Sleep Disorders

Question 1

why do we need sleep?

Answer 1

• memory consolidation
• healing
• growth
• immune response

Question 2

sleep-wake cycle: competition/balance between ________ and ________

Answer 2

sleep-wake cycle: competition/balance between SLEEP LOAD and CIRCADIAN ALTERING SIGNAL

Question 3

deepest level of sleep?

Answer 3

NREM III
(non-REM III)

-get most rest/relaxation

Question 4

what occurs during REM sleep?

Answer 4

• dreams
• mental/physical relaxation
• memory consolidation
• emotional processing

Question 5

physiologic occurances in REM sleep

Answer 5

• rapid eye movement
• increased brain activity
• complete paralysis

Question 6

as the night progresses, does REM get progressively shorter or longer?

Answer 6

REM gets progressively longer

Question 7

primary sleep disorders

Answer 7

Dyssomnias

• idiopathic hypersomnia
• narcolepsy
• sleep apnea
• periodic leg movements
• restless leg syndrome
• insomnia

Parasomnias

• sleep terror
• sleep walking
• sleep talking
• nightmare disorder
• REM behavior disorder

Question 8

secondary sleep disorders

Answer 8

due to external issues

• mental disorders (anxiety, depression, PTSD)
• medical disorders (arthritis, fibromyalgia)
• substance use (drugs, alc, meds)
• sleep deprivation due to schedule etc

MORE COMMON THAN PRIMARY DISORDERS

Question 9

circadian rhythm disorders

Answer 9

• delayed sleep phase disorder
• advanced sleep phase disorders
• free running type
• jet lag disorder
• shift work disorder

Question 10

most adults need ____ hours of sleep per night

Answer 10

7-9 hours

Question 11

in laboratory rats, complete sleep deprivation leads to

Answer 11

• failure to thrive
• excessive food intake with decreased weight
• loss of hair
• skin abnormalities
• hyperactivity
• death at day 22

Question 12

effects of caffeine on sleep architecture

Answer 12

• caffeine blocks adenosine receptors

- sleep structure completely abnormal

Question 13

ways to test for excessive daytime sleepiness

Answer 13

• history
• Epworth sleep scale
• polysomnography
• multiple sleep latency test (MSLT)
• maintenance of wakefulness test (MWT)

Question 14

management of a sleep disorder

Answer 14

-treat any underlying sleep pathology

Patient education

• adequate total sleep time
• proper sleep hygeine
• limited role for medications

Question 15

state boundary disorders

Answer 15

the 3 distinct states (awake, non-REM, REM) are somewhat overlapping
ex: narcolepsy, parasomnias

Question 16

narcolepsy

Answer 16

intrusion of REM sleep features into the waking state

Question 17

parasomnias

Answer 17

inappropriate release of awake behaviors during sleep

Question 18

classic tetrad of daytime sleepiness (narcolepsy)

Answer 18

• cataplexy
• hypnogogic hallucinations
• sleep paralysis

Question 19

neuronal level explanation of narcolepsy

Answer 19

• inconsistent inhibition of REM-on neurons
• go into REM sleep during the day
• REM-on neurons of pons tell medullary inhibitory region to inhibit motor neurons
• –paralysis causes cataplexy
• might start to dream

Question 20

cataplexy

Answer 20

• sudden bilateral loss of muscle tone
• preserved consciousness
• triggered by strong emotions
• localized or generalized
• seconds to minutes

10-50% of narcoleptics do NOT have cataplexy

Question 21

hyponogogic/hypnopompic hallucinations

Answer 21

• upon falling asleep or awakening
• realistic awareness of presence of someone/something in the room
• possible visual, tactile, kinetic, auditory phenomena
• often associated with SLEEP PARALYSIS

40-80% of narcoleptics have this

Question 22

sleep paralysis

Answer 22

• inability to move/speak during onset of sleep or upon awakening
• muscular control regained within several minutes
• may occur in gen pop with sleep deprivation

