Sleep

Question 1

Two forces that impact sleep

Answer 1

• circadian rhythm

- sleep debt

Question 2

Three characteristics of NREM sleep

Answer 2

• decrease in muscle tone
• slow eye movements
• loss of alpha rhythm

Question 3

REM sleep

Answer 3

• muscle atonia
• rapid eye movement
• B waves like awake state

Question 4

Stages of wake –> sleep

Answer 4

1) wake
2) NREM 1-3/4
3) REM

Question 5

Longest stage of sleep

Answer 5

-Stage 2 NREM = 45-55%

followed by REM at 20-25%

Question 6

When does NREM sleep predominate?

Answer 6

-NREM first 2/3 of night; REM last 1/3

Question 7

Adult criteria for OSA:

Answer 7

• more than 90% decrease in airflow
• event lasts 10 seconds or greater
• continued respiratory effort

Question 8

Child criteria for OSA:

Answer 8

same as adult except timing= 2 breath cycles

Question 9

Most common complaint assc with OSA in adults

Answer 9

daytime sleepiness

Question 10

Way to improve patient compliance with CPAP

Answer 10

-will increase libido

Question 11

Med types for OSA

Answer 11

• antidepressants
• nasal steroids
• stimulants

Question 12

Three common secondary causes of Hypersomnolence

Answer 12

• OSA
• PLMD
• Narcolepsy

Question 13

Common primary causes of hypersomnolence

Answer 13

• inadequate sleep
• drugs
• chronobiologic

Question 14

Cause of narcolepsy

Answer 14

-2 hit hypothesis

genetic predisposition, environmental trigger

Question 15

Definition narcolepsy

Answer 15

-excessive daytime sleepiness + abnormal REM sleep

Question 16

Diagnostic criteria for Type 1 narcolepsy:

Answer 16

1) excess need to sleep during daytime for at least 3 months
2) cataplexy, sleep latency less than 8 mins, 2 + SOREMP

… or low hypocretin 1 in CSF

Question 17

Common precipitant of cataplexy in children

Answer 17

-anticipation of a reward

Question 18

Define cataplexy

Answer 18

Sudden loss of muscle tone with retained consciousness

Question 19

Diagnostic criteria for Type 2 narcolepsy:

Answer 19

Type 1 minus cataplexy

symptoms not better explained by other causes

Question 20

Location of hypocretin

Answer 20

perifronical cells of the posterior hypothalamus

Question 21

Function hypocretin 1

Answer 21

stimulates wakefulness and suppresses REM sleep

Question 22

Three REM phenomenon that protrude into wakefulness in narcolepsy

Answer 22

hallucinations
sleep paralysis
cataplexy

Question 23

Three treatments for sleepiness in narcolepsy

Answer 23

• modafinal
• amphetamines
• atomoxetine

Question 24

Treatment for cataplexy

Answer 24

sodium oxybutate

SSRIs

Question 25

Parasomnias assc with REM

Answer 25

• REM behavior disorder

- Sleep related painful erections

Question 26

Define somniloquy

Answer 26

Sleep talking

Question 27

What causes REM behavior disorder?

Answer 27

-loss of REM atonia

Question 28

Acute Causes of REM behavior disorder:

Answer 28

• ETOH w/draw
• nitrazepam withdraw
• biperiden intoxication

Question 29

Disease states assc with chronic REM behavior disorder:

Answer 29

• narcolepsy
• NPH
• extrapyramidal, mitochondrial disease

Question 30

NREM parasomnias

Answer 30

• confusional arousals
• sleep walking
• sleep terrors

Question 31

When are NREM parasomnias most common?

Answer 31

-most common in first third of night

Question 32

Symptom MOST specific for narcolepsy?

Answer 32

-cataplexy

Question 33

Drug that treats both cataplexy and daytime sleepiness?

Answer 33

-sodium oxybutate

Question 34

DRug Treatment of enuresis

Answer 34

TCAs (imipramine) or desmopressin