AASM Membership Sections Newsletter Issue #3
9
tive. It can improve quality of life
and prevent the development of
mental or medical diseases such
as hypertension, diabetes, stroke,
heart disease and depression.
References
Espie, CA, et al. A Randomized, place-
bo-controlled trial of online cogni-
tive behavioral therapy for chronic
insomnia disorder delivered via an
automated media-rich web applica-
tion.
Sleep
2012;35(6):769-781.
Neubauer, DN. Chronic insomnia.
Con-
tinuum: Lifelong Learning in Neurol-
ogy
2013
Feb;19.
Herring, WJ, et al. Orexin receptor
antagonism for treatment of in-
somnia: a randomized clinical trial
of suvorexant.
Neurology
2012
Dec
4;79(23):2265-74.
http://www.fda.gov/NewsEvents/
Newsroom/PressAnnouncements/
ucm334798.htm
http://nccam.nih.gov/
news/2006/091806.htm
Rosekind, MR and Gregory, KB. Insom-
nia risks and costs: health, safety, and
quality of life.
Am. J. Manag. Care
2010;16(8):617-626.
How new Diagnoses
and Approaches will
affect DSM-5 and the
ICSD-3
Fahd Zarrouf, MD
Publication of the
Diagnostic
and Statistical Manual of Mental
Disorders, 5
th
edition
(
DSM-5
)
in
May 2013 will mark one of the
most anticipated events in the
mental health field. Sleep disor-
ders in the
DSM-5
are anticipated
to be organized in three major
groups: insomnia, hypersomnia
and arousal disorders.
Insomnia disorders are con-
sistent with the 2005 NIH State
of the Science position on clas-
sification of insomnia disorders
and the
International Classifica-
tion of Sleep Disorders, 2
nd
edition
(
ICSD-2
).
Some of the suggested
changes include eliminating the
diagnosis of “primary insomnia”
in favor of “insomnia disorder,”
with concurrent specification of
clinically comorbid conditions
(
both medical and psychiatric).
The
DSM-5
enforces using
clinical scales to evaluate the
severity of various disorders. For
insomnia, suggested scales may
include: Insomnia Severity Index,
PROMIS Sleep-Wake Distur-
bance Self-Report, or Women’s
Health Initiative Insomnia
Rating Scale.
The sleep community may find
the
DSM-5
more congruent with
the
ICSD-2
than previous DSM
versions. Does this mean that
the
ICSD-2
is already updated
and ahead of the curve? Many
feel that the
ICSD-2
is becoming
more and more outdated with
disorders rarely used in clini-
cal practice, and diagnoses very
common clinically but rarely
documented as initial diagnoses
because insurance companies
may not pay for tests for these di-
agnoses. Fortunately, the
ICSD-3
is in progress. We look forward
to discussing the changes incor-
porated in the new
ICSD
at the
section meeting in Baltimore.
Avenues between
Insomnia and Other
Medical and Psychiatric
Disorders
Beverly Fang, MD
Recently, there has been more
attention directed to the bidi-
rectional relationship between
insomnia and mental and somat-
ic issues. Insomnia is part of a
prodromal syndrome, a symptom
of exacerbation, and a risk factor
for many psychiatric disorders
including depression, anxiety,
substance abuse, and suicidality.
Insomnia and sleep deprivation
have been linked with cogni-
tive errors, accidents, worsening
chronic pain, and cardiovascular
health. Sleep medicine by nature
is an interdisciplinary field. It
incorporates expertise from those
with a background in mental
health, biological research, and
somatic medicine. One would
anticipate within the field of
sleep medicine that the avenues
between insomnia, mental and
somatic issues would be wide
open and free flowing. And it
can be, but is not necessarily so.
Even the name ‘sleep medicine’
connotes a more clinically medi-
cal field, as currently most sleep
programs are housed within pul-
monary or neurology divisions.
A well rounded sleep clinic will
have access to behavioral and
Continued >>