1. HELPING YOUR PATIENTS GET THE SLEEP OF THEIR DREAMS
OCFP 51ST ANNUAL SCIENTIFIC ASSEMBLY
NOVEMBER 2013
Dr. CAROLE LAMARCHE, C. Psych.

2. 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.

3. Program: 51st Annual Scientific Assembly
Faculty/Presenter Disclosure
Faculty: Dr. Carole Lamarche, C. Psych.
Program: 51st Annual Scientific Assembly
Relationships with commercial interests: N/A 3

4. 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. 4

5. Mitigating Potential Bias
N/A 5

6. 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 COGNITIVE-BEHAVIOURAL TREATMENT FOR INSOMNIA
PROVIDE EXAMPLES OF BRIEF ASSESSMENT AND INTERVENTION STRATEGIES FOR SLEEP DISORDERS
UNDERSTAND WHEN TO REFER TO A SLEEP CLINIC OR PSYCHOLOGIST
copyright Dr. Carole Lamarche, C. Psych.

7. 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.

8. 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.

9. DSM-5 INSOMNIA DISORDER
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.

10. DSM-5 INSOMNIA DISORDER
THE INSOMNIA IS NOT BETTER EXPLAINED BY AND DOES NOT OCCUR EXCLUSIVELY DURING THE COURSE OF NARCOLEPSY, BREATHING-RELATED 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.

11. COMMON PHYSICAL HEALTH FACTORS THAT CONTRIBUTE TO INSOMNIA
CHRONIC PAIN CONDITIONS (I.E. ARTHRITIS
PULMONARY DISEASE
CANCER
FIBROMYALGIA
DEMENTIA
HEART FAILURE
STROKE
GASTROINTESTINAL CONDITIONS (I.E. GERD)
GENITO-URINARY CONDITIONS
HYPERTHYROIDISM
MENOPAUSE
copyright Dr. Carole Lamarche, C. Psych.

12. COMMON PSYCHOLOGICAL HEALTH FACTORS THAT CONTRIBUTE TO INSOMNIA
MOOD DISORDERS
ANXIETY DISORDERS
SUBSTANCE USE DISORDERS
GRIEF REACTIONS
RELATIONSHIP DIFFICULTIES
WORK STRESS
LIFE TRANSITIONS
copyright Dr. Carole Lamarche, C. Psych.

13. copyright Dr. Carole Lamarche, C. Psych.
MOOD DISORDERS
Major Depressive Disorder
Bipolar Disorder
Dysthymic Disorder
Cyclothymia
copyright Dr. Carole Lamarche, C. Psych.

14. copyright Dr. Carole Lamarche, C. Psych.
ANXIETY DISORDERS
PANIC DISORDER
SIMPLE PHOBIA
SOCIAL ANXIETY DISORDER
GENERALIZED ANXIETY DISORDER
OBSESSIVE-COMPULSIVE DISORDER
POST-TRAUMATIC STRESS DISORDER
copyright Dr. Carole Lamarche, C. Psych.

15. 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.

16. SLEEP DISORDERS DISGUISED AS INSOMNIA
SLEEP APNEA
PERIODIC LIMB MOVEMENT DISORDER
RESTLESS LEGS SYNDROME
CIRCADIAN RHYTHM DISORDERS
copyright Dr. Carole Lamarche, C. Psych.

17. LINKS BETWEEN INSOMNIA AND FUTURE HEALTH RISKS
DEPRESSION
HEART FAILURE
DIABETES
HIGH BLOOD PRESSURE
OBESITY
IMMUNE DYSFUNCTION
copyright Dr. Carole Lamarche, C. Psych.

18. copyright Dr. Carole Lamarche, C. Psych.
THE SLEEP DIARY
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.

19. copyright Dr. Carole Lamarche, C. Psych.
THE SLEEP DIARY
TOTAL SLEEP TIME
NUMBER OF AWAKENINGS
SLEEP ONSET LATENCY
LENGTH OF AWAKENINGS
TIME OF AWAKENINGS
ALCOHOL USE
CAFFEINE USE
PHYSICAL ACTIVITY
NAPS
MEDICATION USE
RATINGS OF:
ENERGY
MOOD
SLEEP QUALITY
copyright Dr. Carole Lamarche, C. Psych.

