WASMAN - cme.baptisthealth.net · What is Insomnia? Difficulty initiating or maintaining sleep or...
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11/13/2017 1 What is Insomnia? Difficulty initiating or maintaining sleep or early morning awakening At least 3 times a week Adequate opportunity for sleep Daytime impairment
Transcript of WASMAN - cme.baptisthealth.net · What is Insomnia? Difficulty initiating or maintaining sleep or...
11/13/2017
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What is Insomnia?
Difficulty initiating or maintaining sleep or early morning
awakening
At least 3 times a week
Adequate opportunity for sleep
Daytime impairment
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Morin 2009
Direct & CollateralDirect & CollateralDirect & CollateralDirect & Collateral
Damage
Wickwire 2016
Healthcare, Accidents, Workplace
- Corollary to lymphatic system
- Clears toxins
- Increased flow of CSF thru brain
Works much more powerfully during sleep
Glymphatic System
Nedergaard Lab
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0
0.5
1
1.5
2
2.5
3
3.5
Never Intermittent Persistent
CR
P (
mg
/L)
Insomnia
CRP & Insomnia
18 – 20 Year Follow-up
Baseline
Follow-up
P=0.02
Parthasarathy 2015 Parthasarathy S 2015
What Drives Insomnia?
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Buysse 2011
Kay 2016
Psychophysiological
Cognitive Arousal
Circadian Rhythms
Homeostatic Sleep
Drive
Cortico-Limbic Cognitive
Affective Systems
Hypothalamic Sleep-
Wake Centers
Brainstem Arousal
Centers
INSOMNIA
Physiological Processes Neural Circuits
Activation Impaired Function Deficient Function
Neurobiological Model of Insomnia
Buysse 2011
Sleep-Wake Function In Insomnia
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1. � SOL: Do you nap? “No” Falling asleep watching tv from 7:30 to 9:00 doesn’t count b/c not intentional
2. � SOL & WASO: Sleeps well when spouse away � spouse has untreated OSA
3. �FNA & WASO: “I’m following sleep hygiene & CBT-I guidelines.” � tv in bed, �time in bed awake, wine late evening
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Erland LA 2017
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Beaulieu-Bonneau S 2017
*p < .001
Beaulieu-Bonneau S 2017
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Pearls
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