sleep

Question 1

insomnia 1st line

Answer 1

CBT

Question 2

insomnia short term ttx

Answer 2

benzos 4-8 wks

Question 3

benzo on sleep

Answer 3

lower sleep latency

lower nighttime awakenings

Question 4

benzo se

Answer 4

rebound insomnia
dependence
tolerance
daytime sleepiness
elderly confusionn/dizzy/fall

Question 5

sleep med for shorterm, and lower daytime sleepiness and lower orthohypotension

Answer 5

nonbenzo

zolpidem,zaliplone,ezoplicolone,melatonin,suvorexant

Question 6

causes falls/cognitive impairment in elderly and cognitive impairment in women at higher dose than 10mg

Answer 6

zolpiDEM

Question 7

off-label used for sleep

Answer 7

trazadone, mirtazepine, doxepin

Question 8

mc used depression + sleep prob

Answer 8

trazadone

Question 9

causes of hyper somnolence disorder

Answer 9

viral-IM,GB,Pneumonia,HIV
head trauma
AD genetics

Question 10

ttx of hypersomnolence disorder

Answer 10

first line: modafinil, methylphenidate
2nd line: atomoxetine,

pitolisant
sodium oxybate
scheduled napping

Question 11

least addictive of drugs to help stay awake

Answer 11

atomoxetine

Question 12

moa modafinil

Answer 12

increase dopamine–>more orexin+histamine–>more wakefulnes

Question 13

moa sodium oxybate

Answer 13

GHB (ghb–>gaba) unknown why

Question 14

moa methylphenidate

Answer 14

stop net dat

Question 15

moa pitolisant

Answer 15

h3 –>increased histamine–>wakefulness

Question 16

what leads to wakefulness

Answer 16

dopamine
seratonin-raphe
ne -lc
cholinergic- pontine tegmentum
glutamate
(ARAS)

histamine-posterior hypothal, tuberomammilary nucleus

orexin/hypocretin-lateral hypothalamus

Question 17

narcolepsy CSF

Answer 17

low orexin/hypocretin

Question 18

narcolepsy polysomnograph

Answer 18

reduced rem sleep latency

Question 19

narcoleptic catalepsy ttx

Answer 19

1st line: sodium oxybate

others: pitolisant, atomoxetine, dulox, venlafax, fluox
tca-imipramine, desipramine, clomipramine

Question 20

REM suppression drugs

Answer 20

ssri, snri: fluoxetine, duloxetine, venlafaxine

Question 21

central sleep apnea breathing pattern

Answer 21

chyne stokes crescendo descrescendo

Question 22

central sleep apnea cause

Answer 22

idopathic
or
opioid use

Question 23

ttx obstructive sa vs central sa

Answer 23

osa: cpap/bipap, tonsilelctomy, stimulation
csa: cpap/bipap, o2 supp, acetazolamide, theophyline

Question 24

ttx for delayed sleep phase disorder (of circadian rhythm disorders)

Answer 24

melatonin
bright light
chronotherapy

Question 25

ttx advanced sleep phase

Answer 25

phototherapy

Question 26

ttx shiftwork

Answer 26

modafinil | phototherapy

Question 27

medications that can cause SLEEPWALKING

Answer 27

anticholinergics, sedative hypnotics, lithium | other causes=family history, Obstructive sleep apnea, nocturnal seizures

Question 28

association with REM sleep behavior disorder

Answer 28

PARKINSONS LEWY BODY DEMENTIA ssri, snri, beta blockers,tca narcolepsy

Question 29

ttx of rem sleep behavior disorder

Answer 29

clonazepam | melatonin

Question 30

Restless leg syndrome causes

Answer 30

``` iron def anemia dopamine blocking antiemetics antipsychotics antidepressnats antihistamine ```

Question 31

ttx restless leg syndrome

Answer 31

dopamine agonist + benzo = 1st line gabapentin, pregabalin low potency opioids