20. 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.

21. copyright Dr. Carole Lamarche, C. Psych.
BEHAVIOUR THERAPY
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.

22. NATURE OF COGNITIVE BEHAVIOURAL THERAPY (CBT)
COLLABORATIVE
RELATIVELY SHORT-TERM, MOSTLY PRESENT-FOCUSED
ACTIVE STANCE OF THERAPIST
EMPIRICALLY SUPPORTED
PROBLEM-FOCUSED
HOMEWORK BASED
copyright Dr. Carole Lamarche, C. Psych.

23. THE COGNITIVE-BEHAVIOURAL MODEL
PHYSICAL
ENVIRONMENT
BEHAVIOUR
MOOD
COGNITION
copyright Dr. Carole Lamarche, C. Psych.

24. COMPONENTS OF COGNITIVE-BEHAVIOURAL THERAPY FOR INSOMNIA
PSYCHOEDUCATION ABOUT SLEEP
SLEEP HYGIENE
STIMULUS CONTROL
SLEEP RESTRICTION
COGNITIVE RESTRUCTURING
copyright Dr. Carole Lamarche, C. Psych.

25. PSYCHOEDUCATION SLEEP 101: THE BASICS
SLEEP STAGES
SLEEP ARCHITECTURE
SLEEP NEED
SLEEP ACROSS THE LIFESPAN
copyright Dr. Carole Lamarche, C. Psych.

26. copyright Dr. Carole Lamarche, C. Psych.
SLEEP HYGIENE
INSUFFICIENT TO TREAT CHRONIC INSOMNIA
BEDTIME ROUTINE
ENVIRONMENT: COOL, DARK, QUIET
AVOID ALCOHOL
AVOID CAFFEINE
AVOID NICOTINE
copyright Dr. Carole Lamarche, C. Psych.

27. SLEEP HYGIENE (cont’d)
AVOID EATING A LARGE MEAL BEFORE BED
LEARN STRESS MANAGEMENT
EXERCISE IN THE AFTERNOON
AVOID NAPS
copyright Dr. Carole Lamarche, C. Psych.

28. PSYCHOLOGICAL TREATMENT OF INSOMNIA
STIMULUS CONTROL THERAPY
SLEEP RESTRICTION THERAPY
COGNITIVE THERAPY
copyright Dr. Carole Lamarche, C. Psych.

29. copyright Dr. Carole Lamarche, C. Psych.
STIMULUS CONTROL
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.

30. copyright Dr. Carole Lamarche, C. Psych.
STIMULUS CONTROL
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.

31. copyright Dr. Carole Lamarche, C. Psych.
SLEEP RESTRICTION
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.

32. copyright Dr. Carole Lamarche, C. Psych.
SLEEP RESTRICTION
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.

33. 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.

34. 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.

35. 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.

36. ADDITIONAL PSYCHOLOGICAL INTERVENTIONS
RELAXATION TRAINING
PROGRESSIVE MUSCLE RELAXATION
DIAPHRAGMATIC BREATHING
IMAGERY AND VISUALIZATION
AUTOGENICS
copyright Dr. Carole Lamarche, C. Psych.

37. FACTORS AFFECTING TREATMENT ADHERENCE AND OUTCOME
MOTIVATION
PAIN
MOOD DISORDERS
ANXIETY DISORDERS
SUBSTANCE USE DISORDERS
OTHER PSYCHOLOGICAL HEALTH ISSUES
copyright Dr. Carole Lamarche, C. Psych.

38. 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.

39. copyright Dr. Carole Lamarche, C. Psych.
APPLICATION OF COGNITIVE-BEHAVIOURAL TREATMENT PRINCIPLES TO IMPROVE ADHERENCE
COLLABORATION
NEGOTIATION
VALIDATION
TIMING
EXPERIMENTS
PATIENCE
NEUTRAL STANCE
copyright Dr. Carole Lamarche, C. Psych.

