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A. Block D Neurology > Sleep and its disorders > Flashcards

Sleep and its disorders Flashcards

1
Q

Does sleep affect a specific age group?

A
  • no
  • can affect all ages
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2
Q

There is rapid eye movement (REM) and non-REM sleep. Non-REM can be subdivided into 4 stages 1-4. Which of these stages are involuntary twitches common?

1 - stage 1
2 - stage 2
3 - stage 3
4 - stage 4

A

1 - stage 1

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3
Q

There is rapid eye movement (REM) and non-REM sleep. Non-REM can be subdivided into 4 stages 1-4. Which of these stages is all muscle tone lost?

1 - stage 1
2 - stage 2
3 - stage 3
4 - stage 4

A

2 - stage 2
- except eye movements and middle ear muscles

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4
Q

There is rapid eye movement (REM) and non-REM sleep. Non-REM can be subdivided into 4 stages 1-4. Stages 3-4 are our deeper sleep. Which of the following waves are common in stages 3 and 4?

1 - delta
2 - theta
3 - alpha
4 - beta
5 - gamme

A

1 - delta

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5
Q

When looking at our 1st sleep cycle, does this move from stage 1 through to REM?

A
  • yes
  • lasts around 90-120 minutes
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6
Q

Following the initial sleep cycle, which of the following stages do all subsequent sleep cycles go through in around 90-120 minutes?

1 - stage 1 to REM
2 - stage 2 to REM
3 - stage 3 to REM
4 - stage 4 to REM

A

2 - stage 2 to REM

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7
Q

Which gland secretes melatonin which is important in circadian rhythm and sleep?

1 - anterior pituitary gland
2 - posterior pituitary gland
3 - pineal gland
4 - parathyroid gland

A

3 - pineal gland

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8
Q

Which key nucleus in the brain is responsible for governing the circadian rhythm?

1 - thalamic nucleus
2 - basal ganglia nucleus
3 - sensory nuclei
4 - suprachiasmatic nucleus

A

4 - suprachiasmatic nucleus
- part of hypthalamus

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9
Q

Are we able to modulate our circadian rhythm?

A
  • yes
  • can use photic inputs and non-photic inputs
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10
Q

Do older or younger people sleep more?

A
  • younger people
  • REM decreases as we age by 0.6% per decade
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11
Q

Is sleeping useful for consolidating memories?

A
  • yes
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12
Q

Sleeping is important for consolidating memories. Which part of the brain does this primarily occur in?

1 - basal ganglia
2 - hippocampus
3 - thalamus
4 - suprachiasmatic nucleus

A

2 - hippocampus

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13
Q

From a brains perspective, which of the following are benefits of sleeping?

1 - Learning and memory consolidation
2 - Synaptic modification in the hippocampus linked with memory
3 - Restorative functions such as glucose and proteins for healing
4 - Neural detoxification (glymphatics clearance)
5 - all of the above

A

5 - all of the above

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14
Q

Which of the following is used to describe when someone doesn’t get sufficient sleep?

1 - Insomnia
2 - Hypersomnia
3 - Parasomnias
4 - Circadian rhythm disorders

A

1 - Insomnia
- classed as a symptom rather than a disorder
- this is NOT a diagnosis
- clinically significant in 10% of people

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15
Q

Which of the following is NOT typically affected by insomnia?

1 - Women
2 - Shift workers
3 - Young children
4 - Medical and psychiatric comorbidity

A

3 - Young children

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16
Q

What is short term/acute insomnia?

1 - <4 weeks
2 - <3 months
3 - <6 months
4 - <12 months

A

2 - <3 months
- insomnia typically gets worse if untreated

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17
Q

What is long term/chronic insomnia?

1 - >4 weeks
2 - >3 months
3 - >6 months
4 - >12 months

A

2 - >3 months
- insomnia typically gets worse if untreated

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18
Q

When managing insomnia, which of the following is NOT typically performed?

1 - Identify the cause
2 - Treat any underlying cause e.g. depression, anxiety, pain
3 - Explain clearly what is happening and why
4 - Ensure good sleep hygiene (psychoeducation or CBT)
5 - Advise the person not to drive if they feel sleepy
6 - prescribe sleeping medication
7 - In certain sleep disorders, the DVLA must be informed (sleep apnea)

A

6 - prescribe sleeping medication
- this would only be prescribed if the insomnia is though to be short lived, like loss of a loved one
- benzodiazepines or non-benzodiazepines

19
Q

For long term insomnia, CBT is the 1st line treatment. But what other medication can be offered if there is an acute exacerbation in patients aged >55 y/o?

1 - cortisol
2 - benzodiazepines
3 - melatonin
4 - all of the above

A

3 - melatonin

20
Q

When talking about psychoeducation, we can talk about preparing for bed, including:

  • bed time routine
  • milky drink (contains tryptophan)
  • keep lights low

We should also aim to wind down, but what is the minimum time advised to wind down?

1 - >30 minutes
2 - >1 hour
3 - >2 hours
4 - >6 hours

A

2 - >1 hour

  • tryptophan is a precursor for serotonin and effects melatonin synthesis
21
Q

If medications are to be prescribed to a patient with insomnia, typically how long should they be prescribed for?

1 - <72h
2 - <1 week
3 - <2 weeks
4 - <6 weeks

A

2 - <1 week

22
Q

Which 2 of the following medications are used most commonly in patients with insomnia?

