Sleep and its disorders Flashcards
Does sleep affect a specific age group?
- no
- can affect all ages
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
1 - stage 1
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
2 - stage 2
- except eye movements and middle ear muscles
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
1 - delta
When looking at our 1st sleep cycle, does this move from stage 1 through to REM?
- yes
- lasts around 90-120 minutes
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
2 - stage 2 to REM
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
3 - pineal gland
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
4 - suprachiasmatic nucleus
- part of hypthalamus
Are we able to modulate our circadian rhythm?
- yes
- can use photic inputs and non-photic inputs
Do older or younger people sleep more?
- younger people
- REM decreases 0.6%/decade
Is sleeping useful for consolidating memories?
- yes
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
2 - hippocampus
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
5 - all of the above
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
1 - Insomnia
- classed as a symptom rather than a disorder
- this is NOT a diagnosis
- clinically significant in 10% of people
Which of the following is NOT typically affected by insomnia?
1 - Women
2 - Shift workers
3 - Young children
4 - Medical and psychiatric comorbidity
3 - Young children
What is short term/acute insomnia?
1 - <4 weeks
2 - <3 months
3 - <6 months
4 - <12 months
2 - <3 months
- insomnia typically gets worse if untreated
What is long term/chronic insomnia?
1 - >4 weeks
2 - >3 months
3 - >6 months
4 - >12 months
2 - >3 months
- insomnia typically gets worse if untreated
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)
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
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
3 - melatonin
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
2 - >1 hour
- tryptophan is a precursor for serotonin and effects melatonin synthesis
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
2 - <1 week
Which 2 of the following medications are used most commonly in patients with insomnia?
1 - zopiclone
2 - diazepam
3 - zolpidem
4 - flumazenil
1 - zopiclone
3 - zolpidem
- need to be careful with benzodiazepines or non-benzodiazepines as these can lead to rebound insomnia
Which of the following is used to describe when someone gets too much sleep?
1 - Insomnia
2 - Hypersomnia
3 - Parasomnias
4 - Circadian rhythm disorders
2 - Hypersomnia
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
6 - all of the above
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?
- men
- associated with cataplexy, which is the sudden loss of muscle tone
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
4 - all of the above
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?
- men
- specifically those with a high BMI or large neck
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
6 - all of the above
- treat with Continuous positive airway pressure (CPAP)
- MUST inform the DVLA
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
3 - Parasomnias
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
4 - Nightmares
- form of REM
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
2 - Sleepwalking (somnambulism)
- form of non-REM
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
4 - Circadian rhythm disorders
Which of the following are circadian rhythm disorders more common in?
1 - babies
2 - young adults
3 - older adults
4 - >65 years olds
2 - young adults
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
3 - Zopiclone
