Friday, Oct. 28
14:30 – 16:30 (2 hrs)
Meeting Room: Sheraton Hall C (Lower Concourse)
Raed Hawa*, MD, FRCPC, DABPN; Elliott Lee, MD, FRCPC, DABPN; Christopher Earle, MD, FRCPC; Rajda Malgorzata, MD, FRCPC; Atul khullar, MD, FRCPC, FAASM, DABPN

CanMEDS Roles:

1. Medical Expert
2. Scholar
3. Communicator

At the end of this session, participants will be able to: 1) Discuss pharmacological and non-pharmacological options for managing parasomnia; 2) Describe pharmacological and non-pharmacological options for managing insomnia; and 3) Identify a general approach to investigate and treat excessive daytime sleepiness.

Sleep and psychiatric illness have a bidirectional relation. Although psychiatric illness often contributes to sleep difficulties, sleep disorders can also contribute to mental health disorders. This has been highlighted with the COVID-19 pandemic, with up to one-half of North Americans endured insomnia symptoms since the pandemic started. It is also well established that 80% to 90% of patients with mood disorders have sleep disturbances, which frequently predate the onset of mood symptoms. Unfortunately, sleep disorders are frequently under-recognized in patients with mental health issues. This represents a significant untapped avenue for therapeutic intervention for psychiatrists. Psychiatrists may be the first professional to ask a patient about their sleep, so it is essential for them to recognize sleep disorders. By identifying and treating their patients’ sleep disorders, psychiatrists have the opportunity to dramatically improve their patients’ quality of life and mental health.

Through interactive clinical cases and mini didactic presentations, the presenters will discuss the following topics and an approach clinicians can adopt when faced with these clinical presentations:
1) Sleep complaints – a general approach to assess and treat;
2) Parasomnias – how to assess and treat both pharmacologically and non-pharmacologically;
3) Insomnia – how to approach non-pharmacologically, with an update on cognitive-behavioural therapy for insomnia (CBTi) modalities and new online technologies and apps;
4) Insomnia – how to approach pharmacologically, with an update on hypnotics, including lemborexant; and
5) Excessive daytime sleepiness – considerations and treatment options for psychiatrists.

C09a – Insomnia: Pharmacological Treatment
Elliott Lee, MD, FRCPC, DABPN

At the end of this session, participants will be able to: 1) Describe pharmacological options for managing insomnia; 2) Learn updates on new insomnia medications in the market; and 3) Appreciate the complexity of pharmacological options for insomnia treatment.

A stepped-care approach to the pharmacological treatment of insomnia will be provided, with a review of specific evidence-informed literature and clinical resources for therapists and health care professionals involved in insomnia treatment.

References:

1. Lee EK, Douglass A. Sleep in psychiatric disorders: where are we now? Can J Psychiatry 2010;55:403–12.
2. Zheng X, He Y, Yin F, et al. Pharmacological interventions for the treatment of insomnia: quantitative comparison of drug efficacy. Sleep Med 2020;72:41–9.

C09b – Insomnia: Non-Pharmacological Treatment
Christopher Earle, MD, FRCPC

At the end of this session, participants will be able to: 1) Describe non-pharmacological options for managing insomnia; 2) Learn updates on the newest applications and online resources for behavioural treatments; and 3) Appreciate the complexity and availability of behavioural and cognitive options for insomnia treatment.

A stepped-care approach to the non-pharmacological treatment of insomnia will be provided, with a review of specific evidence-informed, self-guided resources, including workbooks, online programs, online therapy, and educational programs for therapists and health care professionals involved in insomnia treatment.

References:

1. Bragg S, Benich JJ, Christian N, et al. Updates in insomnia diagnosis and treatment. Int J Psychiatry Med 2019;54:275–89.
2. Edinger JD, Arnedt JT, Bertisch SM, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med 2021;17:255–62.

C09c – Parasomnia: Pharmacological and Non-Pharmacological Treatment
Rajda Malgorzata, MD, FRCPC

At the end of this session, participants will be able to: 1) Discuss pharmacological options for managing parasomnia; 2) Discuss non-pharmacological options for managing parasomnia; and 3) Appreciate the complexity of parasomnia treatment in the context of psychiatric comorbidities.

An evidence-based approach will be discussed to help clinicians manage clinical presentations that involve complex interactions between psychiatric disorders and parasomnias.

References:

1. Bollu PC, Goyal MK, Thakkar MM, et al. Sleep medicine: parasomnias. Mo Med 2018;115:169–75.
2. Singh S, Kaur H, Singh S, et al. Parasomnias: a comprehensive review. Cureus 2018;10:e3807.

C09d – Hypersomnia: Pharmacological and Non-Pharmacological Treatment
Atul khullar, MD, FRCPC, FAASM, DABPN

At the end of this session, participants will be able to: 1) Identify a general approach to investigate excessive daytime sleepiness; 2) Identify a general approach to treat excessive daytime sleepiness; and 3) Appreciate the complexity of hypersomnia treatment in the context of psychiatric comorbidities.

An evidence-based approach will be discussed to help clinicians manage clinical presentations that involve complex interactions between psychiatric disorders and excessive daytime sleepiness. A review of the newest pharmacological treatments available on the market will be provided.

References:

1. Sowa NA. Idiopathic hypersomnia and hypersomnolence disorder: a systematic review of the Literature. Psychosomatics 2016;57:152–64.
2. Schredl M. Hypersomnia disorders. In: Stuck BA, Maurer JT, Schlarb AA, et al. Practice of Sleep Medicine. New York (NY): Springer; 2021.