Chelsea N. Di Polito, PharmD, BCPP, Assistant Director of the Peer Review for Mental Health Drugs Program
University of Maryland School of Pharmacy
As experts in psychiatric pharmacy, few disorders keep us up at night wondering how to tackle treatment for our patients quite like insomnia does. There are so many factors to consider when choosing non-pharmacologic and pharmacologic treatments for these patients: What have they tried? What other diagnoses do I have to consider when making my treatment selection? What’s the next logical step if this fails? We also have those tough cases where first and second-line options have been exhausted and we just don’t know how best to manage this patient. Insomnia can be one of those unsuspecting difficult disorders to treat, especially for those who are treatment-resistant or are part of a population that has even more considerations to think about. Because of this, the Program Committee invited our resident expert on the matter, Dr. Megan Maroney, to untangle the intricacies of treating insomnia.
Insomnia: Treatment Resistance and Special Populations provided the attendees with a perfectly paced, comprehensive review of insomnia in these difficult-to-treat, but everyday situations that we all face in practice. This session was a perfect example of what our science-minded members look for in programming: literature, which Dr. Maroney certainly delivered while simultaneously sprinkling in her light-hearted comedic personality throughout. Dr. Maroney was able to cover an impressive amount of information at a level that all audience members could understand, including an important consideration: treatment-resistant insomnia does not have a standardized definition.
Throughout this session, we learned about risk factors for treatment resistance, a non-pharmacologic treatment (apart from practicing good sleep hygiene) that should be tried in every patient: Cognitive Behavioral Therapy – Insomnia (CBT-I), as well as an exhaustive literature review highlighting evidence-based treatment options for disorders ranging from depression and bipolar to schizophrenia and even patients with comorbid obstructive sleep apnea. Furthermore, a dive into treating insomnia in pediatric, geriatric, and pregnancy populations was reviewed with literature supporting her recommendations. Dr. Maroney did an excellent job reiterating the paucity of evidence related to these populations, but was able to capture what evidence she could find and present it in a digestible manner, such as with PTSD:
As well as the child and adolescent population:
Dr. Maroney presented the audience with three interactive patient cases designed to test our knowledge prior to covering the topic in question. These included a treatment-resistant case, a patient with multiple comorbidities, as well as a pediatric case. If you missed seeing this session live, don’t snooze on the opportunity to learn everything you need to know about approaching patients with treatment-resistant insomnia, by watching the recording here.
If you need even more evidence outlining just how valuable this session was, take it from your peers:
“This was my favorite presentation thus far. I loved that the speaker discussed a highly relevant topic, along with informative patient examples.”
“Very well organized and presented. Speaker incorporated plenty of audience interaction and clinical applications. This is a deceptively complex topic, and it was handled well.”
“Great presentation! Loved the info on special populations and the evidence on all the different approaches.”
“I genuinely enjoyed the presentation and will be able to take the lessons learned from this discussion to apply to my practice.”
Thanks to her comprehensive review of insomnia, we can all rest peacefully knowing what literature is available to us and how to treat any of the more complex cases that we come across in our practice.