Sleep-wake Disorders

Question 1

Insomnia disorder A- c

Answer 1

A: A predominant complaint of dissatisfaction with sleep quality or quantity associated with one or more of the following:
1. Difficulty initiating sleep
2. Difficulty maintaining sleep
3. Early morning awakening with an ability to return to sleep

B: Causes clinically significant distress or impairment

C: Sleep difficulty occurs at least three nights per week

Question 2

Insomnia disorder: how frequent is the disturbance? 

Answer 2

3 times per week

Question 3

Insomnia disorder: how long is sleep difficulty present for? 

Answer 3

At least 3 months

Question 4

Insomnia disorder specifiers

Answer 4

With mental disorder
with medical condition
with another sleep disorder
episodic — 1-3 months
persistent —sympt. 3+ mo
recurrent— 2+ episodes/year

Question 5

3 types of insomnia

Answer 5

Initial insomnia
Middle insomnia
Late insomnia

Question 6

Hyper-somnolence disorder

Answer 6

A. Self reported excessive sleepiness despite immense sleep. Lasting at least seven hours with one of the following symptoms:
1. Recurrent periods of sleep relapses into sleep within the day
2. Prolonged sleep episode of more than nine hours per day that is non-restorative
3. Difficulty being fully awake after abrupt awakening

B: occurs 3x/week, 3 months

C: impairments 

Question 7

Hypersomnolence disorder specifier

Answer 7

Acute: < 1 month
Subacute: 1-3 mo
Persistent: 3+ mo

Question 8

Main symptom that differentiates hypersomnolence from other sleep disorders

Answer 8

Sleep inertia (impaired performance following awakening, “sleep drunkenness”)

Question 9

Narcolepsy a-b

Answer 9

A: recurrent periods of irrepressible Need to sleep, lapsing into sleep or napping occurring within the same day, 3x/week, 3 months 

B: at least one of the following:
1. Episodes of cataplexy
2. Hypocretin Deficiency (measured using CSF) 
3. Nocturnal sleep polysomnography showing REM latency =< 15 min

Question 10

Narcolepsy specifiers

Answer 10

1 Narcolepsy with cataplexy or hypocretin deficiency

2. Narcolepsy without cataplexy or without hypocretin deficiency

3.is cataplexy or hypo Kirton deficiency due to a medical condition

4. W/out cataplexy or hypocreyin due to another med condition

Question 11

Cataplexy

Answer 11

Brief, sudden bilateral loss of muscle tone precipitated by emotions

Question 12

Obstructive sleep apnea hypopnea (A)

Answer 12

A: either 1 or two
1. Evidence by polysomnograph of at least five obstructive apnea‘s or hypopnea per hour of sleep and either of the following symptoms
— nocturnal breathing disturbances (snoring, gasping, breathing pause)
— Daytime sleepiness fatigue or on refreshing sleep

2. Evidence by polysomnograph a 15 or more obstructive apnea as per hour of sleep regardless of accompanying symptoms

Question 13

Obstructive sleep apnea hypopnea specifiers

Answer 13

Mild: less than 15
Mod: 15-30
Severe: 30+

Question 14

Central sleep apnea (A-B)

Answer 14

A: evidence by polysomnograph of five or more central apneas per hour of sleep

B: Not better explain by another current sleep disorder

Question 15

Central sleep apnea specifiers

Answer 15

Idiopathic central sleep apnea: caused by respiratory effort, not airway obstruct

Cheyne-stokes breathing:

Comorbid w opiod use

Question 16

Sleep related hypoventilation a

Answer 16

A: Polysomnograph demonstrates episode of decreased Respiration associated with elevated CO2 levels

Question 17

Circadian rhythm sleep wake disorders a-c

Answer 17

A: A persistent pattern of sleep disruption that is primarily due to an alteration of the circadian system required by an individuals physical environment, social or professional schedule

B: The sleep disruption leads to excessive sleepiness or insomnia or both

C: distress or impairment 

Question 18

Circadian rhythm sleep wake disorders specifiers

Answer 18

Delayed sleep phase type
— familial or overlapping

Advanced sleep phase type
— familial

Irregular sleep wake type

Non 24hr sleep wake type

Shift work type

Question 19

Nonrapid eye movement sleep arousal disorder a-c

Answer 19

A: recurrent episodes of incomplete awakening from sleep usually during the first third of the major sleep episode accompanied by either one of the following:
1. Sleepwalking
2. Sleep terrors

B: No or a little dream imagery is recalled

C: Amnesia for the episodes is present

Question 20

Nonrapid eye movement sleep arousal disorder specifiers 

Answer 20

Sleepwalking type
W sleep related eating
W sleep related sexual beh

Sleep terror type

Question 21

Nightmare disorder a-b

Answer 21

A: repeated occurrences of extended extremely dysphoric and well remember dreams that usually involve efforts to avoid threats to survival security or physical integrity and that generally occur during the second half of the major sleep episode

B: awakening from the dream the individual rapidly becomes oriented and alert

Question 22

Rapid eye movement sleep behavior disorder a- d

Answer 22

a. Repeated episodes of arousal during sleep associated with vocalization and or complex motor behaviors

B. Occurs during rapid eye movement sleep usually 90 minutes after sleep at one set

C: Upon awakening the individual is a completely alert and not confused

D: Either of the following:
1. REM sleep without atonia on polysomnographic recording
2. A history suggestive of the disorder

Question 23

Restless leg syndrome a-

Answer 23

A: an urge to move the legs, and uncomfortable sensation in the legs characterized by all of the following:
1. The urge to move the legs begins or worsens during periods of rest
2. The urge to move to legs is partially relieved by movement
3. The urge to move to legs is worse in the evening

B: Three times/week, 3 mo

C: distress