Sleep Disorders

Question 1

What is sleep apnea

Answer 1

Repetitive collapse of airway during sleep (15+ times)

Question 2

What needs to be present if only 5+ episodes of sleep apnea occur

Answer 2

• S/Sx of excess sleepiness, fatigue, or insomnia
• Waking up breathless, choking, or gasping
• Habitual snoring or breathing interruption (noted by partner)
• HTN, T2DM, mood disorder, cognitive dysfunction, CAD, stroke

Question 3

What does sleep apnea cause

Answer 3

Excess daytime sleepiness

snoring, choking, or gasping during sleep

Question 4

What does a sleep apnea PE show

Answer 4

+/- obesity, crowded OP airway, HTN, cor pulmonale

Question 5

RF for OSA include

Answer 5

Male
Obese
older
craniofacial morphology or upper airway soft tissue abnormality
(more common in african americans)

Question 6

What can you use to eval level os obstruction

Answer 6

Mallampti classification

Friedman tongue scale

Question 7

How do you diagnose OSA

Answer 7

Polysomnography

Question 8

How do you treat OSA

Answer 8

Weight loss and exercise (if needed)
Avoid alcohol and benzos
Initial therapy: CPAP
(then can do upper airway surgery, oral appliance, or hypoglossal nerve stimulation )

Question 9

What is insomnia

Answer 9

Difficulty initiating or maintaining sleep

Question 10

Who is insomnia common in

Answer 10

women
low SES
unemployed
widowed/divorced 
substance abuse disorder

Question 11

How do you diagnose insomnia

Answer 11

Clinically- sleep history

but, look for other conditions, meds, or substance abuse

Question 12

What is criteria for insomnia diagnosis

Answer 12

Symptoms 3x week
Difficulty initiating or maintaining sleep Adequate opportunity to sleep
Leads to daytime consequences

Question 13

How long can insomnia last

Answer 13

Short term: <3 mo, usually due to stressor

Chronic: >3 months

Question 14

How do you treat insomnia

Answer 14

Sleep hygiene, stimulus control, relaxation, sleep restriction, CBT, THEN drugs

• Benzo’s (short term d/t ADE): Lorazepam
• Non-benzo sedative: Eszopiclone, Zaleplon
• Melatonin agonist, Doxepin, Suvorexant

Question 15

What do many patients try if insomnia persists

Answer 15

EtOH

Question 16

What is narcolepsy

Answer 16

loss of hypothalamic neurons that make Orexin (promote wakefulness, inhibit REM)

Question 17

Narcolapsy results in

Answer 17

Excess daytime sleepiness (but feels rested upon awakening)

Difficulty sustaining wakefulness, bad REM regulation, disturbed nocturnal sleep

Question 18

What is cataplexy

Answer 18

Sudden muscle weakness w/o LOC, triggered by strong emotions

Question 19

What are the types of Narcolepsy

Answer 19

Type 1: With catcplexy

Type 2: withOUT cataplexy

Question 20

Clinical manifestations of narcolepsy include

Answer 20

Hypnagogic hallucinations (dream like hallucination at sleep onset) 
Sleep paralysis (when waking up or just before sleep) 
Sleep attacks, fragmented sleep, obesity

Question 21

How do you diagnose Narcolepsy

Answer 21

1. H&P
2. Polysomnograph to r/o other causes
3. MSLT

Question 22

What are narcolepsy findings on Polysomnograph

Answer 22

REM within 15 minutes

Question 23

What are narcolepsy findings on MSLT

Answer 23

Sleep latency <8 minutes with REM in at least 2 daytime naps

Question 24

What is the Epworth Sleepines sScale score for most with narcolepsy

Answer 24

> 15

Question 25

How do you treat Narcolepsy

Answer 25

Non-pharm: avoid benzos and alcohol, opiates and anti-psychotics. get good night sleep, 1-2 20 min naos. Screen for depression, anxiety, CV Sx
Pharm: MODAFANIL (promote wakefulness)
Cataplexy: antidepressant, sodium oxybate

Question 26

What is a parasomnia

Answer 26

Undesirable physical event or experience during entry/ within/arousal from sleep
More common in kids
NREM or REM related

Question 27

When does NREM parasomnia occur

Answer 27

During N3 in first 1/3 of sleep cycle, due to dysfunction in neural pathway regulating sleep-wake cycle

Question 28

What are the types of NREM parasomnias

Answer 28

Confusional arousal
Sleep walking
Sleep terror
Sleep related eating disorder

Question 29

How do you diagnose Parasomnias

Answer 29

History

PSG (if w. comorbid sleep disorder)

Question 30

What is the criteria for Parasomnias

Answer 30

Recurrent episodes of incomplete awakening
Inappropriate responsiveness
No cognition or dream report
Complete/partial amnesia

Question 31

How do you treat parasomnias

Answer 31

Avoid sleep deprivation, EtOH
Maintain consistent sleep-wake cycle
Anticipatory awakening
Dont arouse, calmly coax back to bed
Allow free movement