sleep disorders

Question 1

what are the possible functions of sleep try to name 6

Answer 1

conserve energy and effort, produce hormones, promote optimal performance, memory consolidation, mood regulation, augment immune system

Question 2

at what stage do we enter sleep when healthy

Answer 2

normally sleep is entered through NREM

Question 3

if sleep is entered through rem what can that suggest

Answer 3

If it is entered through REM, the person is

either depressed, sleep deprived or has narcolepsy

Question 4

SWS sleep (slow wave) dominates what third of sleep

Answer 4

the first third

Question 5

what third of sleep does rem predominate

Answer 5

last third

Question 6

what percent of sleep does nrem and rem account for

Answer 6

nrem 75-80

rem is 20-25

Question 7

what happens to heart rate in nrem sleep vs rem sleep

Answer 7

nrem hr regular

rem hr is irregular

Question 8

what happens to BP in nrem vs rem

Answer 8

nrem regular

rem variable

Question 9

what happens to RR in nrem vs rem

Answer 9

nrem regular

rem irregular

Question 10

in nrem and rem how is the body responses to o2 and co2 change

Answer 10

nrem decreased,

rem significantly depressed

Question 11

in nrem and rem what happens to muscle tone

Answer 11

nrem preserved

rem absent

Question 12

what happens to brain o2 consumption and cbf

Answer 12

nrem reduced

rem increased

Question 13

what happens to thermoregulation in rem and nrem

Answer 13

nrem homeothermic
rem poikilothermic (not maintained can vary)

Question 14

what happens to penile tumescense and vaginal engorgement in sleep

Answer 14

nrem infrequent

rem frequent

Question 15

As you get older what happens to the different sections of sleep

Answer 15

total sleep time decreases
less SWS
less homeostatic drive
indivudal naps more
Medical, psychiatric, social (e.g. loss of role, reduced social
interaction), environmental factors (e.g. nursing home placement,
reduced exposure to light) and polypharmacy may have an impact
on sleep
other illness can affect sleep

Question 16

as you get older in abscense of pathology what happens to sws and rem sleep

Answer 16

sws decreases,

rem sleep shifts slightly earlier in the night

Question 17

what is a circadian rhythm sleep disorder

Answer 17

sleep disorder that occurs/disrupts over the normal sleep wake cycle over 24hrs

Question 18

name intrinsic primary sleep disorders

Answer 18

they alter the circadian timekeeping system, these disorders include dspd aspd non-24hr (blindness) , irregular (dementia)

Question 19

name extrinsic secondary sleep disorders which is a misalignment between extrinsic and intrinsic signal

Answer 19

shift work disorder

jetlag disorder

Question 20

what is delayed sleep phase disorder

Answer 20

▪ Sleep is out of phase with socially acceptable sleep-wake times,

Question 21

Clinical Features of DSPD

Answer 21

sleep is normal when they can sleep at their desired times. sleeping at conventional times causes sleep deprivation, insomnia or slipiness, unable to advance sleep.

symptoms will be chronic and persistent and may take drugs to help sleep and have a mental issue alongside

Question 22

how do you treat dspd

Answer 22

make sure the person wants treatment.

phottherapy, then melatonin, then cbt-I, then examine for pyschiatric co morbidity(may need to treat that)

Question 23

what is shift work disorder

Answer 23

Insomnia or excessive sleepiness with a recurring work schedule
that overlaps the usual time for sleep. normally one month of this can cause it, sleep log can support this

Question 24

what are the consequences of swd short term

Answer 24

mood disturbances, short day time sleeps, higher risk of accidents, gi problems

Question 25

what are long term risks of SWD

Answer 25

sleep disorder, mood disorder, cancer, drug abuse

Question 26

what advice would tyou give to someone to improve their shift pattern and help swd remembering that each individual is different

Answer 26

dont do more than 3 consec night shifts, distribute rest days, use power naps and caffiene, time meals and melatonin use, choose your own shifts and take regular shifts

