psych sleep disorders

Question 1

how long is a cycle of sleep?

Answer 1

approx every 90 min, NREM sleep alernates with REM sleep;

Question 2

progression through NREM

Answer 2

results in slower brain wave patterns and hgiher arousal thresholds

Question 3

REM sleep brain wave pattern

Answer 3

resembles the EEG of an aroused person

Question 4

vivid dream recall

Answer 4

assoc with awakening from REM sleep

Question 5

dysomnias

Answer 5

insufficient, excessive, or altered timing of sleep

Question 6

parasomnias

Answer 6

unusual sleep-related behaviors

Question 7

primary insomnia

Answer 7

difficulty initiaing sleep (sleep onset insomnia), freq nocturnal awakenings (middle of the night or sleep maintenance insomnia)early morning awakenings (late night or sleep offset insomnia); waking up feeling fatigued (nonrestorative sleep)

Question 8

acute insomnia

Answer 8

between 1 and 4 weeks; usually assoc with stress and resolves spontaneously

Question 9

chronic insomnia

Answer 9

more than 4 weeks; assoc with reduced quality of life and increased risk of psych illness

Question 10

dsm criteria for dyssomnias

Answer 10

difficulty initiating or maintaining sleep or nonrestorative sleep for at least 1 mo

Question 11

treatment for dyssomnias

Answer 11

sleep hygiene measures; CBT; benzos, non-benzo sedatives, antidepressants

Question 12

benzos used for dyssomnias

Answer 12

reduce sleep latency and nocturnal awakening; side effects incl development of tolerance, addiction, daytime sleepiness, and rebound insomnia

Question 13

non-benzos used for dyssomnias

Answer 13

zolpidem (ambien), eszopiclone (Lunesta), and zaleplon (sonata); effective for short-term treatment; assoc with low incidence of daytime sleepiness or orthostatic hypotension

Question 14

zolpidem in the elderly

Answer 14

increased risk of falls and may induce cognitive impairment

Question 15

antidepressants used for dyssomnias

Answer 15

trazadone, amitrytpiline, and doxepin (off-label use)

Question 16

most prescribed sedating antidepressant for patients with chronic insomnia and depressive sx

Answer 16

trazadone

Question 17

morning headaches

Answer 17

can be a sign of OSA

Question 18

narcolepsy tetrad

Answer 18

excessive daytime sleepiness or seep attacks plus REM-related sleep phenomena incl inability to move during transition from sleep to wake, hypnagogic or hypnopompic hallucinations; or a sudden loss of muscle tone evoked by strong emotion

Question 19

cataplexy

Answer 19

sudden loss of muscle tone evoked by strong emotion without loss of consciousness

Question 20

cataplexy occurs in what percent of people dx with narcalepsy

Answer 20

60-80 percent

Question 21

treatment for narcolepsy

Answer 21

daytime naps; get at least 8 hrs of sleep; pharm treatment may incl stimulants and antidepressants

Question 22

modafinil

Answer 22

stimulant effective in the treatment of narcolepsy

Question 23

sodium oxybate

Answer 23

treats narcolepsy, and is particularly effective in the treatment of cataplexy

Question 24

narcolepsy features

Answer 24

irresistible attacks of refreshing sleep that occur daily for at least 3 mos; cataplexy; hallucinations and/or sleep paralysis at the beginning or end of sleep episodes

Question 25

pathophy of narcolepsy

Answer 25

loss of hypothalamic neurons that contain hypocretin; may have autoimmune component

Question 26

treatment for narcolepsy

Answer 26

sleep hygiene; scheduled daytime naps; avoidance of shift work; amphetamines, other stimulants

Question 27

treatments for cataplexy

Answer 27

sodium oxybate (drug of choice); TCAs; SSRIs, SSNRIs

Question 28

idiopathic hypersomnia

Answer 28

excessive daytime sleepiness, prolonged nocturnal sleep episodes, and freq irresistible urges to nap; can be mild or as debilitating as narcolepsy

