Sleep Flashcards
Which of the following is a key factor contributing to insomnia in older adults?
A) Low fluid intake
B) Increased exposure to bright light at night
C) Chronic conditions like arthritis or lung disease
D) Low intake of caffeine
Correct answer: C) Chronic conditions like arthritis or lung disease
What is the definition of insomnia according to the DSM-5?
A) Difficulty initiating or maintaining sleep at least three times a month
B) Difficulty initiating or maintaining sleep, occurring at least three times a week for three months
C) Waking up late in the morning due to fatigue
D) Excessive daytime sleepiness
Correct answer:* B) Difficulty initiating or maintaining sleep, occurring at least three times a week for three months
What is the most common sleep problem reported in older adults?
A) Difficulty staying asleep
B) Early morning awakenings
C) Daytime sleepiness
D) Difficulty falling asleep
Correct answer: D) Difficulty falling asleep
Which of the following sleep changes is not common with aging?
A) Decreased REM sleep
B) Increased total sleep time
C) More frequent awakenings during the night
D) Earlier bedtime and wake time
Correct answer: B) Increased total sleep time
Which of the following sleep hygiene recommendations is appropriate for older adults with insomnia?
A) Drink caffeinated beverages before bed
B) Avoid naps during the day
C) Use the bed for watching TV and reading
D) Eat a large meal right before bedtime
Correct answer: B) Avoid naps during the day
Which circadian rhythm disorder is common in older adults who go to bed early and wake up early?
A) Delayed sleep phase disorder
B) Advanced sleep phase disorder
C) Irregular sleep-wake cycle
D) REM sleep behavior disorder
Correct answer:* B) Advanced sleep phase disorder
Which sleep disorder is characterized by excessive motor activity during REM sleep, often causing the person to act out vivid dreams?
A) Restless legs syndrome
B) REM sleep behavior disorder (RBD)
C) Sleep apnea
D) Narcolepsy
Correct answer:* B) REM sleep behavior disorder (RBD)
Which of the following is a nonpharmacologic intervention recommended for chronic insomnia in older adults?
A) Stimulus control therapy
B) Taking a sedative-hypnotic every night
C) Reducing exercise during the day
D) Increasing alcohol consumption to help with relaxation
Correct answer: A) Stimulus control therapy
Which type of light exposure may help improve sleep for patients with advanced sleep phase circadian rhythm disorder?
A) Exposure to bright light in the evening
B) Exposure to bright light in the morning
C) No light exposure
D) Avoiding any exposure to natural light
Correct answer:* A) Exposure to bright light in the evening
When is a sleep study most indicated in older adults?
A) For patients experiencing nightmares
B) For patients with suspected sleep apnea or periodic limb movement disorder
C) For patients who fall asleep quickly
D) For patients experiencing jet lag
B) For patients with suspected sleep apnea or periodic limb movement disorder
What type of sleep medication is not recommended for older adults due to its anticholinergic effects?
A) Melatonin
B) Benzodiazepines
C) Sedating antihistamines
D) Zolpidem
C) Sedating antihistamines
Which of the following sleep disturbances is associated with Parkinson’s disease and Lewy body dementia?
A) Narcolepsy
B) REM sleep behavior disorder
C) Sleep-onset insomnia
D) Sleepwalking
B) REM sleep behavior disorder
Chronic insomnia** can lead to which of the following mental health conditions?
A) Major depressive disorder
B) Schizophrenia
C) Anxiety disorder
D) Substance abuse disorder
A) Major depressive disorder
Which of the following interventions is useful for improving circadian rhythm in older adults?
A) Avoiding exercise during the day
B) Exposure to bright light therapy
C) Limiting social interactions
D) Staying in bed all day
B) Exposure to bright light therapy
Which sleep disorder involves frequent nighttime awakenings due to stopped breathing?
A) Narcolepsy
B) Sleep apnea
C) Insomnia
D) REM sleep behavior disorder
B) Sleep apnea
What sleep disorder is characterized by daytime sleepiness, sudden sleep attacks, and sometimes cataplexy?
A) Insomnia
B) Narcolepsy
C) Restless leg syndrome
D) Sleep apnea
B) Narcolepsy
Which of the following medications is often used off-label to treat REM sleep behavior disorder?
A) Clonazepam
B) Melatonin
C) Zolpidem
D) Antihistamines
A) Clonazepam
Tapering** the dose of which medication is often recommended to prevent rebound insomnia?
A) Antihypertensives
B) Benzodiazepines
C) Antidepressants
D) Antipsychotics
B) Benzodiazepines
Which of the following sleep stages is most affected by aging?
A) Stage 1
B) Stage 2
C) REM sleep
D) Non-REM sleep
Correct answer: C) REM sleep
Polysomnography** is commonly used to diagnose which of the following sleep disorders?
A) Restless leg syndrome
B) Insomnia
C) Sleep apnea
D) Narcolepsy
Correct answer:* C) Sleep apnea
Question 21:**
Which type of circadian rhythm disorder involves late bedtimes and late wake times?
