Lecture 4- Sleep Disorders 1

Question 1

What is the fragmentation index

Answer 1

Total number of awakenings/shifts to N1 divides by the total sleep time in hours

Question 2

What are the three different types of daytime sleepiness

Answer 2

Physiologic - MSLT: biological drive to sleep
Introspective-ESS SSS: self assessment of internal state
Manifest - MWT, PVT: behavioural signs of sleepiness, inability to volitionally remain awake, performance deficit on psychomotor or cognitive tasks

Question 3

What two questionnaires assess current state of alertness?

Answer 3

Stanford sleepiness scale

Karolinska sleepiness scale

Question 4

What questionnaire assesses general sleep habits?

Answer 4

Pittsburgh Sleep Quality Index

Question 5

Which questionnaire would be used in insomnia?

Answer 5

Insomnia severity index

Question 6

What questionnaire may be used in an adolescent cohort?

Answer 6

Cleveland adolescent sleepiness questionnaire

Falling asleep in classes rather than driving questions

Question 7

What are the last two questionnaires and what are their assessments?

Answer 7

Fatigue severity scale - could be related to EDS and sleep but not always
Munich chronotype questionnaire - preference to sleep time, when you like to go to sleep, could be used with circadian rhythm disorders

Question 8

Who is more at risk of suffering from insomnia

Answer 8

Women - twice more likely than men
Age - over 65s (interestingly more likely to report -60%- a restorative sleep, therefore if not feeling impact on daily life then does not meet criteria)
- 64% of over 65s consider themselves a morning person linking in with advanced sleep phase disorder
Depression - 2/3 have insomnia

Question 9

What are the treatment options for insomnia

Answer 9

Z drugs
- can be addictive long term therefore used 1-3 days
Sleep hygiene
Cognitive behaviour therapy for chronic treatment
Need treatment to have an immediate or regular effect so will work at correct time

Question 10

What is fatal familial insomnia?

Answer 10

Transmissable prion disease
Suffer progressive disturbances of attention and vigilance, working memory, temporal ordering of events and frontal lobe functions
Uniformly fatal

Question 11

What is narcolepsy?

Answer 11

A hypersomnia of central origin
Genetic component - 90% carry HLA-DR2/DQ1 gene
Experience hypnagogic hallucinations
- visual, tactile, auditory or other sensory events at sleep onset
Orexin loss is autoimmune response
- loss of ore in in CSF

Question 12

What treatments are available for narcolepsy?

Answer 12

CNS stimulants to stop EDS
Short naps 
Exercise 
Manage stress
Reduce caffeine