Practical Strategies for the Nonpharmacologic Management of Shift Work Disorder

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Support for this activity has been made possible through an educational grant from Teva Pharmaceuticals.

Release date: 9/30/2014
Expiration date: 9/30/2015
Estimated time to complete: 30 minutes

Activity Description

Shift work disorder (SWD) is a formally recognized sleep disorder that occurs in people who work nontraditional hours (ie, outside of the standard 9 am–5 pm schedule). A number of symptoms are indicative of SWD, but the most common are excessive sleepiness and insomnia. Although several nonpharmacologic and pharmacologic therapies can be used to effectively manage the symptoms of SWD, many people with the condition remain undiagnosed and untreated. This Virtual Practice, which includes a for-credit scientific presentation and three for-credit case studies, has been developed to improve the general understanding of the diagnosis and management of SWD. In addition, the Virtual Practice features several valuable tools that can be used in clinical practice to improve the management of SWD.

This module describes the application of nonpharmacologic strategies that serve as the starting point for managing SWD.

Activity Faculty

Paul P. Doghramji, MD, FAAFP—Program Chair
Attending Physician
Pottstown Memorial Medical Center
Medical Director, Health Services
Ursinus College
Collegeville, Pennsylvania

Karl Doghramji, MD
Professor of Psychiatry, Neurology, and Medicine
Medical Director, Jefferson Sleep Disorders Center
Program Director, Fellowship in Sleep Medicine
Thomas Jefferson University
Philadelphia, Pennsylvania

Jacqueline Valdez-Bedikian, PharmD
Pharmacist-in-Charge
Western Drug Pharmacy
Glendale, California

Teresa D. Valerio, DNP, APN, FNP-BC, CBSM
Assistant Professor
Doctor of Nursing Practice Program Leader
Mennonite College of Nursing
Illinois State University
Normal, Illinois

Target Audience

This activity has been designed to meet the educational needs of primary care physicians, nurse practitioners, physician assistants, pharmacists, nurses, and other health care professionals who are involved in the management of patients who have or are at risk for SWD.

Learning Objectives

After participating in the activity, learners should be better able to:

Implement treatment strategies that utilize nonpharmacologic modalities to alleviate symptoms of SWD

Accreditation and Credit Designation

Physicians
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American Academy of CME, Inc., and RedMedEd. The American Academy of CME, Inc., is accredited by the ACCME to provide continuing medical education for physicians.

American Academy of CME, Inc., designates this enduring material for a maximum of 0.5AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurses
American Academy of CME, Inc., is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

American Academy of CME, Inc., designates this educational activity for 0.5 contact hours.

Pharmacists

The American Academy of CME, Inc., is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.

This activity provides 0.5 contact hours (0.05 CEUs) of continuing education credit. ACPE Universal Activity Number 0297-9999-14-020-H01-P, Knowledge.

Disclosure Statement

According to the disclosure policy of American Academy of CME, Inc., all faculty, planning committee members, editors, managers and other individuals who are in a position to control content are required to disclose any relevant relationships with any commercial interests related to this activity. The existence of these interests or relationships is not viewed as implying bias or decreasing the value of the presentation. All educational materials are reviewed for fair balance, scientific objectivity and levels of evidence. Disclosures are as follows:

Jacqueline Valdez-Bedikian, PharmD, has disclosed no relevant financial relationships with any commercial interests.

Karl Doghramji, MD, has disclosed the following relevant financial relationships:
Consultant: Aptalis, Jazz, Vanda, UCB, Teva Pharmaceuticals
Shareholder: Merck (self and spouse/partner)
Other: Contributor to the Merck Manual and the Merck Manual Home Health Handbook

Paul P. Doghramji, MD, FAAFP, has disclosed the following relevant financial relationships:
Advisory Board: AstraZeneca, Horizon, Merck, Teva Pharmaceuticals
Speakers Bureau: Horizon, Takeda, Teva Pharmaceuticals

Teresa D. Valerio, DNP, APN, FNP-BC, CBSM, has reported no relevant financial relationships with any commercial interests.

Independent Clinical Peer Reviewer
Bennett S. Shenker, MD, MS, MSPH, FAAFP, Assistant Professor of Family Medicine, Rutgers, The State University of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers RWJ Family Medicine Residency at CentraState, Freehold, NJ, has reported the following financial relationship: Board of Managers Central New Jersey Accountable Care Organization

Planning Committee
John JD Juchniewicz, MCIS, CCMEP, and Natalie Kirkwood, RN, BSN, JD, Lead Nurse Planner, American Academy of CME, Inc., have disclosed no relevant financial relationships with any commercial interests.

