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New Directions in the Management of Insomnia New Directions in the Management of Insomnia Balancing Pathophysiology and Therapeutics Proceedings From an Expert Roundtable Discussion Release date: October 10, 2013 Expiration date: October 31, 2014 Estimated time to complete activity: 1.5 hours Jointly sponsored by Postgraduate Institute for Medicine and MedEdicus LLC This activity is supported by an educational grant from Merck & Co. Distributed with 2 Target Audience This activity has been designed to meet the educational needs of physicians involved in the management of patients with insomnia disorder. Statement of Need/Program Overview An estimated 40 to 70 million Americans are affected by Faculty insomnia. According to these estimates, twice as many Americans suffer from insomnia than from major depression. However, the Larry Culpepper, MD, MPH —Co-Chair true prevalence of insomnia is unknown because it is underdiagnosed and underreported. Recent updates in the Professor and Chairman of Family Medicine nosology and diagnostic criteria for insomnia have occurred as Boston University School of Medicine well as advances in understanding pathophysiology, which, in Boston University Medical Center turn, has led to the development of potential new treatments. Boston, Massachusetts The burden of medical, psychiatric, interpersonal, and societal consequences that can be attributed to insomnia and the Tom Roth, PhD —Co-Chair prevalence of patients with insomnia disorder treated in primary Director of Research care underscore the importance of continuing medical education Sleep Disorders and Research Center (CME) that improves the clinical understanding, diagnosis, and Henry Ford Hospital treatment of the disorder by primary care providers. This continuing education activity is based on an expert roundtable Detroit, Michigan discussion and literature review and provides an update in Sonia Ancoli-Israel, PhD insomnia disorder. Professor Emeritus of Psychiatry and Medicine Educational Objectives Professor of Research After completing this activity, the participant should be better University of California, San Diego able to: • Perform a rapid assessment that leads to a diagnosis of La Jolla, California insomnia disorder Andrew Krystal, MD • Summarize the proposed pathophysiology of insomnia disorder Director, Insomnia and Sleep Research Program • Evaluate current and emerging nonpharmacologic and Professor of Psychiatry and Behavioral Sciences pharmacologic therapies for insomnia disorder Duke University Medical Center • Appropriately select therapy for individual patients Durham, North Carolina with insomnia disorder Phyllis Zee, MD, PhD Accreditation Statement This activity has been planned and implemented in accordance Benjamin and Virginia T. Boshes Professor in Neurology with the Essential Areas and policies of the Accreditation Council Director, Sleep Disorders Center for Continuing Medical Education through the joint sponsorship Northwestern University of Postgraduate Institute for Medicine and MedEdicus LLC. The Chicago, Illinois Postgraduate Institute for Medicine is accredited by the ACCME to provide continuing medical education for physicians. Credit Designation The Postgraduate Institute for Medicine designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s) ™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Disclosure of Conflicts of Interest Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest. Faculty Disclosures Method of Participation and Request for Credit The faculty reported the following financial relationships or There are no fees for participating and receiving CME credit for relationships to products or devices they or their spouse/life this activity. During the period October 10, 2013, through partner have with commercial interests related to the content of October 31, 2014, participants must read the learning objectives this CME activity: and faculty disclosures and study the educational activity. Sonia Ancoli-Israel, PhD, had a financial agreement or affiliation PIM supports Green CME by offering your Request for Credit during the past year with the following commercial interests in online. If you wish to receive acknowledgment for completing this the form of Consultant Fees: Ferring Pharmaceuticals; Merck & activity, please complete the post-test and evaluation on