Insomnia

Question 1

Clinical Formulation (7 Categories)

Answer 1

Sleep History
Sleep Diary
Self Report Measures
PPP
Lifespan Issues
Comorbidity
Daytime Functioning

Question 2

Medical Contributors to Insomnia (7)

Answer 2

Lung disease
Chronic pain
Renal failure
Parkinson's
Congestive heart failure
Coronary artery disease
Medication use

Question 3

Cannot diagnose insomnia if comorbid with… (5)

Answer 3

sleep-related breathing disorder
periodic limb movement disorder and restless legs syndrom
circadian rhythm disorders
parasomnias
narcolepsy

Question 4

Is PSG necessary?

Answer 4

Not need for diagnosis (based on self-report)
PSG not recommended for routine assessment
Used if diagnosis uncertain or treatment fails, or if sleep apnea, PLMD, or paradoxical insomnia are suspected

Question 5

How is actigraphy in insomnia?

Answer 5

not well validated in insomnia patients
not indicated for routine diagnosis, assessment, or treatment
can be useful screening tool

Question 6

What to assess for daytime functioning? (4)

Answer 6

Fatigue
Mood
Quality of Life and Function
Sleepiness

Question 7

Examples of Fatigue Measures (2)

Answer 7

Multidimensional Fatigue Inventory

Fatigue Severity Scale

Question 8

Examples of Mood Measures (3)

Answer 8

Inventory of Depressive Symptomatology
Beck Depression Inventory-II
State Trait Anxiety Inventory (STAI)

Question 9

Examples of Quality Measures (1)

Answer 9

SF-36

Question 10

Examples of Sleepiness Measures (3)

Answer 10

Stanford Sleepiness Questionnaire
Epworth Sleepiness Questionnaire
Multiple Sleep Latency Test (MSLT)

Question 11

Fatigue vs Sleepiness (def.)

Answer 11

fatigue: subjective feeling of physical/mental weariness
sleepiness: actual tendency to sleep

Question 12

Is fatigue necessarily associated with increased sleep propensity?

Answer 12

No

Question 13

What is and is not the common compliant among insomnia patients?

Answer 13

Fatigue is the common complaint, not sleepiness

Question 14

Is there a significant difference in MSLT between controls and individuals with insomnia?

Answer 14

No

Question 15

What does the graph for sleepiness over the day look like?

Answer 15

W-shaped

Question 16

PPP Model (3)

Answer 16

predisposing
precipitating
perpetuating

Question 17

Psychiatric assessment of comorbidity (eg)

Answer 17

Structured Clinical Interview for Diagnosis (SCID-IV)

Question 18

Medical assessment of comorbidity (3)

Answer 18

interview
physical examination
questionnaires (eg. Cornell Medical Checklist)

Question 19

Patients in insomnia tend to __________ their SOL

Answer 19

overestimate

Question 20

Patients with insomnia tend to _________ their TST

Answer 20

underestimate

Question 21

The puzzle is ubiquitous across…

Answer 21

subtypes, instruments, contexts, mutliple nights

Question 22

When woken up during different stages in sleep, insomnia patients are more likely to report that…

Answer 22

they had been awake the moment just before they were woken

Question 23

Paradoxical Insomnia: diagnosti criteria (3)

Answer 23

1) meet criteria for insomnia
2) one of:
a) reports little or no sleep
b) mismatch of PSG and sleep diary
3) one of:
a) reports almost constant awareness of the environment across the night
b) conscious thoughts or rumination throughout the night

Question 24

Indivduals with sleep state misperception represent _________________ of a continuum

Answer 24

only one extreme

Question 25

Does the tendency to misperceive sleep preclude the presence of a real sleep deficit?

Answer 25

No, it can be a mechanism that escalates insomnia

Question 26

Transition of wakefulness to sleep is marked by: (3)

Answer 26

progressive loss of consciousness reduction of stimulus reception absence of memory (exact point is elusive)

Question 27

Time seems ________ when the number of units of information processed per unit of time increases

Answer 27

longer

Question 28

Many patients with insomnia report that they ______ when they cannot get to sleep

Answer 28

worry

Question 29

People with insomnia exhibit more_____ frequency EEG (in the _____ to _____ range) at or around sleep onset and during NREM sleep

Answer 29

high frequency (cortical arousal) Beta Gamma

Question 30

How does cortical arousal contribute to sleep mispecreption?

Answer 30

By reducing the differentiation between sleep and wakefulness

Question 31

Sleep is controlled by a "switch" between: (2)

Answer 31

VLPO (during sleep) | Arousal system

Question 32

VLPO

Answer 32

ventrolateral preoptic nucleus

Question 33

Relationship between VLPO and arousal system

Answer 33

VLPO is fully activated during sleep but unable to flip off the arousal system because it's being excited intensely by the limbic system

Question 34

Possible resolutions to misperception of insomnia: (9)

Answer 34

1) The challenge of the context 2) An artefact of sleep onset definition? 3) A deficit in time estimation ability? 4) Worry 5) Selective attention 6) memory bias 7) cortical arousal 8) brief arousals 9) balance of neuronal systems