Chapter 13: Sleep Disorders

Question 1

Sleep is essential for…

Answer 1

Restoration of energy, consolidation of memory and learning, and maintenance of the immune system.

Question 2

How many stages of sleep

Answer 2

5 (1 REM and 4 nREM)

Question 3

Which stage is absent after the first sleep cycle

Answer 3

Stage 1, you go directly from Stage 2 to REM and vice versa

Question 4

Effects of benzos

Answer 4

Suppress stage 3 and 4

Question 5

Effects of antidepressants and alcohol

Answer 5

Suppress REM sleep

Question 6

Stage 2 Sleep EEG

Answer 6

Sleep spindles and K complexes

Question 7

Test for sleep disorders

Answer 7

Must get Polysomnogram (PSG)

Question 8

Which part of brain determines circadian rhythms

Answer 8

Suprachiasmatic nucleus of the hypothalamus

Question 9

Advanced vs. Delayed Sleep-Phase disorders

Answer 9

Advanced means you sleep much earlier, Delayed means you sleep much later

Question 10

Advanced vs. Delayed Sleep-Phase disorders tx

Answer 10

Bright light therapy and Melatonin to reset circadian rhythms

Question 11

Restless Legs Syndrome/Periodic Limb Movements of Sleep

Answer 11

Restless legs happen at night and at rest, accompanied oftenly by periodic limb movements of sleep (happen in the lower body)

Question 12

RLS more in women or men?

Answer 12

In Women.

Question 13

RLS medical cause

Answer 13

Iron deficiency

Question 14

RLS tx

Answer 14

DA agents: ropinirole and pramipexole > levodopa.

Question 15

Why not Levodopa for RLS

Answer 15

Higher incidence of augmentation, progressive movement of symptoms toward an earlier time of day with continued therapy

Question 16

Side effects of DA agonists

Answer 16

Nausea, lightheadedness, and sometimes sleep attacks

Question 17

RLS other tx

Answer 17

Gabapentin, opioids, and benzos.

Question 18

Narcolepsy/Cataplexy syndrome

Answer 18

Excessive daytime sleepiness with narcolepsy, cataplexy, sleep paralysis, and hypnagogic hallucinations

Question 19

Narcolepsy

Answer 19

Irresistible urge to sleep

Question 20

Cataplexy

Answer 20

Sudden loss of muscle tone, often in the setting of laugher or other strong emotions

Question 21

Narcolepsy/Cataplexy onset

Answer 21

Teens/Twenties

Question 22

Narcolepsy/Cataplexy cause

Answer 22

Decreased Hypocretin (can diagnosis from CSF level)

Question 23

Narcolepsy/Cataplexy diagnosis

Answer 23

PSG for Multiple Sleep Latency Test (MSLT): if sleep latency is <8 minutes, with more than 2 episodes of REM at sleep onset, it is diagnostic

Question 24

Narcolepsy/Cataplexy

Answer 24

Modafinil, methylphenidate, amphetamines for narcolepsy

Clomipramine/GHB/SSRIs for Cataplexy

Question 25

Narcolepsy/Cataplexy clinical tetrad

Answer 25

Narcolepsy, cataplexy, sleep paralysis, and hypnagogic hallucinations

Question 26

Parasomnias and dyssomnias

Answer 26

Parasomnias are abnormal behaviors that occur during sleep or sleep-wake transition

Question 27

Distinguishing nightmares from sleep terrors

Answer 27

You remember nightmares

Question 28

REM behavior disorder

Answer 28

Acting out dreams during REM, should not be possible normally

Question 29

REM behavior disorder associated with

Answer 29

Synucleinopathies: PD, Lew body dementia, multiple system atrophy

Question 30

REM behavior disorder tx

Answer 30

Clonazepam

Question 31

Noctural cramps and tx

Answer 31

Lower extremity muscles, tough to treat, tx with Quinine

Question 32

Symptoms of OSA

Answer 32

Excessive daytime sleepiness, snoring, cessation of breathing in the middle of the night, and morning headaches.

Question 33

OSA risk factors

Answer 33

BMI>30, thick neck >17 inches, advanced age.

Question 34

OSA can cause...

Answer 34

Cor pulmonale

Question 35

OSA tx

Answer 35

CPAP, weight loss, alcohol cessation, and sleeping on side

Question 36

OSA test

Answer 36

PSG to test for >5 apneas, hypopneas, or respiratory event-related arousals