HBM 08b: Sleep

Question 1

In active mental concentration, EEG, will show predominantly (X) waves.

Answer 1

X = beta

Question 2

In awake, relaxed/drowsy person, EEG, will show predominantly (X) waves.

Answer 2

X = alpha

Question 3

Fast-wave EEG characterizes which sleep state?

Answer 3

REM

Question 4

Non-REM sleep makes up (X)% of sleep time. It has waves of (high/low) frequency and (high/low) amplitude.

Answer 4

X =75

Low; high

Question 5

Stage 1 sleep lasts (X)% of sleep time and characterized by (Y) wave(s).

Answer 5

X = 5 (very short)
Y = theta

Question 6

Stage 2 sleep lasts (X)% of sleep time and characterized by (Y) wave(s).

Answer 6

X = 45
Y = spindle-shaped (sleep spindles) and K-complexes

Question 7

Stages 3 and 4 are collectively called (X) sleep and lasts (Y)% of sleep time and characterized by (Z) wave(s).

Answer 7

X = delta/slow-wave
Y = 25
Z = slow

Question 8

Bruxism is (X) and usually occurs in (Y) sleep stage.

Answer 8

X = tooth grinding
Y = Stage 2

Question 9

Sleepwalking usually occurs in (X) sleep stage.

Answer 9

X = delta

Question 10

Enuresis usually occurs in (X) sleep stage.

Answer 10

X = delta

Question 11

Night terrors usually occurs in (X) sleep stage.

Answer 11

X = delta

Question 12

Sawtooth waves in EEG indicate:

Answer 12

REM sleep

Question 13

Dreaming occurs in which part of sleep time?

Answer 13

REM

Question 14

REM takes up (X)% of sleep time.

Answer 14

X = 25

Question 15

Average time until first REM, aka (X), is how long?

Answer 15

X = REM latency

90 minutes

Question 16

Shortened REM latency can be seen in which disorders?

Answer 16

1. MDD

2. Narcolepsy

Question 17

Patients normally experience REM in periods of (X) minutes, occurring every (Y) minutes.

Answer 17

X = 10-40
Y = 90

Question 18

Sympathetic activity is (activated/suppressed) in REM.

Answer 18

Suppressed

Question 19

Penile/clitoral erection occur in which part of sleep?

Answer 19

REM

Question 20

T/F: all skeletal muscles are completely paralyzed during REM sleep.

Answer 20

False - all skeletal muscles except those controlling respiration, eye movement, and middle ear ossicles

Question 21

How does sleep latency change with age?

Answer 21

Prolonged

Question 22

Total sleep time is (increased/decreased/unchanged) with aging.

Answer 22

Decreased

Question 23

(Decrease/increase/unchanged) number of nighttime wakings in depression.

Answer 23

Increased

Question 24

List the parasomnias.

Answer 24

1. Bruxism
2. Nightmare disorder
3. Sleep terror
4. Sleepwalking
5. REM sleep behavior disorder

Question 25

(X) agents can be beneficial for insomnia due to sedating side effects. Why should they be avoided in (Y) patients?

Answer 25

``` X = antihistamine (ex: diphenhydramine/benadryl) Y = elderly ``` Can provoke delirium

Question 26

A 70-year old patient comes into clinic, requesting medication to relieve insomnia. What's the best med to prescribe and why?

Answer 26

Trazodone (Desyrel), a sedating antidepressant; prescribing antihistamines in elderly can cause delirium

Question 27

(X) meds can be useful for treating delta sleep disorders, such as (Y). Why?

Answer 27

``` X = benzodiazepines Y = night terrors and bedwetting ``` Reduce likelihood of delta sleep

Question 28

Initial management of insomnia is:

Answer 28

caffeine avoidance and good sleep hygiene

Question 29

Central sleep apnea can be described as:

Answer 29

Open airway, but little to no respiratory efforts

Question 30

Obstructive sleep apnea can be described as:

Answer 30

Airway obstruction preventing air from reaching lungs, despite respiratory efforts

Question 31

Central sleep apnea commonly found in:

Answer 31

Elderly

Question 32

Obstructive sleep apnea commonly found in:

Answer 32

Male and obese patients (40-60 y.o.)

