Transcript Dr. Carole Lamarche, C. Psych. Program

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.
Faculty/Presenter Disclosure
• Faculty: Dr. Carole Lamarche, C. Psych.
• Program: 51st Annual Scientific Assembly
• Relationships with commercial interests: N/A
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.
Mitigating Potential Bias
N/A
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 COGNITIVEBEHAVIOURAL TREATMENT FOR INSOMNIA
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PROVIDE EXAMPLES OF BRIEF ASSESSMENT AND
INTERVENTION STRATEGIES FOR SLEEP DISORDERS
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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
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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
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
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THE INSOMNIA IS NOT BETTER EXPLAINED BY
AND DOES NOT OCCUR EXCLUSIVELY DURING
THE COURSE OF NARCOLEPSY, BREATHINGRELATED 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
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CHRONIC PAIN
CONDITIONS (I.E.
ARTHRITIS
PULMONARY
DISEASE
CANCER
FIBROMYALGIA
DEMENTIA
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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
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MOOD DISORDERS
ANXIETY DISORDERS
SUBSTANCE USE DISORDERS
GRIEF REACTIONS
RELATIONSHIP DIFFICULTIES
WORK STRESS
LIFE TRANSITIONS
copyright Dr. Carole Lamarche, C. Psych.
MOOD DISORDERS
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Major Depressive Disorder
Bipolar Disorder
Dysthymic Disorder
Cyclothymia
copyright Dr. Carole Lamarche, C. Psych.
ANXIETY DISORDERS
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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
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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
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DEPRESSION
HEART FAILURE
DIABETES
HIGH BLOOD PRESSURE
OBESITY
IMMUNE DYSFUNCTION
copyright Dr. Carole Lamarche, C. Psych.
THE SLEEP DIARY
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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.
THE SLEEP DIARY
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TOTAL SLEEP TIME
NUMBER OF
AWAKENINGS
SLEEP ONSET
LATENCY
LENGTH OF
AWAKENINGS
TIME OF
AWAKENINGS
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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.
BEHAVIOUR THERAPY
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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)
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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
BEHAVIOUR
ENVIRONMENT
MOOD
COGNITION
copyright Dr. Carole Lamarche, C. Psych.
COMPONENTS OF COGNITIVEBEHAVIOURAL THERAPY FOR
INSOMNIA
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PSYCHOEDUCATION ABOUT SLEEP
SLEEP HYGIENE
STIMULUS CONTROL
SLEEP RESTRICTION
COGNITIVE RESTRUCTURING
copyright Dr. Carole Lamarche, C. Psych.
PSYCHOEDUCATION
SLEEP 101: THE BASICS
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SLEEP STAGES
SLEEP ARCHITECTURE
SLEEP NEED
SLEEP ACROSS THE LIFESPAN
copyright Dr. Carole Lamarche, C. Psych.
SLEEP HYGIENE
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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)
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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
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SLEEP RESTRICTION THERAPY

COGNITIVE THERAPY
copyright Dr. Carole Lamarche, C. Psych.
STIMULUS CONTROL
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
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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.
STIMULUS CONTROL
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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.
SLEEP RESTRICTION
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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.
SLEEP RESTRICTION
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
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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.
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.
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
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MOTIVATION
PAIN
MOOD DISORDERS
ANXIETY DISORDERS
SUBSTANCE USE DISORDERS
OTHER PSYCHOLOGICAL HEALTH
ISSUES
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.
APPLICATION OF COGNITIVEBEHAVIOURAL TREATMENT PRINCIPLES
TO IMPROVE ADHERENCE
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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
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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


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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
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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
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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 BREATHINGRELATED DISORDERS

OBSTRUCTIVE SLEEP APNEA
HYPOPNEA

CENTRAL SLEEP APNEA

SLEEP-RELATED
HYPOVENTILATION
copyright Dr. Carole Lamarche, C.
Psych.
OBSTRUCTIVE SLEEP
APNEA HYPOPNEA
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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)
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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
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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
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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
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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
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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
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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
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
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
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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

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LIGHT THERAPY
STRETCHING
YOGA
RELAXATION TEACHNIQUES
copyright Dr. Carole Lamarche, C.
Psych.
ADDITIONAL BRIEF
INTERVENTIONS FOR THE
PHYSICIAN

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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,
copyright Dr. Carole Lamarche, C.
ETC.)
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.
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.
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!