Sleep

Question 1

Stages of Sleep

Answer 1

Awake - Beta
Eyes closed - Alpha
N1/Stage 1 - Theta
N2/Stage 2 - Sleep spindles/K complexes
N3 - N3/N4 - Delta

Question 2

N/t in sleep

Answer 2

Sleep promoting: Ach
Wake Promoting: glutamate, orexin, dopamine, NE
Histamine
Serotonin = both sleep promoting and wake

Question 3

NREM - first stage, what type

Answer 3

SWS - slow wave sleep

Question 4

When does REM occur?

Answer 4

last 1/3 of sleep

Question 5

Aging/lifespan changes

Answer 5

Increase waking time

Decrease NREM/REM

Question 6

Changes in sleep architecture w/aging

Answer 6

Reduced total sleep time
Reduced sleep efficiency
Reduced SWS
Increased sleep fragmentation
Increased sleep latency
Phase advance

Question 7

Insomnia Disorder

Answer 7

One of:

Difficulty initiating sleep
Difficulty maintaining sleep
Early morning awakening

Sleep disturbance occurs at least 3 nights/week
Sleep disturbance presence for at least 3 months

RF: F>M

Question 8

Specifier - Insomnia disorder

Answer 8

Episodic - at least 1 month < 3 mos
Persistent - lasts longer than 3 months
Recurrent: 2 or more episodes/1 year

Question 9

Hypersomnolence Disorder

Answer 9

at leas 7 hours

at least 3x/week for 3 months

Question 10

Multiple Sleep Latency Test

Answer 10

gold standard for measuring daytime sleepiness

Question 11

Narcolepsy

Answer 11

Recurrent periods of an irrepressible need to sleep, lapsing into sleep, or napping occurring w/in same day. Occurring at least3/week over past 3 months

The presence of at least one of the following:

1.Cataplexy defined as either (a) or (b), occurring at least a few x/month
a) In individuals with longstanding disease, brief episode of sudden bilateral loss of muscle tone w/ maintained consciousness that are precipitated by
laughter or joking
b) In children or in individuals w/in 6mos of onset, spontaneous grimaces or jaw-opening episodes with tongue thrusting or a global hypotonia, without
obvious emotional trigger

2. Hypocretin deficiency, as measured using CSF hypocretin-1 immunoreactivity values (=1/3 value of healthy subjects or =110pg/ml). Low CSF hypocretin must not be observed in context of acute brain injury, inflammation, or infection
3. Nocturnal sleep PSG show REM sleep latency = 15min, or a MSLT showing a a mean sleep latency =8min and 2 or more sleep- onset REM periods

Question 12

Cataplexy, which muscles not affected?

Answer 12

respiratory or eye muscles

Question 13

Narcolepsy - comorbidity

Answer 13

40% have MDD, SUD, GAD

Question 14

Key feature for REM Sleep Disorder

Answer 14

Upon awakening from these episodes, the individual is completely awake, alert, and not confused or disoriented

Question 15

Management REM Sleep Disorder

Answer 15

Melatonin

Clonazepam

Question 16

Restless Leg Syndrome - RF

Answer 16

Associated with general medical conditions
○Anemia / ↓ iron stores
○Normal pregnancy
○Renal failure
○Rheumatoid Arthritis
○Diabetes
○Thyroid Abnormalities
○Peripheral nerve dysfunction

Question 17

RLS - when and how to treat?

Answer 17

when symptoms impairing > 2 nights/week
Ropinorole
Pramipexole

Question 18

Sleep Changes - MDD

Answer 18

Shortened REM latency
Increased % REM
Increased REM density
Reduced SWS

Question 19

Sleep Changes - GAD

Answer 19

Increased sleep latency

Increased sleep fragmentation

Question 20

Sleep changes - PTSD

Answer 20

PLMS occur frequency

Increased REM density

Question 21

Sleep changes- Dementia

Answer 21

Reduced REM and slow-wave sleep

Diminished melatonin

Question 22

Narcolepsy sleep changes

Answer 22

Hypnopompic hallucinations
Increased REM
Decreased rem latency