Insomnia: Prevalence, Diagnosis, Comorbidity and Treatment


Scope of the Meeting


Goal
Insomnia is often associated with medical and mental disorders and can result into serious impairment of daytime functioning, deterioration of the quality of life, absenteeism and high health care costs.

The goal of this symposium is to inform the attendees about 1) the latest data on prevalence of insomnia around the world, 2) how this changes with age and 3) how it differs between sexes.

Objectives

  1. To diagnose insomnia and which mental disorders, organic diseases and environmental factors are most likely to initiate or maintain insomnia.
  2. To overview both pharmaceutical and cognitive behavioral treatments used to treat insomnia.

Program

Thursday, October 1st, 2015

08:30 - 08:45 Maurice Ohayon, MD, DSc, PhD
Welcome / Overview of the day
 
08:45 - 10:00 Maurice Ohayon, MD, DSc, PhD
Why insomnia is a serious disorder?
 
09:45 – 10:45 Meir Kryger, MD, FRCPC
Sleepiness due to Medical Disorders
 
10:45 - 11:00 Break
 
11:00 - 11:40 Yves Dauvilliers, MD, PhD
Role of the biomarkers in central hypersomnolence disorders
 
11:40 - 12:15 Giuseppe Plazzi, MD, PhD
Cataplexy and pseudocataplexy in the differential diagnosis of CNS hypersomnolences: does atypical cataplexy exist?
 
12:15 - 13:30 Lunch
 
13:30 - 14:10 Thomas Roth, PhD
Consequences of Excessive Sleepiness
 
14:10 - 15:00 Max Hirshkowitz, PhD
National Sleep Foundation (NSF) Sleep Time Recommendation Expert Panel (STREP): An application of the RAND Appropriateness Method
 
15:00 - 15:15 Break
 
15:15 - 17:45 General Discussion
Future directions
 
17:45 - 18:00 Conclusions

Abstracts

The Multiple Facets of Excessive Sleepiness in the General Population

Maurice Ohayon, MD, DSc, PhD
Stanford University, Stanford, CA, USA

This population-based study examined the association between excessive somnolence (ES), fatigue, medical and psychiatric comorbidities and consequences on daily functioning. The study involved a representative sample of 19,136 non-institutionalized individuals living in the US, aged ≥18 (participation rate: 83.2%). Sleep-EVAL questionnaire included sleeping habits; health; sleep, mental and organic disorders (DSM-IV-TR, ICSD-II, ICD-10). ES was observed in 27.8% of the sample; 11.8% of the sample reported at least 2 episodes of ES within the same day. Fatigue had a lower prevalence: Mild fatigue was observed in 3.8% of the sample, moderate fatigue in 4.4% and severe fatigue in 3.9% of the sample. Correlation between excessive somnolence and fatigue was r=0.22. Only 1 third of individuals with severe somnolence reported some levels of fatigue. ES was more strongly associated with sleep disorders than fatigue but fatigue was more strongly associated with mood disorders than ES.

Sleepiness due to Medical Disorders

Meir Kryger, MD, FRCPC
Yale School of Medicine, CT, USA

The complexity of the sleep-wake system makes it vulnerable to malfunction and medical disorders can lead to: Excessive sleepiness; Excessive wakefulness; both sleepiness and wakefulness. Diseases in almost all organ systems can cause hypersomnia. Of the 19 categories of disease in ICD-9, disorders in all but 5 categories (and even here there are exceptions) hypersomnia may occur. Most commonly sleepiness in a sleep clinic is seen in patients with respiratory problems (e.g. sleep apnea), circulatory problems (e.g. congestive heart failure, stroke), neurological disorders (e.g., Parkinson’s, epilepsy, narcolepsy), and mental and behavioral disorders (e.g. depression), At this time is usually difficult to obtain authorization to prescribe wake promoting agents in patients other than those with narcolepsy and sleep apnea.

Consequences of Excessive Sleepiness

Thomas Roth, PhD
Henry Ford Hospital, Detroit, MI, USA

The importance of understanding excessive sleepiness derives not only from its high prevalence but also from the fact that it has significant associated morbidity. The early research on the effects of sleepiness focused on its effects on psychomotor performance in general and the frequency of lapses in performance specifically. There are seminal studies both in the US and Europe that showed that sleep deprived subjects showed significant impairments. These effects were most clearly seen on long monotonous tasks (not different from driving) and the impairments seen were lapses. Lapses are short periods (less than a second) where people fail to respond to the environment. These lapses can have disastrous impact on behaviors such as highway driving, and other jobs that require sustained attention. Subsequent research has broadened the area of inquiry and demonstrated memory deficits, increased risk taking behavior and impairments in executive function that are also associated with sleepiness. More recently the focus has moved from the behavioral consequences of sleepiness to physiological consequences. Sleepiness has been shown to be associated with a variety of physiological functions including increased pain sensitivity and blunted arousal responses. These have significant implications. For example, in patients with sleep apnea the degree of sleepiness correlates with the time to arousal and the resumption of breathing and hence with degree of hypoxemia.

National Sleep Foundation (NSF) Sleep Time Recommendation Expert Panel (STREP): An application of the RAND Appropriateness Method

Max Hirshkowitz, PhD
Baylor College of Medicine, Menninger, TX, USA

Objective: To make scientifically sound and practical recommendations for daily sleep duration across the lifespan.
Methods: The National Sleep Foundation (NSF) convened a multidisciplinary expert panel (“Panel”) with broad representation from leading stakeholder organizations. The Panel evaluated the latest scientific evidence and participated in a formal consensus and voting process. Then, the RAND/UCLA Appropriateness Method was used to formulate sleep duration recommendations.
Results: The Panel made sleep duration recommendations for nine age groups. Sleep duration ranges, expressed as hours of sleep per day, were designated as recommended, may be appropriate, or not recommended. Recommended sleep durations are: 14–17 hours for newborns, 12–15 hours for infants, 11–14 hours for toddlers, 10–13 hours for preschoolers, 9–11 hours for school age children and 8–10 hours for teenagers. 7–9 hours are recommended for young adults and adults and 7–8 hours of sleep are recommended for older adults. The self-designated basis for duration selection and critical discussions are also provided.
Conclusions: Consensus for sleep duration recommendations were reached for specific age groupings. Consensus using a multidisciplinary expert panel lends robust credence to the results. Finally, limitations and caveats of these recommendations are discussed.


This Activity is supported by an Unrestricted Educational Grant from Jazz Pharmaceuticals to Stanford University.