Sleep

Question 1

Percentage of sleep NREM?

Answer 1

75%

Question 2

NREM: hypo or hyperactive state?

Answer 2

HYPO

Question 3

NREM blood flow to brain?

Answer 3

DECREASED

Question 4

Beta

Answer 4

NREM
16-25 Hz

Vigilent
Eyes open

Question 5

Alpha

Answer 5

NREM
8-12 Hz

Drowsy
Eyes closed

Question 6

Theta

Answer 6

NREM
3-7 Hz

Stage 1 (5%) = rolling eyes, hypnogogic hallucinations
Stage 2 (45%) = COMPLEX K, SPINDLES

Question 7

Delta

Answer 7

NREM
0.5-3Hz

Stage 3/4 (12%+ 13%) = SLOW WAVE SLEEP
Most stage 4 in 1/3 of night.

Question 8

Percentage of sleep REM (adults)?

Answer 8

25%

Question 9

REM: hypo or hyperactive state?

Answer 9

HYPER

Question 10

REM blood flow to brain?

Answer 10

INCREASED

Question 11

REM muscle tone?

Answer 11

ATONIA

Question 12

What is paradoxical about REM sleep?

Answer 12

EEG activity more closely resembles awake than slow sleep

Question 13

REM waves?

Answer 13

SAWTOOTH

Last 1/3 of sleep

Question 14

Percentage of sleep REM (neonates)?

Answer 14

up to 50%
Fall asleep directly into REM
16H / day with brief periods of wakefulness

Question 15

Aging sleep changes?

Answer 15

(According to K&S summary):
DECREASED TOTAL SLEEP TIME vs. TOTAL REM SLEEP (see below)
Lower efficiency
Higher fragmentation
INCREASED SLEEP LATENCY
Less slow wave AND REM sleep so % stays the same
Need for sleep doesn’t change

(From K&S text…not helpful)
“Changes in sleep structure among persons over 65 years of age involve both REM sleep and nonrapid eye movement (NREM) sleep. The REM changes include the redistribution of REM sleep throughout the night, more REM episodes, shorter REM episodes, and LESS TOTAL REM SLEEP. The NREM changes include the decreased amplitude of delta waves, a lower percentage of stages 3 and 4 sleep, and a higher percentage of stages 1 and 2 sleep. In addition, older persons experience increased awakening after sleep onset.”

Question 16

Children sleep differences?

Answer 16

DECREASED SLEEP LATENCY (5-10 minutes)
Highly efficient sleep
Easy awakening

Question 17

Dream quality in NREM?

Answer 17

LUCID

PURPOSEFUL

Question 18

Dream quality in REM?

Answer 18

ABSTRACT
SURREAL

More REM eye movements associated with vividness of dreaming)

Question 19

NE in sleep?

Answer 19

Firing = wakefulness and NREM

Question 20

Which neurotransmitter is REM promoting?

Answer 20

Acetylcholine

Question 21

Which is the primary neurotransmitter in reticular activating system?

Answer 21

Acetylcholine

Glutamate as well

Question 22

Where is melatonin produced?

Answer 22

Pineal gland

Question 23

Where is the circadian clock in brain?

Answer 23

Suprachiasmatic nucleus

Question 24

Antidepressants and REM?

Answer 24

Serotonin is anti-REM
Antidepressants increase serotonin

Antidepressants DECREASE REM

Question 25

Process S

Answer 25

Accumulates during wakefulness

Question 26

Process C

Answer 26

Think CIRCADIAN In hypothalamus Regulates temperature and sleep duration

Question 27

Histamine and sleep

Answer 27

In posterior hypothalamus Fire while AWAKE but not during REM and NREM (ANTI-histaminics cause sedation)

Question 28

Long sleepers how many hours?

Answer 28

> 9 hours

Question 29

Short sleepers how many hours?

Answer 29

< 6 hours

Question 30

General timing of sleep disorders?

Answer 30

3 nights per week for at least 3 months

Question 31

Strongest risk factor for insomnia disorder?

Answer 31

Past episode of primary insomnia

Question 32

Normal REM latency?

Answer 32

90 minutes

Question 33

Nocturnal myoclonus often affects which muscle?