Thomas Finnegan, PhD, and Jonathan S. Simmons, ELS, RedMedEd, have reported no relevant financial relationships with any commercial interests.

Robert Gengerke, RedMedEd, has reported the following relevant financial relationships: Freelance writer (sales training and marketing materials): GlaxoSmithKline, Ikaria, Novartis, Gilead Sciences, Forest, Ironwood, Genzyme, Daiichi-Sankyo, Bayer, Noven, Johnson & Johnson.

This activity will discuss off-label or investigational information.

Generic Name	Trade Name	Approved Use (if any)	Unapproved/ Investigational Use
Doxepin	Prudoxin, Silenor, Zonalon	Psychoneurotic patients with depression and/or anxiety Depression and/or anxiety associated with alcoholism (not to be taken concomitantly with alcohol) Depression and/or anxiety associated with organic disease (the possibility of drug interaction should be considered if the patient is receiving other drugs concomitantly) Psychotic depressive disorders with associated anxiety, including involutional depression and manic-depressive disorders	Insomnia in patients with SWD
Estazolam	none	Short-term management of insomnia characterized by difficulty in falling asleep, frequent nocturnal awakenings, and/or early morning awakenings	Insomnia in patients with SWD
Eszopiclone	Lunesta	Treatment of insomnia	Insomnia in patients with SWD
Flurazepam	Dalmane, Dalmadorm	Treatment of insomnia characterized by difficulty falling asleep, frequent nocturnal awakenings, and/or early morning awakenings	Insomnia in patients with SWD
Methamphetamine	Desoxyn	Part of a total treatment program that typically includes other remedial measures for a stabilizing effect in children >6 years of age with a behavioral syndrome characterized by the following group of developmentally inappropriate symptoms: Moderate to severe distractibility Short attention span Hyperactivity, emotional lability, and impulsivity Short-term adjunct in a regimen of weight reduction based on caloric restriction for patients in whom obesity is refractory to alternative therapy (eg, repeated diets, group programs, and other drugs)	Excessive sleepiness in patients with SWD
Ramelteon	Rozerem	Treatment of insomnia characterized by difficulty with sleep onset	Insomnia in patients with SWD
Temazepam	Restoril, Strazepam	Short-term treatment of insomnia (generally 7–10 days)	Insomnia in patients with SWD
Triazolam	Halcion	Short-term treatment of insomnia (generally 7–10 days)	Insomnia in patients with SWD
Quazepam	Doral	Treatment of insomnia characterized by difficulty falling asleep, frequent nocturnal awakenings, and/or early morning awakenings	Insomnia in patients with SWD
Zolpidem	Ambien, Ambien CR, Edluar, Intermezzo	Short-term treatment of insomnia characterized by difficulties with sleep initiation	Insomnia in patients with SWD

Disclaimer

The opinions expressed in this educational activity are those of the faculty and do not represent those of American Academy of CME, Inc., RedMedEd, or the American Nurses Credentialing Center’s Commission on Accreditation. This activity is intended to supplement existing knowledge, published information, and practice guidelines. Learners should appraise the information presented critically and draw conclusions only after careful consideration of all available scientific information.

Method of Participation

There are no fees to participate in the activity. Participants must review all activity information, including the learning objectives, disclosure statements, and content. To receive CME/CNE/CPE credit for participation, participants must complete the posttest (achieving a passing grade of 70% or greater) and program evaluation. Certificates can be printed immediately. For pharmacists, a statement of credit will be issued through CPE Monitor in 6–8 weeks.

Hardware/Software Requirements

Apple iPad or iPad mini (iOS 7 or higher) with an Internet connection
A computer with an Internet connection
- Internet browser: Internet Explorer 9 or higher, Firefox 26 or higher, or Safari 5 or higher
- Additional software: Adobe Flash Player and/or an HTML 5-capable browser is required for video or audio playback; Adobe Acrobat Reader may occasionally be required

Privacy

For more information about the privacy policy of American Academy of CME, Inc., please access http://www.academycme.org/privacy.htm.

Contact

For any questions, please contact CEServices@academycme.org.

Copyright

© 2014. This CME/CNE/CPE-certified program is held as copyrighted by American Academy of CME, Inc., and RedMedEd. Through this notice, the American Academy of CME, Inc., and RedMedEd grant permission of its use for educational purposes only. These materials may not be used, in whole or in part, for any commercial purposes without prior permission in writing from the copyright owners.