neuro13

Question 1

difference between REM and nonREM sleep

Answer 1

REM has atonia of all skeletal muscles other than extraocular muscles and the diaphragm

Question 2

EEG is stage 1 of nonREM sleep

Answer 2

attenuation of the posterior dominant background rhythm

Question 3

EEG in stage 2 nREM sleep

Answer 3

sleep spindles and K complexes

Question 4

EEG in stage 3 nonREM sleep

Answer 4

aka deep or slow wave sleep; characterized by a background that consists of more than 20% in the delta frequency range

Question 5

a typical night of sleep

Answer 5

4 to 6 cycles lasting approx 90 mins each, with an orderly progression between stages; REM acounts for a greater percentage of sleep as the night progresses; REM sleep decreases with age

Question 6

benzos effect on sleep

Answer 6

suppress stage 3 nonrem

Question 7

antidepressants and alcohol effect on sleep

Answer 7

suppress REM sleep

Question 8

polysomnography consists of what?

Answer 8

EEG, electrooculography to monitor eye movements; EMG attached to chin and legs, transducers to measure airflow and chest movements, pulse ox, and ECG

Question 9

circadian rhythm driven by what

Answer 9

suprachiasmic nuc in the hypothalamus, with input from melatonin produced by the pineal gland

Question 10

advanced sleep-phase disorder

Answer 10

patients sleep or awaken earlier than they desire

Question 11

delayed sleep-phase disorder

Answer 11

sleep onset is delayed until early morning with consequent awakening later than desired

Question 12

treatments for sleep phase disorders

Answer 12

bright light therapy and melatonin

Question 13

restless leg syndrome

Answer 13

crawling sensation in the legs when they are still, relieved when they are moved

Question 14

lab studes in patients with restless leg syndrome

Answer 14

loo for iron deficiency;

Question 15

treatment of choice for restless leg syndrome

Answer 15

dopaminergic agents; ropinirole and pramipexole are preferred to levadopa; given half hour before the anticipated start ofsymptoms and then every 2-3 hours after that

Question 16

augmentation

Answer 16

the occurance of RLS symptoms earlier in the day in response to dopamine agonists

Question 17

four components of the narcolepsy/cataplexy syndrome

Answer 17

excessive daytime sleepiness with narcolepsy; sleep paralysis; cataplexy; and hypnagogic hallucinations

Question 18

cataplexy

Answer 18

sudden loss of muscle tone, often in the setting of laughter or other strong emotion

Question 19

hypnagogic hallucinations

Answer 19

occur mmediately upon falling asleep

Question 20

pathophys of narcolepsy/cataplexy

Answer 20

loss of hypocretin-secreting neurons in the hypothal

Question 21

diagnostic for narcolepsy/cataplexy

Answer 21

CSF hypocretin level less than 110 pg/mL

Question 22

multiple sleep latency test

Answer 22

another way to diagnose narcolepsy/cataplexy syndrome; involves several short naps with monitoring of latency to sleep and latency to REM

Question 23

diagnostic for narcolepsy/cataplexy on MSLT

Answer 23

sleep latency of less than 8 min with more than 2 episdes of REM at sleep onset

Question 24

treatment of narcolepsy

Answer 24

amphetamines like methylphenidate and dextroamphetamine; modafinil is agent of choice

Question 25

treatment of cataplexy

Answer 25

TCAs like clomipramine and other antidepressants like fluoxetine and venlafaxine and the GABA metabolite sodium oxybate

Question 26

parasomnias

Answer 26

abnormal behaviors that occur during sleep or sleep-wake transition

Question 27

confusional arousals

Answer 27

type of parasomnia where patients awaken with disorientation, slow speech, and incorrdination

Question 28

sleep terrors

Answer 28

rapid awakening from sleep with fearful behavior and are assoc with autonomic hyperactivty like facial flushing, diaphoresis, and tachycardia

Question 29

somnambulism

Answer 29

interruption of sleep by a variety of complex motor activities, including not only walking but also dressing, driving, or eating

Question 30

Nightmares

Answer 30

arise from REM sleep, unlike night terrors

Question 31

sleep paralysis

Answer 31

perception of being unable to move usually on awakening

Question 32

REM behavior disorder

Answer 32

loss of the normal skeletal musclle atonia during REM, with associated acting out of dreams

Question 33

patients with REM behavior disorder are at increased risk of developing what

Answer 33

Parkinson disease; Lewy body dementia; or multiple system atrophy

Question 34

treatment for REM behavior disorders like nightmares, sleep paralysis, REM behavior disorder

Answer 34

Clonazepam administered at bedtime

Question 35

clonazepam

Answer 35

a benzo

Question 36

nocturnal cramps treatment

Answer 36

quinine most effective; other meds include gapapentin, oxcarbazepine, and diphenhydramne

Question 37

somniloquy

Answer 37

unintelligible mumbling during sleep, which can be provoked by talking to the patient

Question 38

sleep starts or hypnotic jerks

Answer 38

myoclonic jerks that occur with sleep onset

Question 39

bruxism

Answer 39

teeth grinding during sleep; treatment of underlying dental abnormalities or use of a biteplate

Question 40

obstructive sleep apnea

Answer 40

morning headaches; diagnosied on PSG of a combo of more than five apnea, hypopneas, or respiratory related arousals per night

Question 41

apnea

Answer 41

resp pause of at least 10 sec

Question 42

hypopnea

Answer 42

pauses with a reduction of 50% or more in airflow

Question 43

standard treatment for obstructive sleep apnea

Answer 43

CPAP

Question 44

treatment for insomnia

Answer 44

melatonin, antihistamines, benzos, zolpidem, zaleplon