Question 29

Kleine-Levin syndrome

Answer 29

rare disorder characterized by recurrent hypersomnia with episodes of daytime sleepiness with hyperphagia, hypersexuality, and aggression

Question 30

Circadian rhythm sleep disorders

Answer 30

caused by either intrinsic defects in the circadian pacemaker or imapired entrainment (absence of light)

Question 31

subtypes of circadian rhythm sleep disorder

Answer 31

delayed sleep phase disorder, shift-work disorder, and jet lage disorder

Question 32

parasomnias

Answer 32

abnormal behaviors or experiences that occur during sleep and are often assoc with sleep disruption; sx may include abnormal emotions, movements, dreams, and autonomic activity; common in childhood and adolescence

Question 33

sleepwalking

Answer 33

simple to complex behaviors that are initiated in slow wave sleep and result in walking during sleep

Question 34

what dose a sleepwalker look like?

Answer 34

eyes are open with a glassy look; difficulty arousing the sleepwalker during an episode; confusion on awakening, amnesia for episode; episodes usually end with patients returning to bed or awakening confused or disoriented

Question 35

sleepwalking occurs more often in kids with wha?

Answer 35

obstructive sleep apnea

Question 36

risk factors for sleep walking

Answer 36

sleep deprivation, irreg sleep schedules, stress, hyperthyroidism, OSA, seizures, migraines, meds, magnesium def

Question 37

which meds can increase risk of sleep walking

Answer 37

sedatives/hypnotics, lithium, and anticholinergics

Question 38

treatment for sleep walking

Answer 38

refractory cases may respond to clonazepam or other benzos or TCA

Question 39

sleep terrors

Answer 39

episodes of sudden arousal with screaming from slow wave sleep; sympathetic hyperactivation; after episode, patient returns to sleep without awakening; usually amnestic about episode;

Question 40

slow wave sleep

Answer 40

stages 3 and 4 on nonREM

Question 41

risk factors for sleep terrors

Answer 41

fever, nocturnal asthma, GERD, sleep deprivation, CNS-stimulating medications; other sleep disorder such as sleep apnea

Question 42

treatment for night terrors

Answer 42

reassurance that the condition is benign and self-limited; consider low dose short acting benzos in adults with refractory cases; sleep hygeine and psychotherapy

Question 43

nightmare disorder

Answer 43

recurrent frightening dreams that tend to terminate in awakening with vivid recall; no confusion or disorientation upon awakening; can lead to signif stress and anxiety

Question 44

treatment for nightmare diosorder

Answer 44

imagery rehearsal therapy (IRT) involves the use of mental imagery to modify the outcome of a recurrent nightmare; sever cases may benefit from antidepressants

Question 45

REM sleep behavior disorder

Answer 45

muscle atonia during REM slep and complex motor activity assoc with dream mentation (dream enactment); presenting complaint is usually violent behaviors during sleep

Question 46

risk factors for REM sleep behavior disorder

Answer 46

older age (between 60 and 70); psych meds like TCAs, SSRIs, and MAOIs; narcolepsy; brain stem lesions; dementis like olivopontocerbellar atrophy and diffuse lewy body disease

Question 47

treatment for REM sleep behavior disorder

Answer 47

clonazepam is effective in most patients; other agents incl imipramine, carbamazepine, pramipexole, or levodopa

Question 48

first line therapy from chronic insomnia

Answer 48

CBT

Question 49

the best reason to put a patient on longterm benzos

Answer 49

insomnia

Question 50

REM sleep autonomic

Answer 50

increae in bp, hr, and resp rate; this is counterintutive

Question 51

hypnagogic hallucination

Answer 51

when transitioning to sleep

Question 52

hypnopompic hallucination

Answer 52

when transitioning FROM sleep

Question 53

what part of the brain coordinates the 24 hour or circadian rhythmicity

Answer 53

SCN in the hypothalamus

Question 54

best treatment forrecurrent nightmares in PTSD

Answer 54

imagery rehearsal therapy