14
AASMMembershipSectionsNewsletter
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Issue #5
AmericanAcademy
of SleepMedicine
of Pennsylvania for his post-doctoral fellowship.
He completed his neurology residency and clinical
neurophysiology fellowship, including sleepmedicine training
inGeorgetownUniversity. He is a board certified neurologist,
neurophysiologist, and sleepmedicine specialist. He is
currentlyworking as co-director of integrative neurology inSt.
AgnesHospital.
FahdA. Zarrouf, MD
Dr. Zarrouf completed hismedical training and psychiatry
residency at DamascusUniversity/ Medical School Hospitals
inDamascus, Syria. He then completed a combined internal
medicine and psychiatry residency atWest VirginiaUniversity/
CharlestonAreaMedical Center- Charleston,WV. He
completedaSleepMedicineFellowship at theCleveland
Clinic Foundation inCleveland, OH. He is currentlyworking
as anAssistant Professor of Medicine-MUSC, atAnMed
Health,Anderson, SC. He isChief of PsychiatricService and
Medical Director of Transcranial MagneticStimulationCenter
in Internal Medicine, Psychiatry, andBehavioral Medicineat
the Lung&SleepCenter.
MaryRose, PsyD
Dr. Rosewas awarded her PsyD from theVirginiaConsortium
Program inClinical Psychology (OldDominionUniversity,
EasternVirginiaMedical School,William&Mary andNorfolk
StateUniversity). She completedher internshipat the
University of TexasMedical Branch; a fellowship inBehavioral
Medicine at UTMB andShriner’sBurnsHospital, aswell as a
fellowship inSleepMedicine at theMichael EDeBakeyVAMC
inHouston. She is aClinical Psychologist and anAssistant
Professor in theDepartment of Medicine, Pulmonary, Critical
Care andSleepSectionat Baylor College of Medicine. She
is also affiliatedwith theVAMCSleepDisordersCenter, and
MDAndersonCancer Center. Shehas a private sleep clinic
inHouston, and is theClinical Director ofAmericanSleep
Medicine inWebster,TX. She has been involved in the sleep
field for over 20 years, andholds subspecialty credentialing
by theAmericanAcademy of SleepMedicine inBehavioral
SleepMedicine. Sheworkswith both adults and pediatric
patients. Shehas published abstracts, peer reviewed journal
articles, and book chapters in the fieldof sleep disorders
medicine, aswell as in the area of psychosocial outcomes in
medically ill patients.
RebeccaQ. Scott, PhD
Dr. Scott completedher undergraduate degree at Notre
DameCollege inManchester, NH. She then completed
her PhD inHealthPsychology at YeshivaUniversity/Albert
EinsteinSchool of Medicine inNewYork. She also completed
her clinical work in sleep disordersmedicine at TheSleep
DisordersCenter, ColumbiaPresbyterianMedical Center
inNewYorkCity. She currentlyworks as a sleep disorders
specialist at NewYorkSleep Institute. ■
Obstaclesof Implementingan InsomniaClinic
Insomnia treatment is often complex and requires skills in
psychology, pathology, andgeneral sleepmedicine.Theremay
bewhat seems like insurmountableobstacles for theoverall sleep
practice, the clinicians treating thedisorder, and for thepatient.
Someof theseobstacles arediscussedbelow.
First, theobstacles facedby sleeppractices that treat insomnia
include timemanagement, an increasingnumber of patients inneed
of this service, an agingpopulationwith insomnia complaints, drug
abuse/misusebymanypatients, and a lackof reimbursement or
resources formanagement.
Second, theobstacles facedby clinicians and alliedhealth
professionals include lacking the time tomeet theneeds of insomnia
patients, a limitedknowledgeof behavioral sleepmedicine and
different interventions to treat insomnia and comorbidities, and
difficulties in receiving reimbursement formanyof the services.
Insomnia can alsobe co-morbidwithothermedical andmental
problems. Becauseof this, treating insomniamaymean evaluating
anddiscussingother comorbidities (e.g. effect of depressionon
insomnia),whichmaybe time-consuming. Finally, theremaybe
certain reservations, such that patients are coming to the clinic to
“self-medicate” insteadof sincerely seekinghelp for their condition.
Third, there are at least four obstacles facing thepatient.The
first is time limitation;most patients cannotmake the time in
their busy schedules formultiple and frequent visits to receive
cognitivebehavioral treatment for their insomnia.The second
is cost limitation: treating insomniamaybe costly andmaynot
be covered completelyby insurance.The thirdobstacle is the
chronicityof their symptoms - beforefinallyvisiting a sleep clinic,
many insomniapatients report that theyhave tried almost “every
sleep agent out there”.This particular beliefmay leads to increased
negative expectations regarding further treatments.The fourth and
final obstacle is perception.Manypatients think that a “sleep clinic”
primarily treats sleep apnea,whichmay lead them to seek treatment
for their insomniawith their primary carephysicianor psychiatrist.
Overcoming theObstacles:How to Incorporate
Insomnia intoyourPractice
It iswell established that treating insomnia - even in the context of
medical (e.g. Pigeon et al 2012;Martinez et al 2013) andpsychiatric
disorders (Manber et al. 2008) - candecrease the symptoms of the
comorbiddisorder.Due to this, treating insomniamay aid in the
therapyof other disorders, such asCPAP compliance (Pieh et al.
2013).Our recommendations toovercome theobstacles above
include the following:
