AASM Membership Sections Newsletter Issue #3
7
University, her medical training at
Albany Medical College, and her
general psychiatry residency at
University of Maryland/Sheppard
Pratt program. She is currently
working as a staff physician in
sleep medicine at UC Davis Medi-
cal Center in Sacramento, CA.
Fahd Zarrouf, MD
Dr. Zarrouf completed his medical
training and psychiatry residency
at Damascus University/ Medi-
cal School Hospitals in Damas-
cus, Syria. He then completed a
combined internal medicine and
psychiatry residency at West Vir-
ginia University/ Charleston Area
Medical Center- Charleston, WV.
He completed a Sleep Medicine
Fellowship at the Cleveland Clinic
Foundation, Cleveland, OH. He is
currently working as an Assistant
Professor of Medicine-MUSC, at
AnMed Health, Anderson, SC. He
is Chief of Psychiatric Service and
Medical Director of Transcranial
Magnetic Stimulation Center in
Internal Medicine, Psychiatry, and
Behavioral Medicine at the Lung
&
Sleep Center.
Rebecca Quattrucci Scott, PhD
Dr. Scott completed her under-
graduate degree at Notre Dame
College in Manchester, New
Hampshire. She then completed
her PhD in Health Psychology at
Yeshiva University/Albert Einstein
School of Medicine in New York.
She also completed her clinical
work in sleep disorders medicine
at The Sleep Disorders Center,
Columbia Presbyterian Medical
Center in New York City. She is
currently working as a sleep disor-
ders specialist at New York Sleep
Institute.
Steering Committee Profiles
continued
The Future Directions
of Insomnia Medicine
Zhaoming Chen, MD, PhD
Insomnia is the most common
sleep disturbance encountered in
the sleep clinic. The current main
stream treatment is cognitive-
behavior therapy (CBT) and
hypnotics. However, 10-30% of
people still suffer from acute or
chronic insomnia. The cost to
manage insomnia, its associated
mental or medical diseases as
well as poor performance, acci-
dents, and error is very high. The
principle of insomnia manage-
ment is personalized medicine
because one stone is less likely
to hit multiple birds at the same
time. Addressing the underly-
ing etiology, such as medical or
mental disease, is the key. If stress
is reduced, patients can fall asleep
easily. If sleep apnea is effectively
controlled, patients will not wake
up frequently at night. If depres-
sion is well treated, patients will
not wake up too early every
morning. Below, I list possible
future directions of insomnia
medicine.
More research is necessary to
investigate the mechanism of in-
somnia, especially primary, psy-
chophysiological and paradoxical
insomnia. Insomnia is considered
a disorder of imbalance between
the wake-promoting and sleep-
promoting systems in our brain,
leading to a hyperarousal state.
EEG recordings from patients
with primary insomnia reveal co-
existence of non-REM sleep and
awaking state. Further research
may be able to localize specific
receptors mediating the switch
between sleep and wakefulness
states, like orexin neurons con-
trolling the transition of wakeful-
ness and REM states.
It is very important to moni-
tor the side effect of hypnotics. In
general, it is not recommended to
use hypnotics for the long-term.
For some patients with chronic
insomnia refractory to cognitive-
behavior therapy for insomnia
(
CBTI), long-term drug treat-
ment seems to be the only op-
tion. Thus, side effect monitoring
is crucial for chronic insomnia
treatment. This is also the case for
short-term use of hypnotics. The
US Food and Drug Administra-
tion (FDA) recently reduced the
recommended dose of zolpidem
by 50% for women (recom-
mending 5 mg instead of 10 mg)
because of next morning impair-
ment associated with the higher
dose. Morning impairment in-
creases the risk of motor vehicle
accidents and decreases day time
performance. Other hypnot-
ics should be watched for next
morning impairment, especially
for high doses.
More professional therapists
need to be trained in cognitive
Continued >>