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PSYC > Sleep disorders > Flashcards

Sleep disorders Flashcards

1
Q

What are the stages of sleep on polysomnography?

A
  1. Non-REM: Stage 1,2,3,4

2. REM

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2
Q

How is sleep propensity measured? (by which 2 processes?)

Briefly describe.

A

Process S + Process C

  1. Process S (homeostatic drive)
    - sleep pressure increases with increased time awake, dissipates during sleep
  2. Process C
    (circadian drive)
    - oscillation (上下上下) in the day, driven by circadian rhythms
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3
Q

Circadian rhythm is controlled by internal clocks and external cues (light, feedning, temperature, activity.

Which part of the brain acts as a pacemaker for the internal clock?

A

Paired suprachiasmatic nuclei (SCN) of hypothalamus

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4
Q

Give examples of the genes involved in circadian rhythm regulating sleep. (3)

A
  1. CLOCK
  2. PER
  3. CRY
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5
Q

Which of the following are clock genes related diseases?

A. Delay sleep phase
B. Advance sleep phase
C. Jetlag
D. Cancer and DM
E. Affective disorder
A

All of the above

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6
Q

How can we measure sleep? (5)

A
  1. Sleep log/ diary
  2. Questionnaires - Insomnia Severity Index, Pittsburg Sleep quality index (PSQI)
  3. Actigraphy - gross motor activity [yellow and black]
  4. Polysomnography (PSG) [many lines]
  5. CIrcadian rhythms
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7
Q

What can we measure for circadian changes? (3)

A
  1. Core body temperature
  2. Dim light melatonin onset (DLMO)
  3. Cortisol
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8
Q 
Which of the following is a sleep neurotransmitter?
A. Norepinephrine
B. Serotonin
C. Histamine
D. Adenosine 
E. Hypocretin (Orexin)
A

D

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9
Q 
Which of the following is a wake neurotransmitter?
A. GABA
B. Galanin
C. Melatonin
D. IL-1
E. Dopamine
A

E

also acetylcholine

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10
Q

Primary sleep disorders can be divided in dyssomnias and parasomnias.

A

Dyssomnia
- abnormalities in amount, quality, or timing of sleep

Parasomnias
- abnormal episodes that occur during sleep or sleep-wake transitions

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11
Q

Stage N1 of sleep is around 5% of the time spent. ____ waves can be seen in EEG?

A

Theta waves (low amplitude, spike-like waves)

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12
Q

Stage N2 of sleep is around 50% of the time spent. Characteristics of EEG?

A

Sleep spindles and high voltage multiphasic K-complexes

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13
Q

Stage 3-4 is slow wave sleep, 25% of time spent. It is a period of deep sleep with __________ waves: high amplitude, low frequency.

What are the usual arousal characteristics in this stage?

A

Delta

  • unusual arousal characteristics: disorientation, sleep terrors, sleepwalking
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14
Q

REM sleep is around 25% of time spent.
A. It occurs cyclically through the night, every 90 minutes alternating with non-REM sleep

B. Each episode increases in duration

C. Features penile erection, skeletal muscle paralysis, surreal dreaming

D. Saw-tooth patterns in EEG

E. High amplitude, high frequency in EEG

A

E. low amplitude!

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15
Q

Insomnia classification?

DSM-5 Cat A?

A
  1. Difficulty in initiating sleep (DIS): sleep latency >30 mins
  2. Difficulty in maintaining sleep (DMS): nocturnal wakening
  3. Early morning awakening (EMA): >30 mins prior to wake-up time
  4. Sleep that is not refreshing despite adequate length
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16
Q

What is the time frame for diagnosis of insomnia?

A
  1. At least 3 months

2. > or 3 times per week

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17
Q

What are the causes of insomnia (categories)?

A
  1. Primary sleep disorders (primary insomnia, OSA….)
  2. Psychiatric (anxiety, depression, mania, schizophrenia)
  3. Medical
    - Painful: malignancies, arthritis, reflux disease
    - cardiorespiratory discomfort…
    - nocturia..
  4. Substances
    - caffeine and other stimulants
    - Alcohol
    - SSRIs…
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18
Q

Management of insomnia?

