Sleep disorders

Question 1

What does REM stand for?

Answer 1

Rapid eye movement

Question 2

Describe REM sleep

consider why it occurs, when, types of dreams and what happens to the body

Answer 2

Its role is mostly for early brain development

Similar to wakefulness - narrative dreaming

Mostly occurs at the end of the night

Breathing becomes irregular, BP rises, fast EEG activity, cerebral blood flow is increase, loss of muscle tone (paralysis)

Question 3

Describe non-REM sleep

consider why it occurs, when, types of dreams and what happens to the body

Answer 3

Its role is for protein synthesis, cell division and growth

Majority of sleep

Mostly occurs at the start of the night

Rythmic EEG activity, cerebral blood flow is reduced, partial relaxation of muscles

Question 4

Which kind of sleep is more important, REM or NREM?

Answer 4

NREM

REM sleep is mostly for early brain development

Question 5

Describe how REM sleep changes with age

Answer 5

Neonates have 50% REM sleep, this decreases with age

Question 6

How long is the normal circadian rhythm?

Answer 6

25 hours

NB not 24

Question 7

How much sleep is enough?

Answer 7

7-7.5 hours per night

Mid afternoon nap of 15 minutes is equivalent to 90 minutes overnight

Question 8

Give some examples of sleep disorders

Answer 8

Parasomnias

Narcolepsy

Insomnia

Question 9

What are parasomnias?

Answer 9

Sleep disorders that involve abnormal and unnatural movements, behaviors, dreams e.t.c that occur while falling asleep/ sleeping/ waking up

Question 10

Give some examples of how a NREM parasomnia might present

Answer 10

Confusional arousals (motor parts of the brain wake up first)

Sleep walking

Sleep paralysis (awareness is intact but can’t move)

Bruxism (teeth grinding)

Question 11

Give some examples of how a REM parasomnia might present

Answer 11

Simple behaviours

Dreaming

Question 12

What is narcolepsy?

Answer 12

A disorder which affects the control of sleep and wakefullness

Question 13

What affects can narcolepsy have on daily life?

Answer 13

Impairment of social and academic performance

Death by vehicle accidents

Question 14

What are the 5 main signs/ symptoms of narcolepsy

NB patients won’t always have all 4

Answer 14

Daytime sleepiness

Cataplexy

Hypnagogic hallucinations

Sleep paralysis

RBD (REM behaviour disorder)

Question 15

Describe how ‘daytime sleepiness’ in narcolepsy presents

Answer 15

Patient may have involuntary sleeping throughout the day “sleep attacks” which can occur at any time, e.g while eating or talking.

They don’t actually sleep more than is normal in a 24 hour period.

Question 16

Describe cataplexy, a symptom of narcolepsy

Answer 16

Emotions, such as laughing or anger trigger a loss of muscle tone, causing the patient to collapse

Question 17

Describe sleep paralysis, a symptom of narcolepsy

Answer 17

The patient is unable to move on falling asleep or waking up.

Typically lasts a couple of minutes.

Can be very scary for the patient, especially if it is accompanied by the symptom of hallucinations.

Question 18

What are hypnagogic hallucinations, a symptom of narcolepsy?

Answer 18

Hallucinations which occur at sleep onset (when falling asleep)

Question 19

What investigation can be done for narcolepsy?

Answer 19

Overnight polysomnography

Multiple sleep latency test

LP (low CSF hypocretin levels)

Question 20

Describe how the multiple sleep latency test can be performed

(this can be done to investigate for narcolepsy)

Answer 20

4x 25 minute naps are scheduled 2 hours apart

EEG, muscle activity and eye movements are recorded

Time from the start of the nap to the first signs of sleep (sleep latency) are measured

Question 21

What would you expect the multiple sleep latency test to show in patients with narcolepsy?

Answer 21

Patients fall asleep very quickly with REM sleep at the start of the sleep

Question 22

What can cause insomnia?

Answer 22

Loss of association between bed and sleep (e.g using bed to study, use technology e.t.c)

Emotional distractions

Question 23

What drugs can suppress REM sleep with no effect?

Answer 23

Tricyclic drugs

Question 24

How is light transmitted to the brain to influence the circadian rhythm?

Answer 24

Light is transmitted to the brain via retinal ganglion cells which protect to the suprachiasmatic nucleus

Question 25

What part of the brain remains unaffected by lack of sleep and what tasks is this part of the brain responsible for?

Answer 25

Prefrontal brain

Prefrontal brain is important for well rehearsed tasks and routine behaviour

Question 26

REM sleep paraomnias are often seen preceding which condition?

Answer 26

Parkinson’s disease

Question 27

What scale can be used for self-reported sleepiness to estimate if a person is abnormally tired?

Answer 27

Epworth scale