12-4

Question 1

Diagnostic tool to differentiate Sleep-Wake Disorders

Answer 1

An interview is conducted and often followed by polysomnography

Question 2

Measuring a variety of physiological parameters including brain waves, muscle contractions, breathing, etc. during sleep

Answer 2

Polysomnography

Question 3

Difficulty initiating or maintaining sleep for >3 mos

Answer 3

Insomnia Disorder

Question 4

Using bed only to sleep improves what?

Answer 4

Sleep hygiene

Question 5

Treatment for Insomnia Disorder that induces sleep and increases sleep duration but only for short-term use

Answer 5

Sedatives (Benzodiazepines like diazepam)

Question 6

What are the long-term side effects of sedatives to treat Insomnia?

Answer 6

Poor sleep quality; decrease slow wave (N3) and REM

Tolerance and withdrawal

Question 7

Benzodiazepine-like drug(s) with fewer side effects used to treat Insomnia

Answer 7

Ex: Zolpidem

Question 8

Excessive sleepiness despite sufficient sleep (7+ hrs) for >3mos

Answer 8

Hypersomnolence Disorder

Question 9

What is the neuropathology of Hypersomnolence Disorder?

Answer 9

Unknown etiology (idiopathic form)

Exclude other causes (ex: narcolepsy)

Question 10

What treatment method is used for Hypersomnolence Disorder?

Answer 10

Stimulants that promote wakefulness (ex: Modafinil)

Question 11

Recurrent irresistible sleep occurring within the same day, several times per week for >3mos

Answer 11

Narcolepsy

Question 12

A form of narcolepsy that causes sudden loss of muscle tone while awake, an aberrant manifestation of REM sleep

Answer 12

Cataplexy

Question 13

Autoimmune-related hypothalamic neuropeptide deficiency (Narcolepsy)

Answer 13

Hypocretin (Orexin) deficiency

Question 14

Short REM-sleep latency (sleep onset REM) during Narcolepsy

Answer 14

Nocturnal PSG

Question 15

Short REM-sleep latency AND short sleep-onset latency during Narcolepsy

Answer 15

Daytime PSG (Multiple Sleep Latency Test)

Question 16

Stimulants for somnolence

Antidepressants for cataplexy

Answer 16

Narcoleptic Polytherapy Treatment

Question 17

Treats cataplexy AND somnolence (ex: Xyrem AKA GHB)

Answer 17

Narcoleptic Monotherapy Treatment

Question 18

Episodes of breathing cessation/reduction due to upper airway obstruction

Answer 18

Obstructive Sleep Apnea Hypopnea

Question 19

Why do apnea’s/hypopneas cause sleepiness?

Answer 19

Rise in CO2 during apnea’s cause temp arousal (not awaken) bumping from deep to light stage of sleep

Duration adequate but sleep unrefreshing

Question 20

Device that maintains an open airway by delivering compressed air at specific air pressure to the mask’s nasal pillow

Answer 20

Continuous positive airway pressure

Question 21

Multiple episodes of cessation of breathing per night caused by CNS dysregulation of breathing

Answer 21

Central Sleep Apnea

Question 22

How does PSG distinguish OSA and CSA?

Answer 22

Whether thoracic movements occur at the start of apneic episodes

OSA (thoracic efforts)
CSA (no thoracic efforts)

Question 23

What is the treatment for CSA?

Answer 23

Varies depending on cause (ex: respiratory stimulants acetazolamide, nocturnal oxygen)

Question 24

Excessive sleepiness or insomnia resulting from mismatch b/n person’s circadian sleep-wake pattern and environmental sleep-wake schedule

Answer 24

Circadian Rhythm Sleep-Wake Disorder

Question 25

Delayed sleep onset and awakening times, with the inability to fall asleep and awaken at a desired earlier time

Answer 25

CRSWD, Delayed sleep phase type

Question 26

Phototherapy at strategic times during day to adjust timing of sleep-wake cycle

Answer 26

CRSWD treatment

Question 27

Disorders characterized by abnormal behaviors associated with slee

Answer 27

Parasomnias

Question 28

Repeated episodes of incomplete awakening from sleep with sleep walking OR sleep terrors

Answer 28

Non-REM sleep arousal disorder

Question 29

Abrupt terror arousals with panicky scream, intense fear and autonomic arousal, unresponsive to comforting

Answer 29

Sleep terrors

Question 30

Rising from bed and walking about with a blank and staring face, relative unresponsive, and difficulty awakening

Answer 30

Sleep walking AKA somnambulism

Question 31

Characterized by: Episodes occuring within first ⅓ of sleep (slow wave sleep) No (or little) dream imagery Amnesia during episodes

Answer 31

Non-REM Sleep Arousal Disorder

Question 32

What is the treatment for Non-REM sleep arousal disorder?

Answer 32

Benzodiazepines to decrease slow wave sleep

Question 33

Extremely dysphoric dreams that typically involve threats to survival, security or physical integrity

Answer 33

Nightmare Disorder

Question 34

Characterized by: Awakening during REM Rapid alertness upon awakening Dream content remembered Good recall of awakening the next morning

Answer 34

Nightmare Disorder

Question 35

What is treatment for Nightmare Disorder?

Answer 35

Antidepressants to decrease REM

Question 36

Vocalization and/or complex motor movements during REM Action-filled violent dreams Immediately awake, oriented and alert with detailed dream recall

Answer 36

REM Sleep Behavior Disorder

Question 37

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

Answer 37

Neurodegenerative (ex: Parkinson’s, Levy body dementia)

Question 38

Treatment for REM Sleep Behavior Disorder

Answer 38

Clonazepam (benzodiazepine) Modification of sleep environment

Question 39

Urge to move legs in response to uncomfortable sensations that occurs/worsens during inactivity, nocturnal worsening of symptoms, and temporary relief from discomfort by moving Aware of symptoms and complains of insomnia

Answer 39

Restless Legs Syndrome

Question 40

Treatment for Restless Legs Syndrome

Answer 40

Anti-Parkinson’s drugs to increase dopamine (ex: benzo’s, anticonvulsants)

Question 41

Repetitive muscle contractions during sleep, usually lower limb Multiple sleep stage arousals Complains of daytime sleepiness but unaware of movements

Answer 41

Periodic Limb Movements

Question 42

Treatment for Periodic Limb Movements

Answer 42

Anti-Parkinson’s drug to increase dopamine (ex: benzo’s, anticonvulsant)