Sleep Disorders

Question 1

What is wakefulness controlled by?

Answer 1

Reticular activating system

inhibition of RAS results in sleep

Question 2

What is required to get good sleep?

Answer 2

At least 90 minutes of Stage IV sleep

Question 3

4 main categories of patient sleep complaints

Answer 3

1. Hypersomnia (excessive daytime sleepiness)
2. Insomnia
3. Disorders of circadian rhythm
4. Parasomnias (unusual behaviors a/w sleep)

Question 4

Treatment of insomnia

Answer 4

• Sleep hygiene (only sleep and sex a/w bed)
• Go to bed same time every day
• Melatonin

Question 5

What is considered a sleep disturbance?

Answer 5

More than 5 wake ups a night

Question 6

Describe circadian rhythm disorders

Answer 6

Normal sleep once pt is asleep, but sleep does not come at socially acceptable times
(jet lag, shift work)

Question 7

Describe parasomnias

Answer 7

Unpleasant or undesirable behavior patterns a/w sleep

e.g. narcolepsy

Question 8

Define narcolepsy

Answer 8

Sudden onset of REM sleep (NOT the time it takes to fall asleep)

Question 9

Diagnostic test for narcolepsy

Answer 9

• Hypocretin receptor 2 gene deficiency

- Prehypocretin gene deficiency

Question 10

Treatment of narcolepsy

Answer 10

• Amphetamine for hypersomnia
• Imipramine for cataplexy
• SSRIs (suppress REM sleep mildly)
• Daytime naps

Question 11

When should a patient be considered for narcolepsy?

Answer 11

If patient has:

1. Daytime sleepiness
2. Cataplexy
3. Sleep paralysis
4. Hypnagogic/pompic hallucinations

Question 12

Treatment of sleep apnea

Answer 12

• Avoid ETOH before sleep
• Lose weight
• Sleep on side (tennis ball on back)
• CPAP
• Surgery

Question 13

Stages of sleep

Answer 13

I-IV (progressively deeper)

Question 14

Describe REM

Answer 14

• Rapid eye movement

- Sleep with dreaming

Question 15

After first 4 hours of sleep, how is sleep divided?

Answer 15

• Between stage II and REM

- REM stages get more frequent and longer as final 4 hours of sleep occurs

Question 16

Describe insomnia

Answer 16

• Inability to fall or remain asleep

- Deterioration in quality of sleep NOT necessarily volume of sleep

Question 17

Types of insomnia

Answer 17

• Primary (stress, anxiety)

- Secondary (lifestyle issues, active psych disorders, chronic/acute pain, drug abuse)

Question 18

Describe sleep hygiene

Answer 18

Only sleep and sex should be a/w bed - remove TV, reading, computer, phones, etc.

Question 19

How are OTC sleep aids used in insomnia?

Answer 19

• Usually of little benefit

- Include ETOH and benadryl

Question 20

Define cataplexy

Answer 20

Sleep onset triggered by emotional outbursts, laughing, sexual arousal, anger, etc.

Question 21

How to diagnose narcolepsy

Answer 21

Multiple sleep latency test (wake up patient 3 times after full sleep and see how fast they fall back into REM)

Question 22

Pathophys of sleep apnea

Answer 22

• Originally thought to be mechanical (soft tissue “collapse)
• Now, neurons cause dysfunction of pharyngeal motor neuron activity resulting in decreased airway patency