Sleep and its disorders

Question 1

Does sleep affect a specific age group?

Answer 1

• no
• can affect all ages

Question 2

There is rapid eye movement (REM) and non-REM sleep. Non-REM can be subdivided into 4 stages 1-4. Which of these stages are involuntary twitches common?

1 - stage 1
2 - stage 2
3 - stage 3
4 - stage 4

Answer 2

1 - stage 1

Question 3

There is rapid eye movement (REM) and non-REM sleep. Non-REM can be subdivided into 4 stages 1-4. Which of these stages is all muscle tone lost?

1 - stage 1
2 - stage 2
3 - stage 3
4 - stage 4

Answer 3

2 - stage 2
- except eye movements and middle ear muscles

Question 4

There is rapid eye movement (REM) and non-REM sleep. Non-REM can be subdivided into 4 stages 1-4. Stages 3-4 are our deeper sleep. Which of the following waves are common in stages 3 and 4?

1 - delta
2 - theta
3 - alpha
4 - beta
5 - gamme

Answer 4

1 - delta

Question 5

When looking at our 1st sleep cycle, does this move from stage 1 through to REM?

Answer 5

• yes
• lasts around 90-120 minutes

Question 6

Following the initial sleep cycle, which of the following stages do all subsequent sleep cycles go through in around 90-120 minutes?

1 - stage 1 to REM
2 - stage 2 to REM
3 - stage 3 to REM
4 - stage 4 to REM

Answer 6

2 - stage 2 to REM

Question 7

Which gland secretes melatonin which is important in circadian rhythm and sleep?

1 - anterior pituitary gland
2 - posterior pituitary gland
3 - pineal gland
4 - parathyroid gland

Answer 7

3 - pineal gland

Question 8

Which key nucleus in the brain is responsible for governing the circadian rhythm?

1 - thalamic nucleus
2 - basal ganglia nucleus
3 - sensory nuclei
4 - suprachiasmatic nucleus

Answer 8

4 - suprachiasmatic nucleus
- part of hypthalamus

Question 9

Are we able to modulate our circadian rhythm?

Answer 9

• yes
• can use photic inputs and non-photic inputs

Question 10

Do older or younger people sleep more?

Answer 10

• younger people
• REM decreases 0.6%/decade

Question 11

Is sleeping useful for consolidating memories?

Answer 11

• yes

Question 12

Sleeping is important for consolidating memories. Which part of the brain does this primarily occur in?

1 - basal ganglia
2 - hippocampus
3 - thalamus
4 - suprachiasmatic nucleus

Answer 12

2 - hippocampus

Question 13

From a brains perspective, which of the following are benefits of sleeping?

1 - Learning and memory consolidation o
2 - Synaptic modification in the hippocampus linked with memory
3 - Restorative functions such as glucose and proteins for healing
4 - Neural detoxification (glymphatics clearance)
5 - all of the above

Answer 13

5 - all of the above

Question 14

Which of the following is used to describe when someone doesn’t get sufficient sleep?

1 - Insomnia
2 - Hypersomnia
3 - Parasomnias
4 - Circadian rhythm disorders

Answer 14

1 - Insomnia
- classed as a symptom rather than a disorder
- this is NOT a diagnosis
- clinically significant in 10% of people

Question 15

Which of the following is NOT typically affected by insomnia?

1 - Women
2 - Shift workers
3 - Young children
4 - Medical and psychiatric comorbidity

Answer 15

3 - Young children

Question 16

What is short term/acute insomnia?

1 - <4 weeks
2 - <3 months
3 - <6 months
4 - <12 months

Answer 16

2 - <3 months
- insomnia typically gets worse if untreated

Question 17

What is long term/chronic insomnia?

1 - >4 weeks
2 - >3 months
3 - >6 months
4 - >12 months

Answer 17

2 - >3 months
- insomnia typically gets worse if untreated

Question 18

When managing insomnia, which of the following is NOT typically performed?

1 - Identify the cause
2 - Treat any underlying cause e.g. depression, anxiety, pain
3 - Explain clearly what is happening and why
4 - Ensure good sleep hygiene (psychoeducation or CBT)
5 - Advise the person not to drive if they feel sleepy
6 - prescribe sleeping medication
7 - In certain sleep disorders, the DVLA must be informed (sleep apnea)

Answer 18

6 - prescribe sleeping medication
- this would only be prescribed if the insomnia is though to be short lived, like loss of a loved one
- benzodiazepines or non-benzodiazepines

Question 19

For long term insomnia, CBT is the 1st line treatment. But what other medication can be offered if there is an acute exacerbation in patients aged >55 y/o?