40-80% of narcoleptics experience this

Question 23

prevalence of narcolepsy in US

Answer 23

1 in 2,000

• equal in men and women
• presents between ages of 15-30

Question 24

diagnosis of narcolepsy

Answer 24

• symptoms (cataplexy is diagnostic)
• overnight polysomnography
• –sleep fragmentation
• –short REM latency
• mean sleep latency test (MSLT)

Question 25

neurochemical basis of disease

Answer 25

90% of patients with narcolepsy with cataplexy have low HYPOCRETIN (orexin) levels in CSF

Question 26

genetic basis for narcolepsy

Answer 26

90% of narcoleptics with cataplexy have HLA DQB1 allele | ---also in 25% of gen pop without narcolepsy

Question 27

treatment for narcolepsy

Answer 27

- planned short naps, avoid sleep deprivation - avoid sedentary jobs wake promoting drugs - methylphenidate, dextrophetamine, methamphetamine - modafinil, armodafinil, sodium oxybate treatment of cataplexy - SSRIs - SNRIs (Serotonin-NE) - sodium oxybate

Question 28

non-REM parasomnias

Answer 28

- night terrors - sleep talking/walking - sleep related eating disorder - confusional arousal - sleep enuresis inappropriate release of instinctual behaviors

Question 29

REM parasomnias

Answer 29

- nightmare disorder | - REM behavior disorder

Question 30

timing of REM vs non-REM parasomias

Answer 30

REM: last few cycles (second half of the night) non-REM: first few cycles (last half of the night)

Question 31

sleep terror

Answer 31

- sudden cry or piercing scream - intense fear - eyes may be open, but cannot see parent - forget it happened the next day

Question 32

sleep walking

Answer 32

- sitting up or bolting from bed - eyes open with glassy stare - hard to arouse - routine/inappropriate behavior - amnesia of episode next day

Question 33

sleep related eating disorder

Answer 33

- involuntary eating and drinking during main sleep period - consumption of peculiar food - potential injury - morning amnesia

Question 34

neuronal level of explanation for REM parasomnias

Answer 34

- REM on neurons NOT active - ---do not inhibit pons - pons does not inhibit muscles (no sleep paralysis) - enact dreams

Question 35

REM behavior disorders have a strong association with _________

Answer 35

REM behavior disorders have a strong association with PARKINSONS

Question 36

insomnia

Answer 36

- difficulty initiating sleep or maintaining sleep - waking up too early - non restorative sleep - despite adequate sleep opportunity - associated with daytime impairment

Question 37

insomnia could be an early marker for _________

Answer 37

insomnia could be an early marker for DEPRESSION (or other psychiatric disease) -also high risk for alcohol abuse

Question 38

acute insomnia

Answer 38

- adjustment, transient, stress related | - temporally associated with identifiable stressor

Question 39

chronic insomnia

Answer 39

- psychophysiologic - idiopathic - paradoxical comorbid insomnia - due to mental disorder - due to drug/substance - due to medical condition

Question 40

psychophysiologic insomnia -- predisposing, precipitating, perpetrating factors

Answer 40

Predisposing factors - habitual light sleepers - episodic poor sleepers Precipitating factors - stress - environmental - life change Perpetuating factors -anxious concern over health and well being

Question 41

proper sleep hygeine

Answer 41

Proper sleep hygeine - standardized sleep/wake times - limit time awake in bed - remove bedroom clock - limit bright light exposure at night - avoid late evening exercise - limit naps - reduce/eliminate alcohol, caffeine, tobacco

Question 42

behavioral therapies (for insomnia)

Answer 42

- relaxation techniques - sleep restriction - paradoxical intension - biofeedback - circadian rhythm entrainment - CBT

Question 43

OTC meds for insomnia

Answer 43

- melatonin - antihistamines - analgesis - valerian root

Question 44

prescription meds for insomnia

Answer 44

- benzodiazepines - benzodiazepine receptor agonists - melatonin receptor agonists - sedating antidepressants - anticonvulsants - atypical antipsychotics