A) Irregular sleep-wake cycle
B) Advanced sleep phase disorder
C) Delayed sleep phase disorder
D) Narcolepsy
Correct answer:* C) Delayed sleep phase disorder
Which of the following is a common medication that can contribute to sleep disturbances in older adults?
A) Anticholinesterase inhibitors
B) Antibiotics
C) Antacids
D) Bronchodilators
Correct answer:* D) Bronchodilators
Which of the following is an early sign of sleep-related breathing disorders in hospitalized older adults?
A) Excessive daytime sleepiness
B) Insomnia
C) Snoring and periods of stopped breathing during sleep
D) Difficulty falling asleep
C) Snoring and periods of stopped breathing during sleep
Which of the following can worsen sleep apnea when combined with sedatives?
A) Antidepressants
B) Alcohol
C) Antihypertensives
D) Caffeine
B) Alcohol
REM sleep** is important for which of the following functions?
A) Deep breathing
B) Physical healing and memory consolidation
C) Muscle atrophy prevention
D) Increased heart rate during sleep
B) Physical healing and memory consolidation
Which of the following nonpharmacologic interventions can help improve sleep hygiene?
A) Drinking alcohol before bed
B) Establishing a consistent bedtime routine
C) Sleeping with the lights on
D) Using electronic devices right before bed
B) Establishing a consistent bedtime routine
What is the recommended dose of melatonin for sleep disturbances in older adults?
A) 10 mg
B) 5 mg
C) 3 mg
D) 1 mg
C) 3 mg
Which of the following is not recommended for routine management of insomnia in older adults?
A) Short-acting sleep medications
B) Regular exercise
C) Cognitive Behavioral Therapy (CBT)
D) Sedating antipsychotics
D) Sedating antipsychotics
Which of the following is most likely to trigger nighttime awakenings in older adults?
A) Arthritis pain
B) Lack of exercise
C) Exposure to bright light during the day
D) Early bedtimes
A) Arthritis pain
Which of the following interventions is effective in improving sleep for patients with nocturia?
A) Drinking more fluids before bedtime
B) Reducing fluid intake in the evening
C) Increasing caffeine consumption
D) Using over-the-counter diuretics
B) Reducing fluid intake in the evening
Which of the following sleep disturbances is characterized by frequent limb movements during sleep?
A) REM sleep behavior disorder
B) Periodic limb movement disorder
C) Narcolepsy
D) Sleep apnea
B) Periodic limb movement disorder
Which of the following is the most common psychiatric disorder associated with insomnia in older adults?
A) Schizophrenia
B) Generalized anxiety disorder
C) Depression
D) Bipolar disorder
C) Depression
In older adults, excessive daytime sleepiness is commonly related to:
A) Sleep apnea
B) Advanced sleep phase disorder
C) Restless leg syndrome
D) Delayed sleep phase disorder
A) Sleep apnea
Which sleep disorder is typically treated with CPAP therapy?
A) Insomnia
B) Sleep apnea
C) REM sleep behavior disorder
D) Circadian rhythm disorder
B) Sleep apnea
Cognitive behavioral therapy for insomnia (CBT-I)** combines sleep restriction, stimulus control, and which of the following?
A) Relaxation techniques
B) Antihistamines
C) Use of sedatives
D) Exercise before bed
A) Relaxation techniques
Difficulty in initiating or maintaining sleep
Waking up too early
Associated with daytime impairment
Fatigue
Poor concentration
Daytime sleepiness
Concerns about sleep
Symptoms must occur at least three times per week
For chronic insomnia, symptoms must have been present for at least three months
Insomnia
Arthritis
Lung disease, cough, dyspnea from cardiac or other pulmonary illness
Stroke, paresthesias
Neurodegenerative disorders (dementia, Parkinson’s disease)
Gastroesophageal reflux
Nighttime urination
Medical Problems Associated With Insomnia
Agents that increase urination (e.g., diuretics)
Stimulating agents (e.g., caffeine, sympathomimetics, bronchodilators, activating psychiatric medications)
Agents that can cause nightmares and impair sleep
Antidepressants
Antiparkinsonian agents
Antihypertensives (e.g., propranolol)
Cholinesterase inhibitors
Medical Problems Associated With Insomnia
can occur when chronic use of hypnotics is suddenly stopped
Rebound insomnia
Advanced sleep phase: fall asleep early, awaken early—particularly common in older people
Delayed sleep phase: fall asleep late, awaken late
Irregular sleep–wake cycles are common with dementia and in nursing home residents
Circadian Rhythm Sleep Disorders
Sleep logs and wrist actigraphy can be helpful to establish the diagnosis
Refer patients to a sleep specialist when symptoms do not respond to initial management, the diagnosis is unclear, or when another sleep disorder is suspected
Treatment depends on the particular circadian rhythm disorder
Advanced sleep phase may respond to evening exposure to bright light.
Delayed sleep phase may respond to morning exposure to bright light and/or evening melatonin.
Treatment for Circadian Rhythm Sleep Disorders