Question 27

how much sleep do we get on average

Answer 27

The population mode is about 7.5 hours

Question 28

how much sleep do we need

Answer 28

depends on age
new born 12-18 hrs
3 months to 1 year 14-15
1-3 12-14 hrs
3-5 11-13
5-12 10-11
12-18 9 hrs
18+ 7-9 hrs

Question 29

How do I know I’m getting enough sleep? as too much or too little can be bad

Answer 29

You know you're getting enough sleep
when
for most of the day
most days
you have enough energy to do what you want

Question 30

what are some physiologic effects of sleep deprivation

Answer 30

irritability, cognitive impairment, impaired moral judgement, hallucinations, adhd symptoms, heart rate variability, heart disease, decreased reactions, tremours aches, t2dm, impaired immune

Question 31

how can sleep deprivation effect ind at work

Answer 31

Concentration - 68%

• Handling stress - 65%
• Listening - 57%
• Relating to others - 38%
• Solving problems - 57%
• Decision making - 56%

Question 32

how does sleep deprivation compare with alcohol

Answer 32

“Drowsiness is similar to alcohol in how it compromises driving ability by reducing alertness
and attentiveness, delaying reaction times, and hindering decision-making skills”

17 hours of sustained wakefulness impairs performance =
0.05% BAC (0.08% is the legal UK limit)

Question 33

explain Hallucinations in Sleep Deprivation different types

Answer 33

▪ These occur at the sleep/wake transition
▪ Occur on going to sleep - Hypnagogic Hallucinations
▪ Occur on waking from sleep - Hypnopompic Hallucinations

Simple visual or auditory hallucinations (e.g. seeing shadows emerging from
the wall, hearing one’s name being called)
▪ Can be frightening, but insight is retained, and there is no delusional
expansion vs those hallucinations occurring in psychotic illnesses

Question 34

what are parasomnias

Answer 34

▪ Abnormal behaviours that occur in association with sleep
▪ Occur during :
▪ NREM sleep
▪ REM sleep

Question 35

why are parasomnias difficult to diagnose

Answer 35

▪ Diagnostically challenging
▪ Poor patient recall
▪ Limited history if no witness account
▪ Routine investigations are often normal

Question 36

name some sws or nrem parasomnias

Answer 36

▪ Confusional arousal
▪ Sleep Walking (somnambulism)
▪ Night terrors (pavor nocturnus)
▪ Sleep-related Eating Disorder
▪ Sexsomnia

Question 37

how can you treat night terrors a form of parasomnias

Answer 37

Education. CBT-I to stabilise sleep-wake patterns
▪ Scheduled awakening: 30min alarm method for children
▪ Keep the room safe; be aware of new environments
▪ Only wake fully if the episode lasts >45 mins
▪ Pregablin, Clonazepam

Question 38

how can youtry to diagnose nrem parsomnias

Answer 38

▪ Family History
▪ Exacerbated by sleep deprivation, stress, alcohol, OSA,
fever
▪ Patient is often amnesic for the event, but may have partial
recollection
▪ Partner may describe tearfulness or confusion

Question 39

how do you treat nrem parasomnias

Answer 39

Reassurance (benign)
▪ Education – CBT-I to improve sleep pattern
▪ Avoid triggers
▪ Safety
▪ Antidepressants (e.g. Fluoxetine, Trazadone)
▪ Clonazepam
▪ Melatonin

Question 40

what are rem parasomnias

Answer 40

second half of night
nightmares
reccurent sleep paraylysis
nocturnal groaning catathrenia
rem sleep behaviour disorder

Question 41

what signs present in REM sleep Behaviour Disorder

Answer 41

Often correlate with recalled vivid dreams –
usually aggressive
▪ May injure bed partner
second half of night
normally aged 50 onwards

normally males

Question 42

how are rbd and parkinsons associated

Answer 42

RBD is the most robust non-motor predictor of developing Parkinson’s
Disease, and it is a predictor of early cognitive impairment

Question 43

how do you diagnose rbd

Answer 43

Clinical history may be highly suggestive but a v-PSG would confirm the
diagnosis (catching an episode or REM without atonia)

Question 44

how do you treat rbd

Answer 44

patienbt education, stop medications that may be causing it, separate beds, clonazepam, melatonin