Sleep

Question 1

Which stages of sleep become longer in adults? Which become shorter? Which stay about the same?

Answer 1

N1-2 get longer, N3 gets shorter, REM is slightly smaller but not much (about the same) .

Question 2

CBT-I vs short term sleep meds. How does it do in short term? How does it do in long term?

Answer 2

Short term: CBT-I vs meds equally effective

Long-term: CBT more effective because CBT-I gains are maintained 2, 12, 24 months later.

Question 3

How are z drugs and benzos different?

Answer 3

z drugs are selective towards Gaba(a1) unit only. Only hypnotic effect is prominent.

Benzos hit (a1, a2, a3, a5) .

Question 4

How does suvorexant work?

Answer 4

Dual orexine receptor antagonist (ORA) blocks 2 receptors: OX1R and OX2R (for sleep onset and sleep maintenance) .

This ANTAGONIZES wakefulness.

Question 5

Which gland secretes melatonin ?

Answer 5

Pineal gland

Question 6

Timeline for sleep disorders

Answer 6

Occurs 3x/week for at least 3 months . True for insomnia, restless leg

Question 7

What is the narcolepsy prevalence?

Answer 7

0.5% of the population. Genetically linked

Question 8

Hypocretin levels

Answer 8

If low, suggestive of narcolepsy. However, high or normal hypocretin levels does not exclude narcolepsy.

Question 9

What does sodium oxybate do?

Answer 9

Increases N3 sleep . Activates GABA-B receptor. Suppresses inappropriate relaese of night time dopamine and norepi in narcolepsy. Then allows their release during the day, increasing alertness.

Question 10

What is Cheyne-stoke breathing?

Answer 10

Hypoventilation followed by compensatory hyperventilation.

Question 11

In what stage of sleep do sleep walking and sleep terrors occur?

Answer 11

N3, will occur in the first third of sleep episode.

Question 12

What are the two types of Non-REM Sleep Arousal Disorder?

Answer 12

Sleepwalking Type and Sleep Terror type

Question 13

In what sleep phase does dreaming occur?

Answer 13

In REM. Therefore, Nightmare Disorder is a REM sleep dysfunction.

Question 14

REM Sleep Behavior Disorder is associated with what?

Answer 14

Synucleinopathy diagnosis (parkinson’s). Reduced striatal presynaptic dopamine transporters. Could be a prodrome for parkinsons or lewy body.

Question 15

Treatment for REM Sleep Behavior Disorder ?

Answer 15

Clonazepam (90% benefit) , melatonin, levodopa

Question 16

FDA approved for Sleep onset insomnia ONLY?

Answer 16

eszopliclone , ramelteon

Question 17

Stimulation of what cranial nerve will worsen OSA?

Answer 17

Vagus nerve

Question 18

Only drug with FDA approval for both onset insomnia and maintenance insomnia?

Answer 18

eszopliclone

Question 19

Non 24 hour sleep disorder

Answer 19

Give tasimelteonHistory of excessive daytime sleepiness, insomnia, or both, which alternate with asymptomatic episodes, due to misalignment between the 24 hour light-dark cycle and endogenous circadian rhythm; Symptoms persisting over the course of at least 3 months,

Question 20

Theta rhythm occurs during what stage of sleep?

Answer 20

Stage I. EEG reveals rhythmic activity ranging between 5 and 8 Hz and occasional positive occipital sharp transients (POSTs) of sleep. Slow rolling eye movements are also noted

Question 21

Long term sedative/hypnotic use can do what to the sleep cycle?

Answer 21

Increased stages 1 and 2 sleep, reduced stages 3 and 4 sleep, and sleep fragmentation

Question 22

When does sleepwalking happen?

Answer 22

Sleepwalking disorder, or somnambulism, usually occurs in the first third of the night in deep NREM (stages III and IV) sleep and frequently progresses to leaving bed and walking about without full consciousness or later memory. It usually begins between 4 and 8 years of age, has peak prevalence at 12 years of age, is more common in boys, tends to run in families, and happens at least occasionally to 15% of children.

Question 23

in REM sleep behavior disorder, what is actually happening on polysomnography?

Answer 23

Loss of muscle atonia during REM sleep. alpha synucleinopthay

Question 24

What sleep changes happen to the elderly?

Answer 24

• Increased fragmentation of sleep
• Increased latency for the onset of sleep
• Decreased sleep efficiency
• Decreased total sleep time
• Decreased slow-wave

Question 25

Delta waves happen during what stage of sleep?

Answer 25

Stage III

Question 26

Mixed waves happen during what stage of sleep?

Answer 26

REM

Question 27

Sawtooth waves on EEG happen during which phase of sleep ?

Answer 27

REM

Question 28

Nocturnal panic attacks typically appear during which phase of sleep?

Answer 28

between stage 2 and 3

Question 29

POSTS and slow rolling eye movements - which sleep stage?

Answer 29

Stage I