Answer 33

Anterior tibialis | rare side effect of SSRI

Question 34

Hypersomnolence

Answer 34

``` At least 7 hour main sleep period + ONE of: - recurrent periods of sleep in same day - non-restorative main sleep > 9 hours - difficulty being fully awake after abrupt awakening ``` 3x / week x 3 months Tx with Modafinil (1st line)

Question 35

What is a sign of daytime somnolence in kids?

Answer 35

HYPERACTIVITY | being "wired"

Question 36

What is highly specific to hyper somnolence?

Answer 36

SLEEP INERTIA = drunkenness at sleep-wake transition

Question 37

Who is at his for non-24-hour sleep-wake type?

Answer 37

Up to 50% in BLIND people | TBI

Question 38

Most common circadian rhythm sleep disorder?

Answer 38

Delayed phase

Question 39

Impact of Lithium on circadian period?

Answer 39

LENGTHENS

Question 40

Most common single symptom of insomnia disorder?

Answer 40

MAINTENANCE | awake for total 20-30 minutes in the night

Question 41

Most common presentation of insomnia disorder?

Answer 41

COMBINATION of initiation/maintenance/early awakening

Question 42

Gene associated with advanced sleep phase type?

Answer 42

PER2 gene | Autosomal DOMINANT

Question 43

Percentage of night workers with shift work type?

Answer 43

5-10% | Reverses after 2 weeks of normal schedule

Question 44

Irregular sleep-wake type associated with?

Answer 44

Neurodegenerative disorders

Question 45

Narcolepsy criteria

Answer 45

3x / week x. months ONE OF: - cataplexy a few times per month - HYPOCRETIN deficiency using CSF - polysomnography showing REM LATENCY < 15 minutes or MULTIPLE SLEEP LATENCY TEST showing mean sleep latency < 8 minutes + at least 2 sleep-onset REM periods

Question 46

Hypocretin

Answer 46

Excitatory hormone in hypothalamus (stimulates appetite and alertness) With cataplexy but no hypocretin rare (< 5%)

Question 47

Cerebellar ataxia + deadness + narcolepsy?

Answer 47

EXON 21 DNA mutation | Autosomal dominant

Question 48

Narcolepsy + obesity + DM2?

Answer 48

Mutation in the myelin oligodendrocyte glycoprotein gene | Autosomal dominant

Question 49

Genetic marker narcolepsy?

Answer 49

HLA-DR2 positive in 90-100%

Question 50

What percentage of narcolepsy have cataplexy?

Answer 50

50%

Question 51

How to differentiate cataplexy from conversion?

Answer 51

ABOLISHED REFLEXES during cataplexy

Question 52

What percentage have hypnagogic/hypnopompic hallucinations?

Answer 52

20-60%

Question 53

What percentage have sleep paralysis?

Answer 53

20-60%

Question 54

Narcolepsy treatment for daytime somnolence?

Answer 54

Modafinil | Sodium oxybate

Question 55

Narcolepsy treatment for cataplexy/sleep paralysis/hallucinations?

Answer 55

SSRIs/TCA | Sodium oxybate

Question 56

Apnea criteria in OSA?

Answer 56

> 5/hr + symptoms OR > 15/hr

Question 57

Apnea definition?

Answer 57

At least 10 seconds of O2 sat decrease by 3%

Question 58

Central sleep apnea criteria?

Answer 58

At least 5/hr

Question 59

Congenital hypoventilation gene?

Answer 59

PHOX2B gene

Question 60

REM parasomnias?

Answer 60

Nightmares | REM sleep behaviour disorder

Question 61

NON-REM sleep arousal disorders?

Answer 61

Sleepwalking Sleep terrors No memory usually

Question 62

Nightmares

Answer 62

SECOND HALF OF THE NIGHT (because REM) No movement or vocalization Can be caused by: L-dopa B-blockers

Question 63

REM sleep behaviour disorder

Answer 63

END OF NIGHT PRECURSOR OF LBD/PARKINSON (synuclein) Can be unmasked by antidepressants Dreams acted out, no paralysis Injury to partner Alert, not confused on waking Tx with CLONAZEPAM (80-90% respond)

Question 64

What is a black box warning on some sedatives?

Answer 64

SLEEPWALKING

Question 65

Sleep terror

Answer 65

Occurs during FIRST 3RD OF NIGHT (because NON-REM)

Question 66

What to rule out medically with sleep terror?

Answer 66

Temporal lobe epilepsy

Question 67

Other name for restless leg syndrome?

Answer 67

WILLIS-EKBOM

Question 68

Restless leg syndrome criteria?

Answer 68

Urge to move legs Need all 3 1. Worse during rest 2. Relieved by movement 3. Worst at evening

Question 69

What can you give to test if restless leg syndrome?

Answer 69

Dopamine agonist Levo-dopa (+ if 50% improvement in sx) Treat with dopamine agonist, benzos, opiates, anti-epileptics

Question 70

What is not a recognized ethology of restless leg syndrome?

Answer 70

Menopause