1 - cortisol
2 - benzodiazepines
3 - melatonin
4 - all of the above

Answer 19

3 - melatonin

Question 20

When talking about psychoeducation, we can talk about preparing for bed, including:

• bed time routine
• milky drink (contains tryptophan)
• keep lights low

We should also aim to wind down, but what is the minimum time advised to wind down?

1 - >30 minutes
2 - >1 hour
3 - >2 hours
4 - >6 hours

Answer 20

2 - >1 hour

• tryptophan is a precursor for serotonin and effects melatonin synthesis

Question 21

If medications are to be prescribed to a patient with insomnia, typically how long should they be prescribed for?

1 - <72h
2 - <1 week
3 - <2 weeks
4 - <6 weeks

Answer 21

2 - <1 week

Question 22

Which 2 of the following medications are used most commonly in patients with insomnia?

1 - zopiclone
2 - diazepam
3 - zolpidem
4 - flumazenil

Answer 22

1 - zopiclone
3 - zolpidem

• need to be careful with benzodiazepines or non-benzodiazepines as these can lead to rebound insomnia

Question 23

Which of the following is used to describe when someone gets too much sleep?

1 - Insomnia
2 - Hypersomnia
3 - Parasomnias
4 - Circadian rhythm disorders

Answer 23

2 - Hypersomnia

Question 24

Which of the following are associated with causing hyper insomnia?

1 - psychiatric conditions (depression)
2 - medications
3 - sleep/breathing disorders
4 - central causes (narcolepsy)
5 - general medical conditions (hypothyroidism)
6 - all of the above

Answer 24

6 - all of the above

Question 25

Narcolepsy is a rare (0.2-0.5 per 1000) long-term brain condition that can prevent a person from choosing when to wake or sleep and is a cause of hyperinsomnia. Is it more common in men or women?

Answer 25

- men - associated with cataplexy, which is the sudden loss of muscle tone

Question 26

Which of the following can be used to treat narcolepsy? 1 - practical support (e.g. at school/work) 2 - scheduled naps (20 mins) 3 - modafinil (stimulant) 4 - all of the above

Answer 26

4 - all of the above

Question 27

Obstructive sleep apnea is when the airways of the patient are obstructed due to soft tissue around neck that relaxes when we sleep and lie down and can cause hyperinsomnia. Is this more common in men or women?

Answer 27

- men - specifically those with a high BMI or large neck

Question 28

Obstructive sleep apnea (OSA) is when the airways of the patient are obstructed due to soft tissue around neck that relaxes when we sleep and lie down and can cause hyperinsomnia. Which of the following can patients with OSA present with? 1 - Unrefreshing sleep, ”muzzy head” 2 - Cognitive impairment 3 - Low mood 4 - Anxiety 5 - increased cardiovascular risk and mortality 6 - all of the above

Answer 28

6 - all of the above - treat with Continuous positive airway pressure (CPAP) - MUST inform the DVLA

Question 29

Which of the following is used to describe when someone has unusual physical, emotional, perceptual or behavioural events during sleep? 1 - Insomnia 2 - Hypersomnia 3 - Parasomnias 4 - Circadian rhythm disorders

Answer 29

3 - Parasomnias

Question 30

Parasomnia is when someone has unusual physical, emotional, perceptual or behavioural events during sleep. Which if the following is an example of non-REM sleep parasomnias? 1 - Confusional arousal 2 - Sleepwalking (somnambulism) 3 - Sleep terrors 4 - Nightmares

Answer 30

4 - Nightmares - form of REM

Question 31

Parasomnia is when someone has unusual physical, emotional, perceptual or behavioural events during sleep. Which if the following is an example of REM sleep parasomnias? 1 - Sleep paralysis 2 - Sleepwalking (somnambulism) 3 - REM sleep behaviour disorder 4 - Nightmares 5 - Restless leg syndrome

Answer 31

2 - Sleepwalking (somnambulism) - form of non-REM

Question 32

Which of the following is used to describe when someone has dysfunction of their circadian rhythm? 1 - Insomnia 2 - Hypersomnia 3 - Parasomnias 4 - Circadian rhythm disorders

Answer 32

4 - Circadian rhythm disorders

Question 33

Which of the following are circadian rhythm disorders more common in? 1 - babies 2 - young adults 3 - older adults 4 - >65 years olds

Answer 33

2 - young adults

Question 34

If a patient has a dysfunction with their circadian rhythm, we can use which of the following would we NOT use to treat this? 1 - Chronotherapy (sleep hygiene) 2 - Light therapy 3 - Zopiclone 4 - Melatonin

Answer 34

3 - Zopiclone