A
  1. Non-pharmacological
    - education on correct sleep hygiene
    - behavioural treatment
    - cognitive behaviour therapy (CBT)
  2. Pharmacological
    - treat co-morbid medical/ psychiatric illness
    - hypnotics for short term (but have tolerance: 2 weeks), possible dependence
    (Zopiclone, Zolpidem, lorazepam)
19
Q

Time frame for diagnosis primary hypersomnia?

A

present for at least 1 month

not attributable to medical/psychiatric illness, substance misuse, other dussomnia/parasomnia

20
Q

What is the pathophysiology of narcolepsy?

  • local prevalence: 0.034%
  • associated with HLA DQB-0602
A
  • abnormality of REM-inhibiting mechanism (REM intrusions)
  1. Hypocretin deficiency
  2. Post-infectious (neuro)immune destruction of Hct neurons
21
Q

What is the tetrad of narcolepsy?

A
  1. Irresistible attacks of refreshing sleep that may occur at inappropriate times - Daytime sleepiness
  2. Nocturnal sleep disruptions (like very small battery, very fast to be full and use up all)
  3. Cataplexy (sudden, bilateral loss of muscle tone usually precipitated by intense emotion)
  4. Hypnagogic or hypnopompic hallucinations
  5. Sleep paralysis at the beginning or end of sleep episodes
22
Q

Which of the following about narcolepsy is incorrect?
A. Usually 2-5 episodes of sleep per day, 10-20 mins each

B. Hallucination and paralysis occur as result of elements of non-REM sleep intruding into transition between sleep and wakefulness

C. Persistent tiredness

D. Problems with memory and concentration

E. REM sleep instability in narcolepsy hypnogram

A

should be in REM sleep!

23
Q

What is the common criteria for both narcolepsy type 1 and type 2?

both lasted for at least 3 months

A
  1. Multiple Sleep Latency Test <8 mins (sleep latency)

2. Sleep onset REM Period <15 mins >2 times

24
Q

What is the difference between narcolepsy 1 and2?

A

1: definite history of cataplexy, low hypocretin levels
2: absence of typical cataplexy (normal (?) hypocretin levels)

25
Q

Causes of hypersomnia? (4 categories)

A
  1. Primary sleep disorders
    - dyssomnias: primary insomnia, narcolepsy, circadian rhythm sleep disorders…
  2. Depression with atypical features
  3. Medical
    - Encephalitis, meningitis, storke, head injury, SOL, degenerative neurological conditions
  4. Substances: Alcohol, prescribed drugs (e.g. antipsychotics, benzodiazepines, TCA..)
26
Q

Management for primary hypersomnia?

A
  • Stimulants
  • dexamphetamine
  • Methylphenidate (SA: Ritalin; LA: concerta)
  • Nodafinil
27
Q

Management for narcolepsy? (3)

A
  1. Sleep hygiene
    - forced naps at regular times
    - regular sleep-wake schedule
    - usually need combination therapy with pharmacological approach
  2. Avoid potential dangerous activities if no appropriate control
  3. Pharmacological
    - Caffeine: stimulant
    - Methylphenidate: block reuptake of monoamines (dopa)
    - Modafinil (wake promoting agent, non-stimulant)
    - Sodium oxybate (suppressant acting on GABA)
    - Selegine (MAO-B inhibitor)
28
Q

Why may TCAs be given in narcolepsy patients?

A
  • increase muscle tone, control catalepsy and sleep paralysis
29
Q

Parasomnia = non-REM sleep behaviour disorders. Give examples?

A

Sleepwalking, night terror

30
Q

At which stage does sleepwalking arise from?

