Sleep Disorders

Question 1

What are parasomnias?

Answer 1

unusual sleep-related behaviors

Question 2

How are acute and chronic insomnia defined? Why is this an important difference?

Answer 2

acute lasts less than a month and is more likely to resolve spontaneously than chronic

Question 3

What is the preferred treatment for insomnia?

Answer 3

improving sleep hygiene and CBT

Question 4

Describe the features, cause, and treatment of narcolepsy.

Answer 4

• it is defined by irresistible attacks of refreshing sleep that occur daily for at least three months
• associated symptoms include cataplexy, sleep paralysis, and hallucinations (hypnagogic and hypnopompic)
• it is thought to be related to the loss of hypothalamic neurons that contain hypocretin
• treatment is with sleep hygiene, scheduled daytime naps, CNS stimulants, and sodium oxybate for cataplexy

Question 5

What is delayed sleep phase disorder and how is it treated?

Answer 5

• it is normal duration and quality of sleep with onset and awakening times later than desired
• treated with bright light phototherapy early in the morning, melatonin in the evening, and chronotherapy

Question 6

What is advanced sleep phase disorder and how is it treated?

Answer 6

• it is normal duration and quality of sleep with onset and awakening times earlier than desired
• treat with bright light therapy at night

Question 7

What is shift-work disorder?

Answer 7

sleep deprivation and misalignment of the circadian rhythm secondary to nontraditional work hours

Question 8

When during the sleep cycle do most parasomnias occur?

Answer 8

during slow-wave sleep

Question 9

How is sleepwalking treated?

Answer 9

• first line is ensuring safety and proper sleep hygiene

- may use clonazepam or TCAs for refractory cases

Question 10

What is the treatment for night terrors?

Answer 10

typically nothing as they are benign and self-limited

Question 11

What is nightmare disorder and how is it treated?

Answer 11

• it is the recurrence of frightening dreams that tend to terminate in awakening with vivid recall
• the preferred therapy is imagery rehearsal in which the patient rehearses an alternate course for a recurrent dream while awake and relaxed

Question 12

How should REM sleep behavior disorder treated?

Answer 12

clonazepam is most efficacious