sleep Flashcards
5 y/o with screaming/crying for no reason about 1 hour after falling asleep. Sits up in bed with eyes open, trembling, sweating, mother cannot gain his attention for 5 minutes. No new stressors. Boy has no memory of the event. PE normal. Dx? (4x)
SLEEP TERROR
Paralysis when awakening, lasts several minutes. Can see/hear but cannot move during episodes. Disappears spontaneously or when called by his wife. No hallucinations, nightmares, daytime sleepiness or h/o falls. Neuro exam normal (4x)
SLEEP PARALYSIS
REM sleep is first evident at which stage of development? (x3)
IN UTERO
What sleep stage is the most important in restoring the altered functions that result from prolonged sleep deprivation? (3x)
STAGE 4, NON-RAPID EYE MOVEMENT
Insomnia secondary to depression will more consistently affect REM sleep in which of the following ways? (3x)
REDUCED LATENCY TO REM SLEEP
Which of the following is a characteristics change on polysomnogram associated with major depression? (x3)
SHORT REM LATENCY
A pt presents with a hx of irresistible episodic sleepiness that is accompanied by a vivid, dreamlike state at the onset of an episode. Which of the following additional sleep symptoms are likely to be present? (x2)
SLEEP PARALYSIS
8 y/o with persistent delayed sleep onset despite good sleep hygiene, given no indication of broader psychopathology, which med has best evidence to treat this problem and restore normal circadian rhythm? (2x)
MELATONIN
REM sleep behavior disorder is commonly associated with abnormal inclusions containing which of the following proteins? (2x)
SYNUCLEIN
Medical student asks for something to help w/o attention and alertness. Taking a 2-week board review course and struggles to keep up w/ the pace. Sleeping 4hrs/night. Usually sleeps 8hr/night. Dx? (2x)
DYSSOMNIA NOS
Age-related sleep pattern change (2x)
GREATER WAKEFULNESS INTERMIXED WITH SLEEP
What aspect of sleep is increased in older adults? (2x)
DURATION OF AWAKENINGS
What medication is best for decreasing nightmares in PTSD pts? (2x)
PRAZOSIN
Pt reports insomnia, frequent nighttime awakenings, and excessive daytime sleepiness. Sleep study reveals brief lower external jerks with brief repeated arousals. Pt is unaware of these movements. Which dx is most consistent with pt presentation? (2x)
PERIODIC LIMB MOVEMENT DISORDER
HPA axis cortisol production is less active in?
SLEEP ONSET
Neuropeptides decreased in hypothalamus in narcolepsy
OREXIN A
In Narcolepsy weakness in the arms and legs with laughter would respond to which med
VENLAFAXINE
What finding on a multiple sleep latency test (MSLT) confirms the diagnosis of narcolepsy?
DECREASED REM LATENCY
Physiologic changes during REM sleep
INCREASED HEART RATE, INCREASED EYE MOVEMENTS, DECREASED MUSCLE TONE
Brief episodes of sudden loss of muscle tone, with intense emotion are characteristic of:
NARCOLEPSY
65 y/o M trouble falling asleep 2/2 unpleasant aching and drawing sensations in calves and thighs. Also creeping and crawling sensations in legs. Urge to move legs can be suppressed voluntarily for short while but is ultimately irresistible. Most likely Dx is:
RESTLESS LEG SYNDROME
Most common symptom in narcoleptics:
SLEEP ATTACKS
A patient with day time sleepiness, frequent naps. Sleep studies shows that pt enters REM within 5 minutes and wakes frequently at night. Which treatment is appropriate?
MODAFINIL GIVEN DOSE IN THE MORNING
Changes w/ sleep associated with aging:
DELTA WAVE AMPLITUDE DECREASES AND PROPORTIONALLY LESS TIME IS SPENT IN STAGE 3 AND 4
High voltage delta activity with slow eye-rolling on polysomnogram characterizes which stage of sleep?
N3
What is the first step to manage restless leg syndrome?
CHECK FOR IRON DEFICIENCY
Pts over 65 y/o who experience chronic insomnia are most likely to have what comorbid psych conditions
ALCOHOL ABUSE
EEG findings in Stage II (N2) sleep
K-COMPLEXES AND SLEEP SPINDLES
65yo p/w pillow-punching (x several months) in his sleep with sudden awakening from dreams involving pursuit by assailants. Dx?
REM BEHAVIOR DISORDER
The evidence suggests that after completing treatment for insomnia, long term outcomes are better among patients with which medication/therapy?
CBT
EEG biofeedback more effective than progressive muscle relaxation in treating?
