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CME Information
The Sleep Cycle: A Four-Stage Educational Initiative in Insomnia
Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Mount Sinai School of Medicine and MBL Communications, Inc. The Mount Sinai School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.
Credit Designation
The Mount Sinai School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 CreditTM for the Interactive Case Studies, and 2 AMA PRA Category 1 CreditsTM for the Expert Review Supplement. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Faculty Disclosure Policy Statement
It is the policy of the Mount Sinai School of Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. Presenters must also make a meaningful disclosure to the audience of their discussions of unlabeled or unapproved drugs or devices. This information will be available as part of the course material.
Statement of Need and Purpose
Sleep/wake disorders constitute a widespread yet under-recognized public health problem. Most sleep disorders involve difficulty initiating or maintaining sleep and daytime sleepiness. Approximately 50% of American adults report frequent episodes of insomnia. Despite its prevalence and impact on quality of life, only 6% of individuals with insomnia are diagnosed with the disorder. A low rate of recognition of sleep disorders exists among clinicians, emphasizing the need for increased education and training about sleep disorders. The availability of multiple sleep assessment tools requires physicians to acquire skill in determining which will prove most helpful for assessing their patients given the presenting symptoms or complaints. Management of patients with insomnia and comorbid disorders poses a considerable challenge for health care providers. Many medications list insomnia or daytime somnolence as side effects, and a clinician must be able to distinguish between an organic sleep problem and the side effects of medication used to treat another condition. Conversely, some medications commonly prescribed for psychiatric disorders have been shown to enhance sleep. Questions also remain about the safety of long-term use of certain hypnotic agents and the issue of dependence. Rational prescribing recommendations and nonpharmacologic approaches should be elucidated for clinicians. To better serve their patients, physicians need to be aware of emerging options in pharmacotherapy for insomnia. Up-to-date information on evidence from clinical trials and new treatment approaches would equip physicians to make optimal treatment choices as agents become available and to educate patients on prospective treatments. Evidence also supports the use of nonpharmacologic treatments such as cognitive behavioral therapy for some patients with chronic insomnia. Clinicians would benefit from guidance regarding therapeutic interventions for insomnia in complicated patients, including those with psychiatric comorbidities.
Target Audience
This activity is designed to meet the educational needs of primary care physicians and psychiatrists. Other health professionals who care for individuals with sleep conditions may also benefit from this activity.
Learning Objectives
At the completion of this activity, participants should be better able to:
- Assess patients for sleep dysfunctions using available tools and guidelines
- Appropriately refer patients to sleep laboratories for further evaluation and follow-up
- Identify insomnia as a distinct disorder in the presence of comorbid or contributing
conditions
- Employ evidence-based pharmacologic and nonpharmacologic treatments for
patients with insomnia and comorbid conditions
- Interpret clinical data regarding new and emerging treatment strategies for insomnia
Andrew D. Krystal, MD, is professor of psychiatry in the Department of Psychiatry and Behavioral Sciences at Duke University Medical Center in Durham, North Carolina. Disclosures: Dr. Krystal is a consultant to Abbott, Actelion, Arena, Astellas, AstraZeneca, Axiom, Bristol-Myers Squibb, Cephalon, CHDI, Eli Lilly, GlaxoSmithKline, Jazz, Johnson and Johnson, King, Kingsdown Inc, Merck, Neurocrine, Neurogen, Neuronetics, Novartis, Organon, Ortho-McNeil Janssen, Pfizer, Research Triangle Institute, Respironics, Roche, sanofi-aventis, Sepracor, Somaxon, Takeda, and Transcept; and receives grant/research support from Astellas, Cephalon, Evotec, GlaxoSmithKline, Merck, the National Institutes of Health, Neurocrine, Neurogen, Neuronetics, Pfizer, Respironics, sanofi-aventis, Sepracor, Somaxon, Takeda, and Transcept.
John W. Winkelman, MD, PhD, is associate professor of psychiatry at Harvard Medical School and medical director of the Sleep Health Center of Brigham and Women’s Hospital in Boston, Massachusetts. Disclosures: Dr. Winkelman is a consultant to and receives honoraria from sanofi-aventis and Sepracor.
W. Vaughn McCall, MD, MS, is professor and chair in the Department of Psychiatry and Behavioral Medicine at Wake Forest University School of Medicine in Winston-Salem, North Carolina. Disclosures: Dr. McCall receives research support and honoraria from sanofi-aventis and Sepracor.
CME Course Director James C.-Y. Chou, MD, is associate professor of psychiatry at Mount Sinai School of Medicine in New York City. Dr. Chou has received honoraria from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen, and Pfizer.
Activity Review Information
The activity content has been peer-reviewed by James C.-Y. Chou, MD
Review Dates:
Interactive Case Studies: October 22, 2009
Expert Review Supplement: November 19, 2009
Acknowledgment of Commercial Support
Funding for this activity has been provided by an educational grant from sanofi-aventis.
To Receive Credit for this Activity
Interactive Case Studies
After viewing the three online case studies and Q&A session, you will be prompted to fill out an evaluation form and take the posttest. Upon successful completion of the posttest (70% or better) and evaluation, your CME certificate will be available for you to print.
Release date: January 1, 2010
Termination date: January 31, 2011
The estimated time to complete the Interactive Case Studies is 1 hour.
Expert Review Supplement
After reading the supplement, you will be prompted to fill out a registration form followed by a posttest and evaluation. Upon successful completion of the posttest (70% or better) and evaluation, your CME certificate will be available for you to print.
Release date: December 1, 2009
Termination date: December 31, 2010
