Sleep Disorders

Question 1

EEG
awake
eyes closed
NREM1
NREM2
NREM3
REM

Answer 1

low amplitude
alpha

theta (vertex waves)

sleep spindles and K
complexes (precursors to slow waves (gen via thalamic reticular complex)

slow waves (delta: large amplitude) coordinated waves

Question 2

parasomnias

Answer 2

undesirable physical, experiential, behavioral phenomena occur during sleep

arise when elements of specific brain states co=occur

Question 3

physiology of sleep

Answer 3

NREM: up PS, down HR, CO, BP, EMG activity

REM: up sympathetic, paralysis, rapid eye mvmts

Question 4

NREM + wake co-occur

Answer 4

sleepwalking/terrors, confusional arousals

Question 5

REM + wake co-occur

Answer 5

RBD

sleep paralysis/nightmares

Question 6

sleepwalking

Answer 6

resolves by adolescense

STRONG genetic component

Question 7

sleep terrors

Answer 7

motor behavior w/affective discharge

up ANS activity

caution

Question 8

PSG if?

Answer 8

co-morbid sleep d/o

dangerous parasomnia

Question 9

evaluation & MGT

Answer 9

modify factors: avoid sleep deprivation/stress; improve safety of env; meds

BZD: clonazepam

Question 10

REM parasomnias

RBD assoc w?

Answer 10

during REM: paralysis, dreaming, up ANS activity

RBD: loss of paralysis, act out dreams, eyes closed, unresponsive, rapid alertness on awakening, self-injury

elderly men
assoc w parkinsons!

Question 11

Causes of RBD

rx?

Answer 11

antidepressants (serotonergics can cause loss of atonia during REM)

BZDs (clonazepam), melatonin, pramipexole

Question 12

NREM parasomnias

REM parasom: RBD

Answer 12

common in kids, resolve spontaneously

elderly men, assoc w/parkinson’s

Question 13

narcolepsy: 4 cardinal sx

Answer 13

excessive daytime sleepiness
sleep paralysis
hypnagogic/hypnopompic imagery
cataplexy (highly specific for narc)
and automatic behaviors

Question 14

narcolepsy

tx?

Answer 14

onset in kids/teens/YA
w/ and w/o cataplexy
w/: loss of hypocretin/orexin neurons in lateral hypoT; autoimmune rxn

w/o: less clear

antidepressants for cataplexy
sodium oxybate: stabilize sleep

Question 15

restless leg syndrome

4 cardinal sx?

Answer 15

more in women and elderly
N. European descent
dx made clinically
assoc w/periodic limb movements

URGE
U: urge to move legs (akasthesia)
R: rest-induced
G: get better w/movement
E: evening predominance

Question 16

primary/secondary RLS causes?

tx?

Answer 16

primary: CNS iron metabolism dysfxn
secondary: iron def anemia, renal failure, pregnancy, med-induced (antidepressants, antiemetics, antipsychotics, antihistamines)

iron supplementation
DA agonist (prami/ropinir)
a2 Ca channel (pregabalin)

Question 17

delayed sleep phase syndrome

advanced sleep phase syndrome

Answer 17

adolescents; initial insomnia and difficulty waking
think: alerting signal shifts right

elderly; early AM awakening
think: alerting signal shifts left

Question 18

circadian rhythm d/o tx

Answer 18

regularizing sleep/wake patterns, light exposure, melatonin

Question 19

vast majority type of insomnia?

Answer 19

co-morbid

women>men
smoking/alcohol/drugs

Question 20

depression w/insomnia?

Answer 20

2 fold RR of developing depression if you have insomnia

Question 21

most medications for insomnia focus on what factors?

Answer 21

perpetuating (these stick around after precipitating ones are gone)

Question 22

CBT is…

Answer 22

just as effective as meds for insomnia

Question 23

drugs for insomnia

Answer 23

BZDs: zolpidem
melatonin agonists (ramelteon) but not good for maintenance bc short half-life

orexin antagonists (suvorexant)

doxepin for sleep maintenance