INSOMNIA
17 yo with increased sleep duration to 18 hours, lethargy and cognitive slowing. Sleep EEG is normal.
KLINE-LEVIN SYNDROME
Pt p/w complaints of excessive daytime sleepiness, morning headaches, and excessive nighttime sweating. Symptoms are consistent with which sleep disorder?
OBSTRUCTIVE SLEEP APNEA
Which of the following is characteristic of sleep in individuals over the age of 65, as compared to that of young adults?
INCREASED FRAGMENTATION
Which medication is most effective in the treatment of cataplexy?
CLOMIPRAMINE (TCAs 2/2 TO INC NE)
51y/o pt w/ dysthymic disorder has responded well to citalopram. However, the pt continues to complain of morning headaches, anxiety and daytime fatigue. The psychiatrist prescribes clonazepam and the pt immediately reports profound daytime sedation. The differential dx, in addition to a direct sedative effect of the drug, should include:
SLEEP APNEA
Somnambulism during childhood is associated with which of the following stages of sleep measured by an EEG?
STAGE IV
Night terrors typically appear when in life?
CHILDHOOD
42 y/o anesthesiologist with repeated episodes of falling asleep in the OR, mild depression, irritability and mild cognitive troubles. UDS is negative. He gained substantial weight in 18 months, which he attributes to poor eating habits. Most likely Dx:
BREATHING-RELATED SLEEP D/O
A characteristic of non-REM sleep?
DECREASED RECALL OF DREAM ACTIVITY
Somnambulism during childhood is associated with which of the following stages of sleep measured by an EEG?
STAGE IV
Night terrors typically appear when in life?
CHILDHOOD
42 y/o anesthesiologist with repeated episodes of falling asleep in the OR, mild depression, irritability and mild cognitive troubles. UDS is negative. He gained substantial weight in 18 months, which he attributes to poor eating habits. Most likely Dx:
BREATHING-RELATED SLEEP D/O
A characteristic of non-REM sleep?
DECREASED RECALL OF DREAM ACTIVITY
According to DSM 5, Length of time of sleep difficulty for diagnosis of insomnia
3 MONTHS
Most common explanation given by individuals >65 years for difficulty maintaining sleep?
NOCTURIA
67 y/o with MDD doing well on SSRI but continues to have insomnia and sleepiness during day. Snores loudly, morning headaches, and night sweats. Dx?
BREATHING-RELATED SLEEP DISORDER
Which of the following measures of rapid eye movement (REM) is typically reduced in MDD?
SLEEP ONSET TO REM ONSET
MDD has what sleep abnormality?
SHORTENED REM LATENCY, DECREASED STAGE 4 SLEEP, INCREASED AWAKENINGS IN THE SECOND HALF OF THE NIGHT
REM sleep behavior disorder associated with which pathology:
PARKINSON’S DISEASE
Involuntary jerking of legs while falling asleep, not uncomfortable, stops with falling asleep
NORMAL PHENOMENON, NONPATHOLOGICAL
Predominantly non-REM sleep problem:
ENURESIS
Sinusoidal waves at 9-11 Hz on EEG is:
DEEP SLEEP
Pt working overtime develops frightening nocturnal episodes characterized by semi- wakefulness and inability to move, accompanied by the sense that an intruder is present. The pt denies daytime sleep attacks or sudden loss of motor control. Best initial tx?
GETTING SUFFICIENT SLEEP
A patient reports feeling “irritable” with inability to sleep more than an hour at night one week after receiving 80 mg prednisone daily for a poison ivy rash.
BEGIN TO GRADUALLY TAPER THE PATIENT OFF OF THE PREDNISONE
Most effective treatment for REM sleep behavior disorders.
CLONAZEPAM
Which of the following aspects of sleep is increased in older adults?
SUBJECTIVE QUALITY
A 35 yo recurrent episodes of awakening during sleep waking up with a panicked scream and sweating, racing HR. can’t remember, daytime drowsiness affecting functioning, EEG normal. What is the diagnosis?
SLEEP TERRORS
Most effective treatment for OSA
POSITIVE PRESSURE THERAPY
32 yo with episodes of severe sleepiness and falls asleep while driving, reporting episodes of paralysis and hallucinations while awakening. Symptoms are best explained by a deficiency of what?
OREXIN
Which sleep disorder is associated w/ mild neurocognitive disorder w/ Lewy bodies?
REM SLEEP BEHAVIOR DISORDER
Maximium sleepiness in humans occurs when melatonin reaches its highest point and when what reaches lowest point
BODY TEMPERATURE
This is characteristic of sleep in individuals over the age of 65 compared to young adults
INCREASED SLEEP FRAGMENTATION
