2017 CSS Conference
Sunday Technologist 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 amPAP and ASV Workshop - Part I
Speaker: Elaina Zebroff RRT, Regional Clinical Specialist, Western Canada, ResMed
Speaker: Steve Bouchard RRT, Clinical Product Specialist , Philips Healthcare
Workshop will be 30 minute Presentation from RESMED followed by 30 minutes from RESPIRONICS.  

The sleep world is changing and sleep labs are seeing more and more difficult/complex patients.

Learning Objective:   
  • At the end of this session you will be able to understand advanced technologies and algorithms such as ASV, AVAPS and Bi-level modes. 
  • A review of all modes, clinical application and case studies will be done.
11:30 am - 12:00 pmPAP and ASV Workshop - Part II
Speaker: Elaina Zebroff RRT, Regional Clinical Specialist, Western Canada, ResMed
Speaker: Steve Bouchard RRT, Clinical Product Specialist , Philips Healthcare
Hands on with Devices.  

Learning Objective:
  1. To discuss devices and hands on opportunity to try devices with the experts
12:00 pm - 1:00 pmLunch & Exhibits Open
Sponsored by
1:00 pm - 2:00 pmIntegrating Polyvagal Theory into Pain Management: the Bi-Directional Relationship between Sleep and Pain and the Relevance of Markers of Sleep Instability in Sleep Medicine
Dr. Celeste Thirlwell B.Sc (neuro), MD, FRCPC, Sleep Medecine Specialist, Center for Sleep and Chronobiology

The session will review how the Polyvagal Theory provides a theoretical rationale for integrating the assessment of the Autonomic Nervous System (ANS) as a key component in the work-up of patients with pain and disordered sleep.

This session reviews the indications for, and benefits of, integrating Polyvagal Theory into treatment of patients with pain and disordered sleep. Findings from patient polysomnograms highlight the critical role of the autonomic nervous system (ANS) in understanding the complexity of sleep disorders, pain, and non-restorative sleep. The key elements of the pathophysiology underlying these sleep conditions, and their overlapping clinical symptoms, will be elaborated (i.e. the distinction between sleepiness and fatigue; the level of symptom distress; the impact of pain and disturbed sleep on daytime functioning, cognition, mood and affect). There is compelling research evidence that dysregulated ANS activity is an overlooked factor in pain and disordered sleep. The session will highlight how the needs of our patients can benefit from identifying and addressing underlying ANS dysregulation.

Learning Objectives:

  1. To understand that Polyvagal Theory can be used to address the underlying ANS dysregulation found in patients with pain and disordered sleep
  2. To understand the application of behavioral, cognitive and social interventions aimed at stabilizing the ANS and improving compliance and outcomes in pain patients

1:00 pm - 2:00 pmL’influence de la lumière et du rythme circadien sur le sommeil
Speaker: Sébrina Aubin, Université de Montréal
Cette présentation vise à informer les praticiens quant à la contribution du rythme circadien sur la structure et microstructure du sommeil. De plus, puisque la lumière joue un rôle important sur le maintien d’un rythme circadien synchronisé, son influence sur le cycle éveil-sommeil sera aussi abordé.
2:00 pm - 3:00 pmScoring Bootcamp
Speaker: Natalie Morin RPSGT, TEPM (polysomnographie)

Interactive session to understand the AASM rules to improve collections and be able to analyze challenging studies. 

Learning Objective:
  1. Review the latest AASM scoring guidelines for staging, arousals, respiratory and limb movements scoring.
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