sleep wake disorders

Question 1

progression through NREM sleep results in _________ brain wave patterns and __________ arousal thresholds

Answer 1

progression through NREM sleep results in slower brain wave patterns and higher arousal thresholds

Question 2

In REM sleep, brain wave patterns resemble the EEG of an

Answer 2

aroused person

Question 3

awakening from REM sleep is associated with _________ dream recall

Answer 3

vivid

Question 4

dyssmonias

Answer 4

insufficient, excessive or altered timing of sleep

Question 5

Parasomnias

Answer 5

unusual sleep related behaviors

Question 6

most common of the hypersomnias

Answer 6

breathing-related disorders– OSA, CSA

Question 7

excessive daytime sleeping

Answer 7

hypersomnias

Question 8

acute insomnia

Answer 8

<3 months is generally associated with stress or changes in sleep schedule and usually resolves spontaneously

Question 9

chronic insomnia

Answer 9

> 3 months to years ans is associated with reduced quality of life and increased risk of psychiatric illness

Question 10

first line therapy for chronic insomnia

Answer 10

CBT

Question 11

DSM5 crit for insomnia disorder

Answer 11

1. difficulty in initiating/maintaiing sleep or early morning awakenings
2. occurs at least 3 days a week for at least 3 months

Question 12

most common reason pt. are put on long term benzos

Answer 12

insmonia

Question 13

REM sleep is characterized by _______ in blood pressure, heart rate and respiratory rate

Answer 13

increased

Question 14

complain of nonrestorative sleep, automatic behaviors and difficulty awakening in the morning

Answer 14

hypersomnolence disorder

Question 15

hypersomnolence disorder DSM5 crit

Answer 15

1. excessive sleepiness despite at least 7 hours of sleep, with at least one of the following:
   a) recurrent periods of sleep within the same day
   b) prlonged nonrestorative sleep >9 hr
   c) difficulty being fully awake after awakening

Question 16

treatment for hypersomnolence disorder

Answer 16

life-long therapy with modafinil or stimulants such as methylphenidate

*** amphetamine like antidepressants such as atomoxetine are second line therapy

Question 17

chronic breathing related disorder characterized by repetitive collapse of the upper airway during sleep and evidence by polysomnography of multipe episodes of panea or hypopnea per hour of sleep

Answer 17

OSA

Question 18

OSA treatment

Answer 18

positive airway therapy: CPAP or BiPAP

• behavioral strategies such as weight loss and exercise

Question 19

evidenced by five or more central apneas per hour of sleep– can be idiopathic with Cheyne-Stokes breathing ir due to opioid use

Answer 19

central sleep apnea

Question 20

cheyne-stokes breathing

Answer 20

pattern of periodic crescendo-decrescendo variation in tidal volume due to heart failure, stroke or renal failure

Question 21

30% of chronic opioid users have

Answer 21

central sleep apnea

Question 22

treatment for CSA

Answer 22

treat underlying condition

Question 23

polysomnographydemonstrated decreased respiration and elevated CO2

Answer 23

sleep related hypoventilation

Question 24

hypnagogic

Answer 24

hallucinations when going to sleep

Question 25

hyponopomic

Answer 25

hallucinatios when transitiong from sleep

Question 26

characterized by excessive daytime sleepiness and falling asleep at inappropriate times

Answer 26

narcolepsy

Question 27

narcolepsy DSM5

Answer 27

1. recurrent episodes of need to sleep, lapsing into sleep, or napping during the day, occurring at least 3 times per week for at least 3 months associated with at least one of the following
   i) cataplexy
   ii) hypocretin deficiency in CSF
   iii) reduced reM sleep latency on polysmnography

Question 28

pathophysiology of narcolepsy

Answer 28

linked to loss of hypothalamic neurons that produe hypocretin

Question 29

catatonic catalepsy

Answer 29

unprovoked muscular rigidity

Question 30

narcolepsy treatment:

1. daytime sleepiness
2. cataplexy

Answer 30

1. daytime sleepiness– amphetamines

2. cataplexy– sodium oxybate

Question 31

recurrent patterns of sleep disruption due to an alteration of the circadian system or misalignment between the endogenous circadian rhythm and sleep-wake schedule required by an individuals’s environemnt or shcedule

Answer 31

circadian rhythm

Question 32

chronic or recurrent delay in sleep onset and awakening with preserved quality and duration of sleep

Answer 32

delayed sleep phase disorder – puberty

Question 33

normal duration and quality of sleep with sleep onset and awakening timres earlier than desired

Answer 33

advanced sleep phase disorder – older age

Question 34

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

Answer 34

shift work disorder – >16 hr shift

** bright light phototherapy to facilitate rapid adaptation to night shift

Question 35

sleep disturbances associated with travel across multiple times szones

Answer 35

jet lag disorder

Question 36

The _______________ in the hypothalamus coordinates 24-hr or circadian thythmicity

Answer 36

suprachiasmic nucleus

Question 37

abnormal behaviors, experiences or physiological events that occur during sleep or sleep-wake transitions

Answer 37

parasomnias

Question 38

repeated episodes of incomplete arousals that are bired and usually occur duirng the first third of the sleep episode

Answer 38

Non-REM sleep arousal disorder

Question 39

recurrent frightening dreams that occur during the seond half of the sleep episode; terminates in awakening with vivid recall

Answer 39

nightmare disorder

Question 40

recurrent epsiodes of sudden terror arousals, usually beginning with screaming or crying that occur during slow-wave sleep; patients usually return to sleep without awakening

Answer 40

sleep terrors

Question 41

treatment for nightmare disorder

Answer 41

desensitization/imagery rehersal therapy (IRT) involves the use of mental imagery to modify the outcome of a reucrrent nightmare

Question 42

IRT is successful in treating recurrent nightmares in

Answer 42

PTSD

Question 43

repeated arousals during sleep associated with vocalization or complex motor behavior occurring during REM sleep– lack of muscle atonia during REM sleep

Answer 43

REM sleep behavior disorder

Question 44

urge to move legs accompanied by unpleasant sensation in the legs, characterized by relief with movement. aggravation with inactivity and only occurring or worsening in the evening

Answer 44

resltess leg syndrome

Question 45

first line treatment for restless leg syndrome

Answer 45

dopamine agonist and benzo are first in line

Question 46

risk factors for resless leg syndrome

Answer 46

iron deficiency