1. Prevalence of Insomnia ~20% of patients in primary-care medicine report sleep disturbances 1 Among adult patients (18 years of age): 2-4 –~40% report 1 symptom of insomnia 3x/week –20% are dissatisfied with their sleep –10%-13% meet criteria for an insomnia disorder More prevalent among women, middle-aged and older adults, and individuals with poor self-rated physical or psychological mental health 2 1.Simon GE et al. Am J Psychiatry. 1997;154(10):1417-1423. 2.Morin CM et al. Can J Psychiatry. 2011;56(9):540-548. 3.Morin CM et al. Sleep Med. 2006;7(2):123-130. 4.Ohayon MM. Sleep Med Rev. 2002;6(2):97-111.

2. Insomnia Prevalence: Canadian Statistics 1 1.Morin CM et al. Can J Psychiatry. 2011;56(9):540-548.

3. Subjective Complaints Difficulty falling asleep at bedtime Waking up at night Waking up too early in the morning Difficulty going back to sleep after premature awakening Non-restorative sleep

4. Presenting Symptoms 1.Morin CM et al. Can J Psychiatry. 2011;56(9):540-548. Recent Canadian survey: 1 Initial Patient ComplaintFrequency Combination of 2 symptoms47% Difficulty initiating sleep28% Difficulty maintaining sleep15% Early-morning awakening10% Nonrestorative sleep / poor sleep quality37% Concomitant insomnia symptom71%

5. Comorbidities of Insomnia High frequency of psychiatric comorbidities 1,2 -Anxiety -Mood disorder -Substance abuse Evidence of high rates of comorbidity with medical conditions 2,3 -Pain -Hypertension -Congestive heart failure -Diabetes -Obesity 1.Roth T et al. Biol Psychiatry. 2006;60(12):1364-1371. 2.Pearson NJ et al. Arch Intern Med. 2006;166(16):1775-1782. 3.Suka M et al. J Occup Health. 2003;45(6):244-250.

6. What is the Cost of Insomnia? 1-6 1.Roth T et al. Biol Psychiatry.2006;60(12):1364-1371. 2.Simon GE and VonKorff M. Am J Psychiatry. 1997;154(10):1417-1423. 3.Daley M et al. Sleep. 2009;32(1):55-64. 4.Daley M et al. Sleep Med. 2009;10(4):427-438. 5.National Institutes of Health. Sleep. 2005;28(9):1049-1057. 6.Sivertsen B et al. J Sleep Res. 2009;18(1):122-128. PsychosocialReduced quality of life Increased risks of depression OccupationalReduced productivity Increased disability EconomicHigher healthcare utilization Public safetyIncreased risks of accidents due to impaired vigilance

7. Economic Burden of Insomnia 1 1.Daley M et al. Sleep. 2009;32(1):55-64.

8. Sleep History Patient assessment should cover the following: 1 Nature of the sleep complaint, onset and circumstances, duration, severity, and course Sleep-wake schedule, pre-bedtime routines, and daytime functions Medical and psychiatric contributing factors Other sleep-related symptoms Alleviating and exacerbating factors, medication and substance use, and current and past treatments 1.Morin CM et al. Can J Psychiatry. 2011;56(9):540-548.

9. Consensus Sleep Diary – Sample Page Reproduced with permission from Carney CE et al. Sleep. 2012;35(2):287- 302. Copyright © 2012, Associated Professional Sleep Societies, LLC. Todays date4/5/11 1. What time did you get into bed? 10:15 p.m. 2. What time did you try to go to sleep? 11:30 p.m. 3. How long did it take you to fall asleep? 55 min. 4. How many times did you wake up, not counting your final awakening? 3 times 5. In total, how long did these awakenings last? 1 hour 10 min. 6. What time was your final awakening? 6:35 a.m. 7. What time did you get out of bed for the day? 7:20 a.m. 8. How would you rate the quality of your sleep? q Very poor q Poor q Fair q Good q Very good q Very poor q Poor q Fair q Good q Very good q Very poor q Poor q Fair q Good q Very good q Very poor q Poor q Fair q Good q Very good q Very poor q Poor q Fair q Good q Very good q Very poor q Poor q Fair q Good q Very good q Very poor q Poor q Fair q Good q Very good q Very poor q Poor q Fair q Good q Very good 9. Comments (if applicable)I have a cold SampleID/Name

10. Insomnia Severity Index Copyright © Morin, C.M. (1993, 1996, 2000, 2006). 1.Difficulty falling asleep: NoneMildModerateSevereVery Severe 01234 2.Difficulty staying asleep: NoneMildModerateSevereVery Severe 01234 3.Problem waking up too early in the morning: NoneMildModerateSevereVery Severe 01234 4.How SATISFIED/dissatisfied are you with your current sleep pattern? Very SatisfiedSatisfiedNeutral DissatisfiedVery Dissatisfied 01234 For each question below, please circle the number corresponding most accurately to your sleep patterns in the LAST MONTH. For the first three questions, please rate the SEVERITY of your sleep difficulties.

11. Insomnia Severity Index (cont.) 5.To what extent do you consider your sleep problem to INTERFERE with your daily functioning (eg, daytime fatigue, ability to function at work/daily chores, concentration, memory, mood)? Not at allA littleSomewhatMuchVery much 01234 6.How NOTICEABLE to others do you think your sleeping problem is in terms of impairing the quality of your life? Not at allA littleSomewhatMuchVery much 01234 7.How WORRIED/distressed are you about your current sleep problem? Not at allA littleSomewhatMuchVery much 01234 For each question below, please circle the number corresponding most accurately to your sleep patterns in the LAST MONTH. Guidelines for Scoring/Interpretation: Add scores for all seven items (Total score ranges from 0-28) 0-7 = No clinically significant insomnia 8-14 = Subthreshold insomnia 15-21= Clinical insomnia (moderate severity) 22-28 = Clinical insomnia (severe)