIC LIMB MOVEMENT DISORDER copyright Dr. Carole Lamarche, C. Psych.

INTERVENTIONS FOR RESTLESS LEGS SYNDROME MEDICATIONS: DOPAMINERGICS (E.G. REQUIP (ROPINIROLE), MIRAPEX (PRAMIPEXOLE) AND NEUPRO PATCH (ROTIGOTINE) ANTICONVULSANTS OPIOIDS MUSCLE RELAXANTS copyright Dr. Carole Lamarche, C. Psych.

ADDITIONAL INTERVENTIONS FOR RESTLESS LEGS SYNDROME LIGHT THERAPY STRETCHING YOGA RELAXATION TEACHNIQUES copyright Dr. Carole Lamarche, C. Psych.

ADDITIONAL BRIEF INTERVENTIONS FOR THE PHYSICIAN ENCOURAGE DECREASE IN CAFFEINE, ALCOHOL AND NICOTINE USE ENCOURAGE USE OF MASSAGE OR WARM BATH ENCOURAGE USE OF HEAT OR ICE IDENTIFY VITAMIN AND MINERAL DEFICIENCIES (IRON, MAGNESIUM, ETC.) copyright Dr. Carole Lamarche, C. Psych.

WHEN TO REFER TO A SLEEP CLINIC WHEN YOU SUSPECT THERE IS A SLEEP DISORDER THAT NEEDS POLYSOMNOGRAPHY TO BE CORRECTLY DIAGNOSED SLEEP APNEA NARCOLEPSY REM SLEEP BEHAVIOUR DISORDER copyright Dr. Carole Lamarche, C. Psych.

WHEN TO REFER TO A PSYCHOLOGIST WHEN YOU SUSPECT A PSYCHOLOGICAL DISORDER THAT IS MODERATE TO SEVERE (MOOD DISORDER, ANXIETY DISORDER, SUBSTANCE USE DISORDER) WHEN THE PATIENT HAS CHRONIC PHYSICAL PAIN WHEN THE PATIENT IS HAVING DIFFICULTY IMPLEMENTING YOUR SUGGESTIONS copyright Dr. Carole Lamarche, C. Psych.

copyright Dr. Carole Lamarche, C. Psych. SOME USEFUL WEBSITES Canadian Sleep Society: www.css.to Mayo Clinic: www.mayoclinic.com/health/insomnia American Sleep Apnea Association: www.sleepapnea.org Restless Legs Syndrome Foundation: www.rls.org copyright Dr. Carole Lamarche, C. Psych.

copyright Dr. Carole Lamarche, C. Psych. USEFUL REFERENCES SINK INTO SLEEP. 2013. J. DAVIDSON THE INSOMNIA WORKBOOK. 2009. S. SILBERMAN & C. MORIN SAY GOODNIGHT TO INSOMNIA. 2009 G. JACOBS QUIET YOUR MIND AND GET TO SLEEP. 2013. C. CARNEY & R. MANBER INSOMNIA 1993. C. MORIN copyright Dr. Carole Lamarche, C. Psych.

THE END THANK YOU!