1 - zopiclone
2 - diazepam
3 - zolpidem
4 - flumazenil

A

1 - zopiclone
3 - zolpidem

  • need to be careful with benzodiazepines or non-benzodiazepines as these can lead to rebound insomnia
23
Q

Which of the following is used to describe when someone gets too much sleep?

1 - Insomnia
2 - Hypersomnia
3 - Parasomnias
4 - Circadian rhythm disorders

A

2 - Hypersomnia

24
Q

Which of the following are associated with causing hyper insomnia?

1 - psychiatric conditions (depression)
2 - medications
3 - sleep/breathing disorders
4 - central causes (narcolepsy)
5 - general medical conditions (hypothyroidism)
6 - all of the above

A

6 - all of the above

25
Q

Narcolepsy is a rare (0.2-0.5 per 1000) long-term brain condition that can prevent a person from choosing when to wake or sleep and is a cause of hyperinsomnia. Is it more common in men or women?

A
  • men
  • associated with cataplexy, which is the sudden loss of muscle tone

Kleine Levin syndrome = sleeping beauty syndrome

26
Q

Is narcolepsy more common in adolescents or older patients?

A
  • adolescents
27
Q

Which of the following can be used to treat narcolepsy?

1 - practical support (e.g. at school/work)
2 - scheduled naps (20 mins)
3 - modafinil (stimulant)
4 - all of the above

A

4 - all of the above

28
Q

In narcolepsy do patients just feel tired all the time?

A
  • No

Can be sleepy during the day, but then awake at night

29
Q

In narcolepsy and insomnia, which one is likely to be tired all the time?

A
  • insomnia

Narcolepsy patients can have awakening times

30
Q

Do patients with narcolepsy dream quickly or have no dreams?

A
  • dream quicker than normal sleepers

This can cause hallucinations though

Hypnopompic = hallucinations upon waking
Hypnogogic = hallucinations upon sleeping

31
Q

Is narcolepsy or insomnia more likely to cause sleep paralysis (inability to move body upon waking)?

A
  • narcolepsy
32
Q

Cataplexy is the loss of muscle tone in patients with narcolepsy. When is this most likely to occur?

1 - following exercise
2 - upon waking
3 - heightened emotions
4 - upon falling asleep

A

3 - heightened emotions
- patient remains conscious but lose tendon reflexes

Laughing and crying

33
Q

Which of the following is used to describe when someone has unusual physical, emotional, perceptual or behavioural events during sleep?

1 - Insomnia
2 - Hypersomnia
3 - Parasomnias
4 - Circadian rhythm disorders

A

3 - Parasomnias

34
Q

Parasomnia is when someone has unusual physical, emotional, perceptual or behavioural events during sleep. Which if the following is an example of non-REM sleep parasomnias?

1 - Confusional arousal
2 - Sleepwalking (somnambulism)
3 - Sleep terrors
4 - Nightmares

A

4 - Nightmares
- form of REM

35
Q

Parasomnia is when someone has unusual physical, emotional, perceptual or behavioural events during sleep. Which if the following is an example of REM sleep parasomnias?

1 - Sleep paralysis
2 - Sleepwalking (somnambulism)
3 - REM sleep behaviour disorder
4 - Nightmares
5 - Restless leg syndrome

A

2 - Sleepwalking (somnambulism)
- form of non-REM

36
Q

A parasomnia is a sleep disorder that involves unusual and undesirable physical events or experiences that disrupt your sleep. Are medications the 1st line in these patients?

A
  • No

AIm to:
- reduce stress and anxiety
- ensure adequate sleep duration
- CBT
- address potential underlying causes (tricyclic antidepressants)

RBD: clonazepam or melatonin first-line

37
Q

A parasomnia is a sleep disorder that involves unusual and undesirable physical events or experiences that disrupt your sleep. Typically treatment involves:

  • reduce stress and anxiety
  • ensure adequate sleep duration
  • CBT
  • address potential underlying causes (tricyclic antidepressants)

If medication is given, which 2 are 1st line?

1 - clonazepam
2 - melatonin
3 - zopiclone
4 - sertraline

A

1 - clonazepam
2 - melatonin

38
Q

A parasomnia is a sleep disorder that involves unusual and undesirable physical events or experiences that disrupt your sleep and can sometimes appear similar to seizures. Do seizures or parasomnias cause post-event confusion?

A
  • seizures
39
Q

A parasomnia is a sleep disorder that involves unusual and undesirable physical events or experiences that disrupt your sleep and can sometimes appear similar to seizures. Do seizures or parasomnias occur more often in the same night?

A
  • seizures
40
Q

A parasomnia is a sleep disorder that involves unusual and undesirable physical events or experiences that disrupt your sleep and can sometimes appear similar to seizures. Which of the these typically occurs in the 1st 3rd of the night?

A
  • parasomnias
41
Q

Which of the following is used to describe when someone has dysfunction of their circadian rhythm?

1 - Insomnia
2 - Hypersomnia
3 - Parasomnias
4 - Circadian rhythm disorders

A

4 - Circadian rhythm disorders

42
Q

Which of the following are circadian rhythm disorders more common in?

1 - babies
2 - young adults
3 - older adults
4 - >65 years olds

A

2 - young adults

43
Q

If a patient has a dysfunction with their circadian rhythm, we can use which of the following would we NOT use to treat this?

1 - Chronotherapy (sleep hygiene)
2 - Light therapy
3 - Zopiclone
4 - Melatonin

A

3 - Zopiclone

A. Block D Neurology (39 decks)

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