Sleep Wake Disorders

Question 1

What are the stages of sleep and what do they mean? 
N1:
N2:
N3:
REM:

Answer 1

Non-Rem
N1: transitional
N2: Light sleep-non restorative
N3: slow wave, delta, “deep” sleep which is restorative, disorientation upon waking up, and amnesia for a brief awakening
REM: (rapid eye movement)
Physiological activation, dreaming, paralysis

Question 2

What are the Diagnostic Tools for Sleep Wake Disorders (SWDs)

What does the Epworth Sleeping Scale Measure?

Answer 2

An interview followed by a PSG (polysomnograph)

How good your sleep is 
Score:
0-10: Normal
11-14: Mild sleepiness
15-17: Moderate sleepiness
>18: Severe sleepiness

Question 3

Insomnia Disorder

What is Etiology behind Insomnia?

Answer 3

Difficulty initiating or maintaining sleep for 3 or more months

Etiology: learned arousal response to bedtime and other cues associated with the sleep environment: eating, etc in bed. The arousal is from inappropriate sleep hygiene

Question 4

What is the treatment for Insomnia? There are 3

Answer 4

1. Improve sleep hygiene: avoid caffeine, exercise, take a hot bath, maintain consistent sleep schedule
2. Sedatives-benzodiazapines (diazepam) to decrease slow wave sleep and REM
3. Benzo-like drugs: Zolpidem-have fewer side effects

Question 5

What is Hypersomnolence Disorder?

What is the neuropathology behind it?

Treatments?

Answer 5

Excessive sleepiness despite sufficient sleep (at least 7 hours) for 3 or more months

Unknown

Stimulants to promote wakefullness: Modafinil (Provigil), Adderall, Ritalin, anything Amphetamine-like

Question 6

What is Narcolepsy

You have to have at least 1 symptom out of what list of 3?

Answer 6

Recurrent irresistible sleep (Nap Attack) several times per week for 3 or more months

1. Cataplexy
2. Hypocretin deficiency
3. Characteristic PSG abnormalities

Question 7

What is Cataplexy?

What are some symptoms associated with REM that are NOT diagnostic?

Answer 7

Sudden loss of muscle tone while AWAKE, typically precipitated by emotion, and considered an aberrant manifestation of REM sleep

Sleep Paralysis, Hypnagogic, and Hypnopompic

Question 8

What is Hypocretin?

Answer 8

Also called Orexin: deficiency in this neuropeptide that may be auto-immune related-need a spinal tap

Question 9

What are characteristic PSG abnormalities?

Answer 9

1. Nocturnal PSG-go into REM very quickly

2. Daytime PSG-that and you go to sleep quickly

Question 10

Treatment for Narcolepsy

There are 2

Answer 10

1. Polytherapy: Stimulants for somnolence (Modenifil) & Antidepressants for cataplexy
2. Monotherapy: Xyrem (sodium oxybate)
   Super illegal drug, but can treat both symptoms and available via a restricted distribution system

Question 11

Breathing Related Sleep Disorder

What are they and what are the two types?

Answer 11

Excessive sleepiness or insomnia due to sleep-related breathing condition

1. Obstructive Sleep Apnea Hypopnea
2. Central Sleep Apnea

Question 12

What is obstructive sleep apnea?

Why does the apnea/hypopnea cause sleepiness?

What is the classic profile?

Answer 12

Multiple episodes of breathing cessation/reduction occur per night due to an upper airway obstruction-occurs when soft tissue in the back of the throat collapses during sleep

Cause sleepiness because the rise in CO2 causes temporary arousal from sleep which bumps the person from a deep to light stage of sleep

Middle aged, overweight male who snores loudly and intermittently

Question 13

What is the treatment for OSAH

There are 4.

Answer 13

CPAP, lose weight, bumper belt, mandibular devices

Question 14

What is Central Sleep Apnea and what causes it?

Answer 14

Multiple episodes of cessation of breathing caused by CNS dysregulation

Idiopathic cause

Question 15

What can differentiate a OSA from CSA?

What is the clue

Treatment of CSA?

Answer 15

PSG on whether thoracic movements occur at the start of apneic episode

OSAH-there is effort
CSA-no effort

Acetazolamide: respiratory stimulant

Question 16

What is Circadian Rhythm Sleep-Wake Disorder

Example?

Treatment?

Answer 16

When your sleep cycle is off from environmental cues

I go to bed at 2 and wake up at 10, but I have to be at school at 8.

Phototherapy:
light-decrease melatonin-keep you awake
dark-increase melatonin-make you sleepy

Question 17

What are Parasomnias?

There are 5

Answer 17

Disorders characterized by abnormal behaviors associated with sleep

Question 18

1. Non-Rem Sleep Arousal Disorder

What is it?
Characterized by?
Treatment?

Answer 18

Incomplete awakening from sleep with either

1. Sleep Walking (somnambulism)-unresponsive and difficult to wake
2. Sleep Terrors-unresponsive to comfort by others

Episodes within first third of sleep-during SWS, no dreams and no rememberance in the morning

Benzodiazapenes

Question 19

Nightmare

How is it different?

Treatment?

Answer 19

Awakening during 2nd half of sleep, remember everything

Antidepressants

Question 20

REM Sleep Behavior Disorder

How is it confirmed?

Loss of motor inhibition during REM sleep is associated with what?

Treatment

Answer 20

Vocalizations and/or complex motor movements during REM sleep

PSG to make sure its REM without Atonia

Neurodegenerative disease-Parkinsons’s, Lew body Dementia

Clonazapam

Question 21

What is Restless Leg Syndrome?

Is patient aware?

Treatment?

Answer 21

Urge to move legs in response to uncomfortable sensations at night

Yes

Anti-Parkinson’s drugs: to increase dopamine

Question 22

Periodic Limb Movements

How is this different from RLS?

Treatment?

Answer 22

Muscle contractions during sleep-occur throughout the whole night

Patient is UNAWARE of movements, diagnosed with PSG

Similar to RLS

Question 23

What are sleep startles?

Answer 23

When muscle contractions occur upon initially falling asleep:

but they don’t mean anything