Question 33

Daytime sleepiness resulting from airway obstruction is called (X) syndrome.

Answer 33

X = Pickwickian

Question 34

CPAP stands for (X) and is used to treat (Y).

Answer 34

``` X = Continuous positive airway pressure (device) Y = obstructive sleep apnea ```

Question 35

T/F: Antidepressants are used to treat sleep apnea.

Answer 35

True - act as respiratory stimulants

Question 36

Cataplexy is (X) and seen in which disorder?

Answer 36

X = sudden physical collapse, due to loss of all muscle tone after strong emotional stimulus Narcolepsy

Question 37

Treatment for narcolepsy

Answer 37

Stimulant agents (ex: ritalin); timed daytime naps can also help

Question 38

Sleep is regulated by which systems?

Answer 38

1. Sleep drive | 2. Body clock (circadian rhythm)

Question 39

Sleep drive is a result of (X) build-up.

Answer 39

X = adenosine

Question 40

Circadian rhythm is controlled by:

Answer 40

SCN (suprachiasmatic nucleus)

Question 41

SCN is located in which part of brain?

Answer 41

Hypothalamus

Question 42

SCN responds to (X) signals by controlling (Y).

Answer 42

``` X = Light/dark signals Y = release of melatonin (hormone) ```

Question 43

List some dyssomnias.

Answer 43

1. Insomnia 2. Breathing-related disorders 3. Narcolepsy 4. Hypersomnias 5. Circadian rhythm sleep disorder

Question 44

Insomnia is seen in (X)% of population.

Answer 44

X = 30 (common)

Question 45

Insomnia affects (males/females) more often.

Answer 45

Females (twice as often)

Question 46

Patients with narcolepsy go right into which sleep stage during a sleep attack?

Answer 46

REM

Question 47

T/F: Narcolepsy is a fairly common sleep disorder.

Answer 47

False - rare (0.03-0.16% of population)

Question 48

Narcolepsy often seen in (males/females) and has an onset at which age range?

Answer 48

Seen in M/F equally; onset during adolescence

Question 49

Hypnagogic hallucinations are associated features of:

Answer 49

Narcolepsy

Question 50

Circadian rhythm disorders present with (insomnia/excessive sleepiness).

Answer 50

Either or

Question 51

(Light/darkness) stimulates (X) hormone release from (Y).

Answer 51

Darkness; X = melatonin Y = SCN

Question 52

Jet lag is a type of (X) disorder.

Answer 52

X = circadian rhythm

Question 53

Combined treatments are useful for which dyssomnias?

Answer 53

Insomnia only (short-term med and psychotherapy)

Question 54

Parasomnias occur during (REM/non-REM) sleep.

Answer 54

Could occur during either

Question 55

Nightmare disorder occurs during which sleep stage?

Answer 55

REM

Question 56

T/F: Nightmare disorder interfere with daily life functioning.

Answer 56

True

Question 57

Nightmare disorder is more common in (children/adults/elderly).

Answer 57

Children

Question 58

Treatment for nightmare disorder may involve:

Answer 58

Antidepressants and/or relaxation training

Question 59

Piercing scream during sleep is often indicative of which disorder?

Answer 59

Night terror disorder

Question 60

Night terror disorder is more common in (children/adults/elderly).

Answer 60

Children

Question 61

In (night terror/nightmare) disorder, child can't be easily awakened.

Answer 61

Night terror

Question 62

In (X) disorder, a dyssomnia, patient has little memory of event the next day.

Answer 62

X = night terror

Question 63

Usually, the best treatment(s) for sleep terror disorder involve:

Answer 63

Waiting (they go away on their own) and/or relaxation techniques

Question 64

In severe sleep terror disorders, (X) used for treatment.

Answer 64

X = antidepressants or benzodiazepines

Question 65

T/F: It's both dangerous and difficult to wake a sleepwalker.

Answer 65

False - difficult, but not dangerous