Insomnia

Question 0

perpetuating factors

Answer 0

mental arousal in bed (intrusive thoughts)
negative expectations
heightened somatic tension in bed
complaint more fixed over time
cognitions; cognitive distortions and catastrophization

Question 1

insomnia is associated with

Answer 1

psychiatric disorders- major depressive disorder
certain substances
medical/neurological disorders

Question 2

cognitive distortions

Answer 2

things you believe about your sleep

“chemical imbalance” “i should stay in bed even if i cant sleep”

Question 3

catastrophization

Answer 3

worrying about what a poor night of sleep will mean for the rest of the day

Question 4

daytime consequences

Answer 4

only one required to make diagnosis

Question 5

4 nature of complaints

Answer 5

difficulty falling asleep
mid cycle awakening sustained
mid cycle awakening brief/repetitive
early morning awakening

Question 6

difficulty falling asleep

Answer 6

anxiety, depression, delayed sleep phase, conditional arousal

Question 7

mid cycle awakening

Answer 7

conditioned arousal, depression, anxiety

Question 8

MCA (brief/repetitive)

Answer 8

phyisological event/other-Obstructive sleep apnea or other underlying medical sisue

Question 9

early motnign awakening

Answer 9

depression
advanced sleep phase
cnditioned arousal

Question 10

sleep logs

Answer 10

if person has ocd or anxiety- bad

Question 11

epworth sleepiness scale

Answer 11

rate the likelihood of dosing off in following circumstances..

Question 12

polysomnography

Answer 12

not indicated for routine evaluation of insomnia

Question 13

Chronic Insomnia Disorder

Answer 13

> 3x/week, >3x/month

Question 14

short-term insomnia disorder

Answer 14

symptoms present for <3 months

Question 15

arousal and affective disturbance in insomnia

Answer 15

HPA axis: cortisol in insomnia patients higher during early sleep period- lacking cortisol drop

symp elevated HR and BP at sleep onset

Question 16

medication beliefs

Answer 16

provide effect short-term relief for many with insomnia; improvements typically wane with discontinuation of medication

Question 17

FDA approved hypnotics

Answer 17

benzos
BzRAs- benzo receptor agonists- Imidazopyridines, cycopyrrolones, pyrazolopyrmidines
melatonin agonists
histamine agonists

Question 18

sedating anti-depressants

Answer 18

tricyclic antideprssants- amitriptyline
trazodone
mirtazpaine

Question 19

most effective long term management

Answer 19

CBT

Question 20

important in CBT

Answer 20

cogntiive distrotions, relaxation training, biofeedback, stimulus control, slepe rstriction (restrict time in bed to actual sleep time)

Question 21

for average sleep efficiency greater than 85%

Answer 21

increase TIB by 15 minutes

Question 22

for average sleep efficiency over one week less than 85%

Answer 22

decrease TIB by 15 mins

Question 23

short term insomnia may be complicated by

Answer 23

conditioned arousal

Question 24

treatment focused on short term insomnia

Answer 24

sleep hygiene! get out of bed | hypnotics as indicated

Question 25

restless leg vs perioic limb mobement

Answer 25

bed partner telling story in periodic limb movement | clinical features of interrupted, light sleep and/or daytime sleepiness

Question 26

etiology of periodic limb movement disorder

Answer 26

``` familial neuropathy/radiculopathy/myelopathy Fe deficiency end-stage renal RA substances (caffeine, alch) ```

Question 27

PLMS polysomnograph

Answer 27

repeptive episodes of muscle contraction

Question 28

treatment PLMS

Answer 28

dopamine agents - ropnirole, carbidopa benzos opioids anticonvulsants

Question 29

parasomnias tessted for by

Answer 29

multiple sleep latency test | 4-5 nap opportunites at 2 hr intervals

Question 30

narcolepsy

Answer 30

disorder of sleep-wake regulation involving inappropriate manigestations of REM sleep

Question 31

etiology narcolepsy

Answer 31

destruction of orexin neurons in hypothalamus-- maybe via HLA (inconclusive)

Question 32

CSF-orexin

Answer 32

significantly reduced in patients with narcolepsy and cataplexy

Question 33

cataplexy

Answer 33

inappropriate intrusion of REM atonia into waking

Question 34

sleep-onset REM

Answer 34

sleep paralysis

Question 35

in catalplexy, you typically maintain

Answer 35

consciousness

Question 36

15% with full Nercoleptic tetrade

Answer 36

``` excessive sleepiness/sleep attacks cataplexy sleep paralysius hypnagogic/hypnapompic- really clear hallucinations with intruder disturbed nocturnal sleep ```

Question 37

treatment narcolepsy

Answer 37

sleepiness- stimulations- amphetamine, metylphenidate, modonifil, gamahydroxybutryate, planned naps cataplexy-rem suppressant (tricycle/ssri/snri), GHB psychosocial support-education

Question 38

idiopathic hypersomnia

Answer 38

excessive sleepiness daily for > 3 months (MSLT will show a mean latency <8 mins) insufficient sleep ruled out supportive features- long nocturnal sleep, sleep drunkeness, long unrefreshing naps, possible autnomic disturbance

Question 39

parasomnias

Answer 39

abnormal events or behaviors whcih arise from sleep or sleep-wake transition

Question 40

types of parasomnias

Answer 40

nREM | REM -rem behavior disorder, nightmares, sleep paralysis

Question 41

nREM-disorder of arousal

Answer 41

sleep walking, night terrors, confusional arousals

Question 42

patho of nREM

Answer 42

arise from stage 3/4 sleep high amplitude delta waves first third of the night (when we get most of our N3 sleep) amnesia/partial recall

Question 43

treatment nREM

Answer 43

``` gently guide back to bed remove dangerous items benzos psychogical treatment stop ambien if ambien started it! ```

Question 44

REM behavior disorder

Answer 44

dream enactment associated with loss of muscle atonia in REM sleep predom male 45-50% with neuropath but others are idiopathic

Question 45

REM behavior associated neuropathy

Answer 45

synucleopathies parkinsons dementia with lewy bodies multisystem atrophy

Question 46

treatment of REM behavior disorder

Answer 46

neuro eval pharm treatments-clonazepam safety