Sleep Disorders

Question 1

Parasomnias

Answer 1

Unusual experiences or behaviors
Sleep terror disorder
Sleep wlaking

Question 2

Dyssomnias

Answer 2

Abnormalities in amount, quality or timing
Insomnia
Hypersomnia
Narcolepsy

Question 3

Suprachiasmatic Nucleus (SCN)

Answer 3

Located in the hypothalmus
Acts as timekeeper for melatonin release from pineal gland.
Responsible for circadian rhythm

Question 4

2 categories of sleep

Answer 4

REM and non-REM

Question 5

First line meds for insomnia

Answer 5

Melatonin

Atarax

Question 6

Sedative Hypnotics

Answer 6

Zaleplon (Sonata)
Zolpidem (Ambien)
Both work well for sleep onset insomnia

Question 7

Zaleplon (Sonata)

Zolpidem (Ambien)

Answer 7

Rapid onset of action
Works well with sleep onset insomnia
Preg cat C

Question 8

Ambien CR

Answer 8

Extended release
Sleep onset and sleep maintenance
Preg cat B

Question 9

Eszopiclone (Lunesta)

Answer 9

Sleep onset insomnia

Preg cat C

Question 10

Estazolam (ProSom)

Answer 10

Benzo
Intermediate acting
Slow onset, long duration
For sleep maintenance insomnia
preg cat D

Question 11

Temazepam (Restoril)

Answer 11

Benzo
Same profile as for ProSom
Sleep maintenance

Question 12

Ramelteon (Rozerem)

Answer 12

Melatonin agonist
Promotes sleep via melatonin effect
Sleep onset insomnia

Question 13

TCA’s

Answer 13

Trazodone (Desyrel)
Amitriptyline (elavil)
Nortriptyline (good for elderly)

Question 14

Narcolepsy

Answer 14

Chronic neurological disorder
Brain unable to regulate sleep/wake cycles
Fall into REM within 5 mins, as opposed to 60
Onset from 20 - 40

Question 15

Narcolepsy S/S

Answer 15

Extreme drowsiness during the day
Sleep attacks lasting 15 mins or so
Pt cannot move as falling asleep and waking up
Cataplexy: sudden loss of muscle tone generally lasting less than 30 seconds.

Question 16

Causes of narcolepsy

Answer 16

Lack of hypocretin
May be familial
Stress induced

Question 17

Narcolepsy Tx

Answer 17

Good sleep hygiene
Scheduled naps (15 - 20 mins)
Modafinil (Provigil) first-line
TCA’s

Question 18

Periodic Limb Movement Disorder (PLMD)

Answer 18

Patient moves limps involuntarily during sleep

May be related to parkinsons or narcolepsy

Question 19

RLS, PLMD Causes

Answer 19

CKD
DM
Iron deficiency
Parkinsons
Peripheral neuropathy
Pregnancy
Meds, withdrawl from sedative

Question 20

RLS, PLMD Tx

Answer 20

Stretching, massage, warm bath
Avoid stimulants
Treat underlying disorder

Question 21

Which stage of sleep does sleep walking occur?

Answer 21

Stages 3 and 4