2017 CSS Conference
Sunday Dental Program
Sunday April 30, 2017
7:00 am - 4:00 pmRegistration Open
8:00 am - 9:00 amKeynote 4 - Insomnia - A Transdiagnostic Approach
Prof. Dieter Riemann Ph.D., Dipl. Psych, Department of Clinical Psychology and Psychophysiology, Centre for Mental Disorders, Freiburg University Medical Centre, Germany
Till recently, insomnia was differentiated into primary/ secondary forms, indicating that insomnia can be due to somatic or mental disorders, can be substance-related or can occur as a primary disorder, unrelated to other disorders. Even more sophisticated insomnia subtypes were described as psychophysiologic, idiopathic or paradoxical forms. In contrast, DSM-5 introduced "insomnia disorder" as an umbrella category and NIH suggested a transdiagnostic approach towards insomnia with the RDoC criteria. Own work based on an extensive meta-analysis of the polysomnographic literature in mental disorders and insomnia indicates that insomniac symptoms like prolonged sleep latency or increased nocturnal awakenings are not specific for any given disorder but transdiagnostic in nature. The hyperarousal concept of insomnia, too, can be viewed as a transdiagnostic mechanism triggering and maintaining most insomnias. 

Own work focusing on autonomic, neurophysiologic and neuroimaging studies in insomnia, accumulated evidence that "hyperarousal" on several levels, including subjective perception ,is not specific for insomnia subtypes. CBT-I, as first-line treatment for insomnia, in the meantime also has been proven to be effective in so-called "secondary" insomnias, including severe somatic or mental disorders.
Learning Objectives

  1. Describe the diagnostic approach of DSM 5 towards insomnia
  2. Describe the transdiagnostic nature of insomnia symptoms for mental disorders
  3. Describe the major signs of hyperarousal for insomnia patients

9:00 am - 10:00 amKeynote 5 - Speaking, Smiling and Gesturing During Sleep - Ethology of Nocturnal Behaviors
Isabelle Arnulf MD, PhD, Professor of Neurology, Pierre and Marie Curie University, Paris, France

We are supposed to be quiet and immobile when sleeping, except for brief arousals and position changes. However, a fine examination of video and audio sounds during the night reveals numerous exceptions to this rule, including complex behaviors such as sleep talking, expressing facial emotions and gesturing. They can be seen in subjects with NREM and REM parasomnias, but also in normal adult subjects. These vocalizations, speeches, whispering and shouting, smiles, fear expressions, and movements have been insufficiently studied per se, whereas they can be seen as an extraordinary, open window upon mental content and brain functioning during sleep. What does the sleeping brain say? Are emotions visible on the sleeper face? What is the variety (and potential generators) of the behaviors observed in RBD and sleepwalking? We will expose the observations of several hundred of sleepers studied from an ethological point of view during the night. 

Learning Objectives

  1. To learn about the movements and behaviors displayed during sleep in patients with REM sleep behavior disorders, and to infer about their brain sources
  2. To learn about sleep talking and what is said by the sleeping brain
  3. To learn about facial expression during sleep

10:00 am - 10:30 amHealth Break & Exhibits Open
10:30 am - 11:30 amOral Appliance Therapy & The Edentulous Patient
Fernanda Almeida DDS, MSc, PhD, Associate Professor, University of British Columbia, Vancouver, BC
This session will provide attendees the knowledge on existing literature evaluating the role of edentulism on OSA and the possible efficacy of oral appliances in this population

In the session we will:
  • Evaluate the evidence of incidence of OSA in the edentulous population; 
  • Understand the possible treatments for edentulous patients; 
  • Explain denture wear or oral appliance wear in the edentulous patient and 
  • Discuss possible guidance on how to treat edentulous OSA patients
11:30 am - 12:30 pmLunch & Exhibits Open
12:30 pm - 1:30 pmThe OSA/TMD/Bruxism Connection. Does it Exist? When Should we Treat?
Jean Patrick Arcache DDS, Dental Surgeon, Université de Montréal
The sleep and pain connection: it`s implication for the dentists.

In the recent years multiple clinical studies have focused on pain in the head and neck area as well as on sleep breathing disorders. A few of these studies have looked at an eventual link between sleep, bruxism, pain, sleep breathing disorders. This presentation will attempt to shed some light on the maze of articles and try to dissipate the confusion about this eventual link.

Learning objectives: 

The dentists attending this lecture should have a clear idea about the most recent studies on:  
  1. Bruxism, TMD disorders, and sleep 
  2. Pain and sleep 
  3. Come out of the lecture with practical tools for their practice

1:30 pm - 3:00 pmDifficult Case Presentations
Moderator: Fernanda Almeida DDS, MSc, PhD, Associate Professor, University of British Columbia, Vancouver, BC
3:00 pm - 3:30 pmHealth Break
3:30 pm - 4:30 pmKeynote 6 - Manual Scoring of Polysomnograms: What Are We Missing?
Magdy Younes MD, FRCPC, PhD, Distinguished Professor Emeritus , University of Manitoba
Manual scoring of polysomnograms is based on rules developed for visual scoring in the mid 1960’s, at a time when personal computers had not yet even been invented. It is truly amazing that it is still the main tool for assessing sleep quality after 50 years of dramatic advances in digital technology. The EEG is full of information that cannot be quantified by the naked eye. Utilizing this information through digital analysis may greatly enhance the clinical usefulness of sleep studies. In this presentation, I will present some of the new developments in this area including the Odds-Ratio-Product (ORP) a continuous index of sleep depth/quality, scaling of arousal intensity, regional differences in sleep depth, quantitation of alpha intrusion and spindle characteristics (frequency, duration and intensity), speed with which deep sleep returns following arousals and awakenings, enhancements to the multiple sleep latency test, and use of digitally scored spindles, K complexes and delta wave duration to reduce inter-scorer variability in staging sleep.

Learning Objectives:

  1. To appreciate the difficulty of evaluating sleep depth/quality from conventional scoring (R&K rules) of sleep data.
  2. To learn about emerging technologies in evaluating sleep
  3. To appreciate the potential clinical benefits of incorporating digital EEG analysis in routine polysomnography.

4:30 pm - 5:00 pmConference Wrap-up