Sleep Wake

Question 1

Briefly describe NREM sleep

Answer 1

• slower brain waves on EEG

- harder to arouse

Question 2

Briefly describe REM sleep

Answer 2

• faster waves on EEG
• atonia, eye movements
• lower arousal threshold
• waking during REM= memory of dreams
• higher HR, BP, RR

Question 3

Two types of sleep disorders

Answer 3

• parasomnia: unusual sleep-related behavior

- dyssomnia: insufficient/excessive/altered sleep

Question 4

MC sleep related disorders

Answer 4

-assc with breathing OSA/CSA

Question 5

When should insomnia disorder be ruled out?

Answer 5

If it is part of another psych disorder (ie anxiety)

Question 6

Contrast acute and chronic insomnia disorder

Answer 6

• acute: less than 3 months

- chronic: more than 3 months

Question 7

Treatment for insomnia

Answer 7

• CBT

- Benzos, Z drugs, antidepressants

Question 8

What antidepressants are used in the treatment of insomnia

Answer 8

• mirtazapine
• trazadone
• amitryptiline, doxepin

Question 9

What are the three Z drugs?

Answer 9

• zaleplon (sonata)
• zolpidem (ambien)
• eszopiclone (lunesta)

Question 10

Risk assc with zolpidem

Answer 10

more than 10mg can cause increased cognitive impairment in women

Question 11

Effects of zolpidem in eldery

Answer 11

falls + cog impairment

Question 12

In what ways are Z drugs better than benzos?

Answer 12

-lower incidence of orthostatic hypotension and daytime sleepiness

Question 13

Hypersomnolence disorder description

Answer 13

excessive daytime sleepiness despite getting 7+ hours of sleep

Question 14

Causes of hypersomnolence disorder

Answer 14

• viral infections
• head trauma
• genetic

Question 15

Treatment for hypersomnolence disorder

Answer 15

-modafinil
-stimulants
-atomextine
(+/- scheduled naps)

Question 16

Dx of OSA

Answer 16

• excessive daytime sleepiness

- apneic episodes (more than 15/hour)

Question 17

CSA causes

Answer 17

• idiopathic
• with Cheyne Strokes Breathing
• assc with opioid use

Question 18

Describe Cheyne Strokes breathing

Answer 18

• periodic crescendo decrescendo breathing

- heart/renal failure, stroke, DKA assc

Question 19

Sleep related hypoventilation:

• polysomnography finding
• common physical complaint

Answer 19

• poly: descreased breathing, elevated CO2

- morning headaches

Question 20

What is the narcolepsy tetrad?

Answer 20

• daytime sleepiness
• hallucinations (hypnogognic/pompic)
• cataplexy
• REM related parasomnias

Question 21

CSF finding in Narcolepsy?

Answer 21

-low hypocretin

Question 22

Cause of narcolepsy

Answer 22

loss of hypothalamic neurons +/- autoimmune component

Question 23

Treatment of daytime sleepiness in narcolepsy

Answer 23

• modafinil, methylphenidate, sodium oxybate

- amphetamines

Question 24

Treatment of cataplexy in narcolepsy:

Answer 24

• sodium oxybate
• TCAs
• SSRIs
• SNRIs

Question 25

What is the DOC for cataplexy, which also treats daytime sleepiness?

Answer 25

-sodium oxybate

Question 26

Sleep disorder assc with recurrent patterns of sleep disruption due to alteration between circadian rhythym and individuals environment/work schedule

Answer 26

-circadian rhythm sleep wake disorders

Question 27

Part of brain responsible circadian rhythym

Answer 27

suprachiasmatic nucleus

Question 28

Non-REM sleep arousal D/O: | characteristics

Answer 28

-non-conscious arousal during first third of sleep leading to sleep walking/ sleep terrors

Question 29

How to treat refractory cases of sleep walking

Answer 29

-low dose BDZ

Question 30

Are sleep terrors remembered?

Answer 30

No, occur during NREM sleep

Question 31

Autonomic signs of sleep terrors

Answer 31

- tachycardia - tachypnea - diaphoresis - mydriasis

Question 32

Nightmare D/O treatment

Answer 32

- desensitization/imagery rehearsal therapy | - prazosin/SSRIs if assc with PTSD

Question 33

REM sleep behavior disorder cause

Answer 33

loss of muscle atonia during REM sleep

Question 34

Coniditions assc with sleep behavior disorder

Answer 34

- neurodegenerative disorders - parkinsons - lewey body - multiple systems atrophy

Question 35

Treatment of REM sleep behavior d/o

Answer 35

- clonazepam | - melatonin

Question 36

Screen for _____ always in restless leg

Answer 36

- iron deficiency anemia | - drug related cause

Question 37

First line treatment for RLS

Answer 37

- dopamine agonists | - BDZ