SM_88b: Sleep Disorders

Question 1

Describe history for sleep disorders

Answer 1

History for sleep disorders

• Patient and bed partner
• Bedtime / awak (week and weekend)
• Time to fall asleep
• Nocturnal awakening
• Daytime memory
• Daytime activities
• Medical conditions
• Medications: narcotics, SSRI, non-prescription meds/herbs, illicits
• Social history: alcohol, caffeine, illicts, work schedule
• Family history: narcolepsy, parasomnia, OSA have genetic influence

Question 2

Describe medical conditions associated with sleep disorders

Answer 2

Medical conditions associated with sleep disorders

• Anemia / renal disease - restless leg syndrome
• Acromegaly / Cushing - OSA
• Heart failure - central sleep apnea
• Anxiety / depression - insomnia
• Parkinson’s disease - REM behavior disorder

Question 3

____, ____, and ____ are sleep disorders with genetic influences

Answer 3

Narcolepsy, parasomnia, and OSA are sleep disorders with genetic influences

Question 4

Describe social history factors related to sleep disorders

Answer 4

Social history factors related to sleep disorders

• Alcohol consumption: worsening OSA / insomnia
• Caffeine: stimulants contribute to insomnia
• Illicit drugs: alter sleep architecture
• Work schedule: shift work / nocturnal disruption

Question 5

____ is when an individual has trouble getting sleep / staying asleep for 3 nights/week for ≥ 3 months

Answer 5

Chronic insomnia is when an individual has trouble getting sleep / staying asleep for 3 nights/week for ≥ 3 months

Question 6

Describe the pathophysiology model of insomnia

Answer 6

Question 7

Describe CBT for insomnia

Answer 7

CBT for insomnia

Question 8

____ and ____ are commonly used medications for chronic insomnia

Answer 8

GABA_A agonists and orexin antagonists are commonly used medications for chronic insomnia

Question 9

____ is a condition when breathing stops involuntarily for brief periods of time during sleep

Answer 9

OSA is a condition when breathing stops involuntarily for brief periods of time during sleep

Question 10

Mallampati score is used to ____ and ____

Answer 10

Mallampati score is used to assess ease of intubation and predict OSA

Question 11

Someone with OSA will have ____, ____, and ____

Answer 11

Someone with OSA will have mouth open, tongue out, and no vocalization

Question 12

____ and ____ can lead to breathing difficulties during sleep such as in OSA

Answer 12

Micro / retrognathia and macroglossia / tonsils can lead to breathing difficulties during sleep such as in OSA

Question 13

___ is most effective treatment for OSA

Answer 13

CPAP is most effective treatment for OSA

Question 14

____ is when breathing stops and starts during sleep due to failure of brain to send signals to muscles that control breathing

Answer 14

Central sleep apnea is when breathing stops and starts during sleep due to failure of brain to send signals to muscles that control breathing

Question 15

CSA is treated with ____ or ____

Answer 15

CSA is treated with phrenic nerve stimulation or adaptive servo-ventilation

Question 16

_____ is excessive daytime sleepiness

Answer 16

Hypersomnia is excessive daytime sleepiness

Question 17

____ is overwhelming daytime drowsiness and sudden attacks of sleep

Answer 17

Narcolepsy is overwhelming daytime drowsiness and sudden attacks of sleep

Question 18

Hypersomnia has ___ and ___

Answer 18

Hypersomnia has excessive daytime sleepiness and sleep drunkenness

Question 20

Narcolepsy may have ____, ____, ____, ____, and ____

Answer 20

Narcolepsy may have excessive daytime sleepoiness, sleep paralysis / hallucinations, cataplexy, difficulty staying asleep during night, and refreshing night-time sleep and naps

Question 21

Restless leg syndrome is ____

Answer 21

Restless leg syndrome is a condition that causes an uncontrollable urge to move the legs, typically in the evening or night hours when sitting / lying down

Question 22

____ is the unusual behaviors people experience prior to falling asleep, when asleep, or during arousal period between sleep and wakefulness

Answer 22

Parasomnia is the unusual behaviors people experience prior to falling asleep, when asleep, or during arousal period between sleep and wakefulness

Question 23

Describe parasomnia examples

Answer 23

Parasomnias

• Disorders of NREM sleep: confusional arousals, sleep walking, sleep terrors, and sleep related eating disorder
• Disorders of REM sleep: nightmares, REM behavior disorder, and recurrent isolated sleep paralysis

Question 24

Insomnia is best treated with ____

Answer 24

Insomnia is best treated with CBT ± short term use of hypnotic

Question 25

Most effective treatment for OSA is ____

Answer 25

Most effective treatment for OSA is CPAP

Question 26

Narcolpesy is ____ associated with low ____ levels

Answer 26

Narcolpesy is cataplexy associated with low hypocretin/orexin levels

Question 27

Restless leg syndrome is treated with ____, ____, and ____

Answer 27

Restless leg syndrome is treated with iron supplements, dopamine agonists, or pregabalin/gabapentin

Question 28

REM behavior disorder is ____ and often an early symptom of a ____

Answer 28

REM behavior disorder is loss of muscle tone during REM sleep and often an early symptom of a synucleinopathy