A

stage 3,4; predominantly in first third of the night

31
Q

Sleepwalking
A. Amnesia about the even
B. Difficult to be aroused during the event
C. Ambulation under altered consciousness
D. 10-20% of children have at least one episode
E. Females > Males

A

E is incorrect (equal distribution)

32
Q

REM sleep behaviour disorder (RBD)

Symptoms?

A
  1. Violent behaviours during sleep
  2. Dream enacting
  3. Injury to self/ bed-partner
33
Q

RBD
A. MC in elderly
B. MC in male
C. Excessive phasic EMG activity during REM sleep
D. Sustained muscle activity in REM sleep
E. First half of the night

A

E is incorrect
- last half of the night!

A: >50 years old

34
Q

Definition of REM sleep behaviour disorder (RBD) in ICSD-3?

3

A
  1. Repeated episodes of sleep related vocalization and/or complex motor behaviours
  2. Demonstration of abnormal REM sleep behaviour
  3. Presence of REM sleep without atonia
35
Q

Pharmacological treatment for RBD?

A
  • dont forget home safety first!
  1. Clonazepam (long-acting benzo)
  2. Melatonin
  3. Others: Pramiprexole/L-DOPA
36
Q

Which of the following differences in NREM (non-REM/disorders of arousal) & RBD (in REM sleep) is incorrect ?
A. Family history is significant in RBD but not in NREM

B. Slow-wave sleep in NREM; REM sleep in RBD

C. NREM can be goal directed with eyes open; RBD has gross motor movements related to dream content, eyes are closed

D. NREM leaves bedrom; RBD rarely

E. NREM might respond to external stimulation or verbal questions; RBD does not

A

A

37
Q

Which of the following differences in NREM (non-REM/disorders of arousal) & RBD (in REM sleep) is incorrect ?

A. Vivid dream recall in RBD but not in NREM

B. Arousal threshold is high in NREM but lor in RBD

C. Mental state after awakening is confused and disorientated in RBD; but fully awake and functional in NREM

D. Low to moderate autonomic activation in NREM, none autonomic acitivation in RBD

E. Hypersynchronous delta waves, frequent awakenings and microarousals in slow wave sleep for NREM; absense of muscle atonia in RBD in REM sleep

A

C

38
Q

What are the differences in triggers between NREM and RBD?

A

NREM
- sleep deprivation, noise, stress, obstructive sleep apnea, periodic leg movements during sleep

RBD
- alcohol withdrawal, SSRIs, TCAs

39
Q

Restless leg syndrome - incorrect?
A. urge to move legs but not always accompanied by or felt to be caused by uncomfortable and unpleasant sensations in legs

B. Conditions begins during periods of rest and inactivity

C. Symptoms is worse in the morning

D. female: 2:1

E. higher BMI patients more common

A

C

evening/at night

40
Q

Risk factors for restless leg syndrome?

A. Sleep deprivation

B. Uremia

C. Thyroid diseases

D. pregnancy

E. Peripheral neuropathy and myelopathy

A

All of the above

  • also DM, smoking, caffeinated drinks
  • Commonly associated with periodic leg movement syndrome (PLMS) - repetitive stereotypic movements during sleep, mostly affecting lower limbs
41
Q

Treatment options for restless leg syndrome?

A
  1. Exercise
  2. Alpha-2-delta ligands (first line)
  3. Dopaminergic therapy (first line)
  4. IV and oral iron formulations
  5. Opiates
  6. Sedative hypnotics
42
Q

Pathophysiology for Periodic leg movement syndrome?

A

Dopaminergic, genetics

periodic leg movement syndrome (PLMS) - repetitive stereotypic movements during sleep, mostly affecting lower limbs

43
Q

OSA prevelance is higher in

A. Obese
B. Elderly
C. Hypertensive
D. Intellectual disabilities 
E. with insomnia
A

all except E

  • Has significant CVS and neurpsychiatric morbidity!
44
Q

OSA: abnormalities of ventilation during sleep > results in?

A

Disruptions to sleep > results in unrefreshing sleep and excessive sleepiness during day

PSYC (3 decks)

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