sleep disorders

Question 1

cortisol levels in insomnia

Answer 1

higher during early sleep hours due to HPA axis activation

Question 2

cardiovascular symptoms in insomnia

Answer 2

higher BP and HR, especially at sleep onset

Question 3

functional neuroanatomic changes in insomnia

Answer 3

several parts of the cortex show higher activity

Question 4

EEG changes in insomnia

Answer 4

high frequency activity during NREM2 and NREM3

Question 5

thinking/psych in insomnia

Answer 5

cognitive arousal and mood disturbance

Question 6

epworth sleepiness scale

Answer 6

0-3 for likeliness of dozing in certain situations
0-9 is normal
10-14 mild
15-18 moderate
19-24 severe

Question 7

adjustment (short term) insomnia is characterized by…

Answer 7

an acute stressor

Question 8

how can adjustment insomnia become chronic?

Answer 8

if complicated by conditioned arousal

Question 9

treatment of adjustment insomnia

Answer 9

• based on preventing complications

- sleep hygiene mostly

Question 10

most common comorbidities with chronic insomnia

Answer 10

• psychiatric is the biggest
• circadian
• breathing disorders

Question 11

psychiatric disorders most commonly comorbid with insomnia

Answer 11

MDD
anxiety disorders
personality disorders
psychosis

Question 12

drug induced insomnia

Answer 12

• stimulants
• alcohol
• some anti-depressants
• withdrawal from sleep meds

Question 13

pharm vs CBT for insomnia

Answer 13

• meds are good for short term relief
• CBT shows just as high effectiveness and lasts longer
• CBT+meds no better than just CBT

Question 14

what should all chronic insomnia patients receive?

Answer 14

a course of CBT1 whenever possible

Question 15

definition of narcolepsy

Answer 15

A disorder of sleep-wake regulation involving inappropriate manifestations of REM sleep

Question 16

five primary symptoms of narcolepsy

Answer 16

• excessive sleepiness
• cataplexy - sudden loss of muscle tone associated with emotion
• sleep paralysis
• hypnagogic/hypnapompic hallucinations
• disturbed sleep

Question 17

which symptom is virtually diagnostic of narcolepsy

Answer 17

cataplexy - intrusion of REM atonia into waking

Question 18

HLA in 90% of narcoleptics

Answer 18

HLA-DQB1

Question 19

narcolepsy results from……

Answer 19

destruction of hypocretin neurons

Question 20

where are hypocretin neurons?

Answer 20

lateral hypothalamus

Question 21

narcolepsy meds

Answer 21

• stimulants

- gammahydroxybuturate (GHB)

Question 22

meds for cataplexy

Answer 22

goal is reduce onset of REM

• tricyclics
• SSRI/SNRI

Question 23

what are parasomnias?

Answer 23

Abnormal events or behaviors which arise from sleep or sleep-wake transition

Question 24

two categories of parasomnias and examples

Answer 24

1) nREM
Disorders of arousal
- Sleepwalking
- Night terrors
- Confusional arousals
2) REM
Nightmares
REM Behavior disorder
Sleep paralysis

Question 25

disorders of arousal occur during which stages of sleep?

Answer 25

3/4

Question 26

who generally gets disorders of arousal?

Answer 26

kids 4-6

Question 27

disorders of arousal meds

Answer 27

benzos

Question 28

what is a REM behavior disorder?

Answer 28

Dream enactment behavior associated with loss of muscle atonia in REM sleep

• verbalizations
• walking/running
• violence

Question 29

who generally has REM behavior disorder?

Answer 29

• elderly men

- 50% of neuropathology (parkinsons, lewy body)