sleep wake disorders

Question 1

non rem sleep

Answer 1

Stage 1: Transitional
Stage 2: Light sleep (non-restorative)
Stage 3: (“slow wave”, “delta”, “deep” sleep)
‒ Restorative sleep
‒ Disorientation upon awakening
‒ Amnesia for a brief awakening
‒ N3 length decreases across cycles

Question 2

REM SLEEP

Answer 2

Physiological activation (large fluctuations in
respiration, thermoregulation, and circulation)
‒ Dreaming
‒ paralysis (Low muscle tone throughout the body)
‒ Rapid orientation upon awakening
‒ Memories for a brief awakening
‒ REM length increases across cycles

Question 3

INSOMINIA

Answer 3

DIFFICULTY SLEEPING FOR 3PLUS MONTHS

Question 4

Hpersomnolence disorder

Answer 4

Excessive sleepiness despite sufficient sleep (7+
hrs) for 3+ months

Question 5

Narcolepsy

Answer 5

1. Recurrent irresistible sleep occurring
   within the same day, several times per
   week
   AND
2. At least 1 of the following:
   a) Cataplexy
   b) Characteristic polysomnography (PSG) abnormalities
   c) Hypocretin deficiency

Question 6

Cataplexy

Answer 6

Sudden loss of muscle tone while awake
– Typically precipitated by strong emotion
– Considered a REM-related behavior occurring
outside of REM sleep

Question 7

obstructive sleep apnea hyppnea (OSHA)

Answer 7

Multiple episodes of cessation of breathing per
night caused by upper airway obstruction.
* Obstruction usually occurs when soft tissue in
the back of the throat collapses during sleep
* Rise in CO2 during apneas causes temporary
arousal (usually not awakening) from sleep

Question 8

central sleep apnea

Answer 8

2+ episodes of breathing cessation per night
caused by CNS dysregulation of breathing.

Question 9

CIRCADIAN RHYTHM SLEEP-WAKE
DISORDER

Answer 9

Excessive sleepiness or insomnia resulting from
a mismatch between a person’s circadian sleepwake pattern and the sleep-wake schedule
required by the environment

Question 10

CIRCADIAN RHYTHM SLEEP-WAKE
DISORDER TREATMENT

Answer 10

Light → SCN → inhibits pineal gland → decreases
melatonin → alert

No light → SCN → activates pineal gland →
increases melatonin → drowsy

Question 11

NON REM AROUSAL

Answer 11

1. Sleep Walking: Rising from bed, walking about
   with a blank & staring face, unresponsive, and
   difficult to wake
2. Sleep Terrors: Abrupt terror arousals (usually
   with panicky scream), intense fear and
   autonomic arousal, and unresponsive to comfort
   by others

Question 12

sleep terrors

Answer 12

Episodes occur in first 1/3 of sleep (slow wave sleep [SWS])
* No (or little) dream imagery
* Amnesia for the episodes

Question 12

Nightmare

Answer 12

Awakening in the 2nd half of sleep period (during REM sleep)
* Rapid alertness upon awakening
* Dream content is well remembered
* Good recall of the awakening the next morning

Question 13

REM SLEEP BEHAVIOUR DISORDER

Answer 13

• Vocalizations and/or complex motor movements
  occur during REM sleep
• REM sleep without atonia is confirmed by PSG
• Not induced by a substance
• Typically action-filled, violent dreams
• Immediately awake, oriented and alert with
  detailed dream recall

Question 14

RESTLESS LEG SYNDROME

Answer 14

• Urge to move legs in response to uncomfortable
  sensations with all the following:
• Occurs/worsens during inactivity
• Nocturnal worsening of symptoms
• Temporary relief from discomfort by moving
• Patient is aware of symptoms and complains of
  insomnia

Question 15

PERIODIC LIMB MOVEMENTS

Answer 15

• Repetitive muscle contractions during non-REM
  sleep, usually of the lower limb:
• Associated with multiple sleep stage arousals
• Patient complains of daytime sleepiness but is unaware of
  movements
• Electromyogram during PSG confirms diagnosis