Co.; and Prudue Pharma L.P. www.cmeuniversity.com . On the navigation menu, click on Larry Culpepper, MD, MPH, had a financial agreement or “Find Post-test/Evaluation by Course” and search by course ID affiliation during the past year with the following commercial 9496 . Upon registering and successfully completing the post-test interests in the form of Consultant Fees: Boehringer Ingelheim with a score of 70% or better and the activity evaluation, your Pharmaceuticals Inc.; Forest Labs; Janssen Pharmaceuticals, Inc.; certificate will be made available immediately. Jazz Pharmaceuticals plc; H. Lundbeck A/S; Merck & Co.; Media Pfizer Inc.; Reckitt Benckiser Pharmaceuticals Inc.; Sunovion Monograph Pharmaceuticals Inc.; and Takeda Pharmaceuticals Inc. Speakers Bureau: Merck & Co. Ownership Interest: M3 Disclosure of Unlabeled Use (My Mood Monitor). This educational activity may contain discussion of published Andrew Krystal, MD, had a financial agreement or affiliation and/or investigational uses of agents that are not indicated by the during the past year with the following commercial interests in FDA. The planners of this activity do not recommend the use of the form of Consultant Fees: Abbott Laboratories; AstraZeneca; any agent outside of the labeled indications. Bristol-Myers Squibb; Eisai Inc.; Jazz Pharmaceuticals plc; The opinions expressed in the educational activity are those of the Johnson & Johnson; Merck & Co.; Neurocrine Biosciences, Inc.; faculty and do not necessarily represent the views of the planners. Novartis; Respironics, Inc.; Roche; Sunovion Pharmaceuticals Please refer to the official prescribing information for each Inc.; and Teva Pharmaceutical Industries Ltd. Contracted product for discussion of approved indications, contraindications, Research: Abbott Laboratories; Astellas Pharma; Brainsway; and warnings. National Institutes of Health; NeoSynch; Pfizer Inc.; St. Jude Medical (for Advanced Neuromodulation Systems [ANS]); and Disclaimer Participants have an implied responsibility to use the newly Teva Pharmaceutical Industries Ltd. acquired information to enhance patient outcomes and their Tom Roth, PhD, had a financial agreement or affiliation during own professional development. The information presented in the past year with the following commercial interests in the form this activity is not meant to serve as a guideline for patient of Consultant Fees: Jazz Pharmaceuticals plc; Merck & Co.; management. Any procedures, medications, or other courses Neurocrine Biosciences, Inc.; Novartis; Pfizer Inc.; Purdue of diagnosis or treatment discussed or suggested in this activity Pharma L.P.; Speakers Bureau: Purdue Pharma L.P. Contracted should not be used by clinicians without evaluation of their Research: Impax Laboratories, Inc.; Valeant Pharmaceuticals patient’s conditions and possible contraindications and/or (for CeraVe). dangers in use, review of any applicable manufacturer’s product Phyllis C. Zee, MD, PhD, had a financial agreement or affiliation information, and comparison with recommendations of during the past year with the following commercial interests in other authorities. the form of Consultant Fees: Ferring Pharmaceuticals; Jazz Pharmaceuticals plc; Merck & Co.; Purdue Pharma L.P.; Takeda Pharmaceuticals Inc.; Vanda Pharmaceuticals Inc.; and UCB, Inc. Contracted Research: Philips Respironics. Ownership Interest: Teva Pharmaceutical Industries Ltd. The planners and managers reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this CME activity: The following PIM planners and managers, Laura Excell, ND, NP, MS, MA, LPC, NCC, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CCMEP, and Jan Schultz, RN, MSN, CCMEP, and the following MedEdicus editors and planners, Casey Covrett, PharmD, BCPS, and Cynthia Tornallyay, RD, MBA, CCMEP, hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months. 3 4 Pathophysiology of Insomnia Introduction Current research suggests that insomnia is a disorder of An estimated 40 to 70 million Americans have insomnia. 1 “hyperarousal” that is present 24 hours each day. The According to these estimates, twice as many Americans suffer from pathophysiology of insomnia is multifactorial and may be thought insomnia than from major depression. 2 Patients with insomnia of in terms of dysregulation involving the following 3 components:
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