Respiratory & Sleep Medicine_ Insomnia and Sleep Disorders

Question 1

What is the definition of insomnia?

Answer 1

Unsatisfactory sleep that impairs daytime functioning

Question 2

What are three criteria for diagnosing insomnia?

Answer 2

1. Presents with difficulty initiating sleep or maintaining sleep, or with sleep that is nonrestorative for at least 1 month
2. Occurs despite adequate opportunity and circumstances for sleep
3. Impaired sleep causes deficits in daytime activity

Question 3

What groups of people have higher rates of insomnia?

Answer 3

• Adult women
• persons who are unemployed
• divorced
• widowed
• or of lower SES

Question 4

What are symptoms of impaired daytime function?

Answer 4

• Fatigue
• headaches
• GI symptoms
• sleepiness
• poor attention/concentration
• increased errors/accidents
• reduced motivation
• mood disturbance
• or social dysfunction

Question 5

What are common causes of acute insomnia (<30 days)?

Answer 5

• Situation stress
• environmental stressors
• or death of a loved one

Question 6

What are the initial categories of treatment options for insomnia?

Answer 6

• Behavioral therapies including relaxation and cognitive therapy
• exercise
• sleep hygiene instruction
• stimulus control therapy
• sleep restriction therapy
• medications

Question 7

What are reasons to avoid the use of over-the-counter antihistamines for insomnia?

Answer 7

• Residual drowsiness
• reduced sleep quality
• anticholinergic side effects
• minimal effectiveness

Question 8

What are examples of good sleep hygiene actions?

Answer 8

• Maintain regular sleep schedule
• avoid caffeine after lunch
• avoid alcohol near bedtime
• avoid smoking
• decrease light and stimuli in bedroom
• exercise for 20 minutes daily more than 4 hours prior to bedtime
• avoid daytime naps
• avoid large meals before bed
• maintain same sleep and wake time
• avoid excessive time in bed

Question 9

What are the contraindications to medications used to treat insomnia?

Answer 9

• Pregnancy
• excess alcohol consumption
• renal or hepatic disease
• pulmonary disease or sleep apnea
• adults over 75

Question 10

What classes of medications target GABA receptors and can be used to promote sleep?

Answer 10

• Long-acting benzodiazepines
• nonbenzodiazepines
• melatonin agonists

Question 11

Examples of non-benzodiazepines

Answer 11

• eszopiclone
• zaleplon
• zolpidem

Question 12

What is the advantage of nonbenzodiazepines (eszopiclone, zaleplon, zolpidem) over benzodiazepines for the treatment of chronic insomnia?

Answer 12

• Fewer adverse effects
• decreased risk of dependency

Question 13

What are common side effects of medications used to treat insomnia?

Answer 13

• daytime sedation
• drowsiness
• lightheadedness
• cognitive impairment
• dependence
• night wandering

Question 14

Patients with insomnia due to a circadian rhythm disorder may benefit from what therapies?

Answer 14

• melatonin
• phototherapy or
• chronotherapy

Question 15

Before considering medication or treatment of insomnia, what should you do?

Answer 15

treat any condiitons that may be causing the insomnia

• medical conditions
• psychiatric illness
• substance abuse, or
• sleep disorder

Question 16

In this type of insomnia, the person has conditioned anxiety around falling asleep or staying asleep and often has a genetic vulnerability, medication disorders, psychiatric conditions or acute stress?

Answer 16

• Primary psychophysiologic insomnia.

Question 17

What are the common sleep problems in the following age groups?
- infants and toddlers.

Answer 17

• Night Waking
• bedtime resistance

Question 18

What are the common sleep problems in the following age group?

preschool aged children

Answer 18

• difficulties falling asleep
• Night awakenings

Question 19

What are the common sleep problems in the following age groups?

• middle childhood

Answer 19

• bedtime resistance, sleep related anxiety

Question 20

Common sleep problems in adolescents

Answer 20

insomnia.

Question 21

What behavioural interventions are advised for the treatment of behavioural in children?

Answer 21

• consistent bedtime routines
• systemic ignoring
• counseling
• bedtime fading
• positive reinforcement
• parent education

Question 22

What are some common examples of circadian rhythm sleep disorders?

Answer 22

• Jet lag and shift work

Question 23

What common medical conditions are associated with insomnia?

Answer 23

• Pulmonary disease
• IHD
• heartfailure
• GORD
• BPH
• Menopause
• rheumatologic disease
• Pain
• PTSD
• Hypothyroidism
• diabetes mellitus
• neurologic disease

Question 24

Early morning awakening is a hallmark symptom of what condition?

Answer 24

depression

Question 25

What psychiatric conditions are associated with insomnia?

Answer 25

* depression * substance abuse * anxiety * post traumatic stress disorder.

Question 26

What medications commonly cause insomnia?

Answer 26

* Caffeine * appetite suppressant * calcium channel blockers * some antidepressants * Prednisone

Question 27

shift to work sleep disorder has been associated with what medical and psychiatric problems?

Answer 27

* gastrointestinal symptoms * cardiovascular symptoms * depression * substance abuse.

Question 28

What is a name for a sleep-wake cycle longer than 24 hours , accompanied by difficulty falling asleep?

Answer 28

* Delayed sleep phase syndrome

Question 29

An older adult complains of falling asleep and waking up before the desired clock time. What is the diagnosis?

Answer 29

* Advanced sleep phase syndrome.

Question 30

What is the difference between a patient with advanced sleep phase syndrome and depression?

Answer 30

* Depression has decreased latency (longer time) to REM sleep.

Question 31

An urge to move the legs, accompanied by painful, itching, or creeping sensation in the legs, when a patient lies down to fall asleep is suggestive of what syndrome?

Answer 31

* Restless Leg Syndrome (RLS)

Question 32

What lab tests should you do to identify possible secondary causes of restless leg syndrome?

Answer 32

* Serum ferritin * pregnancy test * serum chemistry to rule out uremia and diabetes.

Question 33

What is the differential diagnosis of RLS?

Answer 33

* nocturnal leg cramps. * akathisia * Peripheral neuropathy * vascular disease.

Question 34

What class of medications are first line for the treatment of restless leg syndrome?

Answer 34

* dopaminergic agents such as pramiprexole, ropinirole and pergolide.

Question 35

This disorder is characterized by rhythmic limp movement, usually lower legs during sleep, causing fragmentation of sleep.

Answer 35

* Periodic leg movement disorder (nocturnal myoclonus)

Question 36

pauses in respiration during sleep, accompanied by brief arousals in nocturnal hypoxemia, along with daytime deficits should suggest what diagnosis?

Answer 36

Obstructive sleep apnea.

Question 37

OSA diagnosis can be confirmed by what study?

Answer 37

* Polysomnography (sleep study)

Question 38

What are risk factors for obstructive sleep apnea?

Answer 38

* condition causing narrowing of the airways * obesity * male sex * smoking * nighttime nasal congestion * familiar history of OSA * menopause

Question 39

OSA increases the risk of what other problems?

Answer 39

* motor vehicle collisions * hypertension * cardiovascular disease * impaired neurocognitive function

Question 40

# Define apnea.

Answer 40

Absence of airflow at the nose and mouth for 10 seconds or more

Question 41

hypopnea Is ....

Answer 41

* greater than 50% reduction airflow at nose and mouth for at least 10 seconds.

Question 42

What is the treatment of choice in obstructive sleep apnea?

Answer 42

Nasal continuous positive airway pressure, CPAP