40. 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.

41. BRIEF ASSESSMENT STRATEGIES FOR THE PHYSICIAN
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.

42. BRIEF ASSESSMENT STRATEGIES FOR THE PHYSICIAN
ASK PATIENTS HOW MUCH ALCOHOL THEY USE PER DAY
ASK PATIENTS ABOUT CAFFEINE USE
ASK PATIENTS ABOUT NAPPING
copyright Dr. Carole Lamarche, C. Psych.

43. INTERVENTIONS FOR INSOMNIA
MEDICATIONS
BENZODIAZEPINES
BENZODIAZEPINE RECEPTOR AGONITSTS
ANTI-DEPRESSANTS
ANTI-PSYCHOTICS
copyright Dr. Carole Lamarche, C. Psych.

44. 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.

45. BRIEF INTERVENTIONS FOR THE PHYSICIAN
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.

46. BRIEF INTERVENTIONS FOR THE PHYSICIAN
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.

47. DSM-5 BREATHING-RELATED DISORDERS
OBSTRUCTIVE SLEEP APNEA HYPOPNEA
CENTRAL SLEEP APNEA
SLEEP-RELATED HYPOVENTILATION
copyright Dr. Carole Lamarche, C. Psych.

48. OBSTRUCTIVE SLEEP APNEA HYPOPNEA
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.

49. OBSTRUCTIVE SLEEP APNEA HYPOPNEA (CONT’D)
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.

50. 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.

51. 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.

52. 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.

53. BRIEF ASSESSMENT STRATEGIES FOR THE PHYSICIAN
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.

54. ASSESSMENT OF SLEEP APNEA
PROPER DIAGNOSIS RELIES ON OVERNIGHT POLYSOMNOGRAPHY, POSSIBLE DAYTIME POLYSOMNOGRAPHY, INCLUDING OXYGEN DESATURATION
copyright Dr. Carole Lamarche, C. Psych.

55. INTERVENTIONS FOR OBSTRUCTIVE SLEEP APNEA
CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP)
BILEVEL POSITIVE AIRWAY PRESSURE (BiPAP)
ORAL APPLIANCES
POSITIONAL STRATEGIES (I.E. TENNIS BALL)
copyright Dr. Carole Lamarche, C. Psych.

56. 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.

57. ADDITIONAL BRIEF INTERVENTIONS FOR THE PHYSICIAN
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.

58. 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.

59. DSM-5 RESTLESS LEGS SYNDROME
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.

60. DSM-5 RESTLESS LEGS SYNDROME
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.

61. DSM-5 RESTLESS LEGS SYNDROME
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.

62. DSM-5 RESTLESS LEGS SYNDROME
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.

63. 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.

64. 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.

65. 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.

66. 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.

67. ADDITIONAL INTERVENTIONS FOR RESTLESS LEGS SYNDROME
LIGHT THERAPY
STRETCHING
YOGA
RELAXATION TEACHNIQUES
copyright Dr. Carole Lamarche, C. Psych.

68. ADDITIONAL BRIEF INTERVENTIONS FOR THE PHYSICIAN
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, ETC.)
copyright Dr. Carole Lamarche, C. Psych.

69. 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.

70. 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.

71. copyright Dr. Carole Lamarche, C. Psych.
SOME USEFUL WEBSITES
Canadian Sleep Society:
Mayo Clinic:
American Sleep Apnea Association:
Restless Legs Syndrome Foundation:
copyright Dr. Carole Lamarche, C. Psych.

72. copyright Dr. Carole Lamarche, C. Psych.
USEFUL REFERENCES
SINK INTO SLEEP J. DAVIDSON
THE INSOMNIA WORKBOOK S. SILBERMAN & C. MORIN
SAY GOODNIGHT TO INSOMNIA G. JACOBS
QUIET YOUR MIND AND GET TO SLEEP C. CARNEY & R. MANBER
INSOMNIA C. MORIN
copyright Dr. Carole Lamarche, C. Psych.

73. THE END
THANK YOU!