Sleep Disorders

Question 1

the body’s anatomic timekeeper triggering the release of melatonin from the pineal gland

Answer 1

suprachiasmatic nucleus (SCN) is located in the hypothalamus

Question 2

Measures and records the electrical activity of the brain

Answer 2

EEG

Question 3

Where melatonin is released from

Answer 3

pineal gland

Question 4

Tx of circadian rhythm disorders

Answer 4

Sleep Hygiene. Bright Light Therapy/. Chronotherapy. Ramelteon (Rozerem). Provigil/ Nuvigil (shift work 150mg/day)

Question 5

Widely used in the field of sleep medicine as a subjective measure of a patient’s sleepiness and test of how likely a patient is to doze off or fall asleep

Answer 5

Epworth Sleepiness Scale. 0 would never doze or sleep to 3 which is high chance of dozing/sleeping

Question 6

First step in management of insomnia

Answer 6

maintain a sleep log for 2-4 weeks

Question 7

First line meds for insomnia

Answer 7

Melatonin 1 hr before and 1 right before bed. Atarax/Hydroxyzine at night x 2 wks

Question 8

Sedative hypnotics for insomnia

Answer 8

Zaleplon (Sonata). Zolpidem (Ambien). Ambien Cr . Lunesta (eszopiclone)

Question 9

Only sedative hypnotic that is category B for pregnancy.

Answer 9

Ambien Cr

Question 10

Name the benzodiazepine hypnotics: more useful in sleep maintenance insomnia

Answer 10

estazolam (ProSom). Temazepam (Restoril)

Question 11

Antidepressant that has the least anticholinergic effects best for elderly

Answer 11

nortriptyline

Question 12

Name the 3 TCA’s used in sleep disorders

Answer 12

trazodone (desyrel), amitriptyline (elavil), nortriptyline

Question 13

What two TCAs are also commonly used for back pain associated with nerve pain

Answer 13

amitriptyline and nortriptyline

Question 14

CI to melatonin agonists

Answer 14

severe hepatic impairment

Question 15

Name the melatonin agonist

Answer 15

ramelteon (Rozerem)

Question 16

When do narcoleptics generally experience REM?

Answer 16

within 5 minutes while most people 1hr

Question 17

Sx include periods of extreme drowsiness during the day often followed by a sleep attack, sleep paralysis, cataplexy

Answer 17

narcolepsy

Question 18

define sleep paralysis

Answer 18

Pt cannot move as they start falling asleep or when they first wake up

Question 19

define cataplexy

Answer 19

sudden loss of muscle tone while awake that makes them unable to move

Question 20

cause of narcolepsy

Answer 20

low levels of Hypocretin

Question 21

medications for narcolepsy

Answer 21

modafinil (Provigil)***, Armodafinil (Nuvigil), Methylphenidate (Ritalin)

Question 22

Sx include jaw soreness, flattening of teeth and radiating AM headaches

Answer 22

bruxism

Question 23

Sx include sensation of wanting to move legs while awake, “heebie jeebies” or “creepy crawler” sensations

Answer 23

Restless Leg Syndrome

Question 24

Risk factors for sleep apnea

Answer 24

BMI > 30, neck circumference > 17”, narrow airway, large tongue

Question 25

Tx for obstructive sleep apnea

Answer 25

weight loss, smoking cessation, CPAP

Question 26

Tx for pickwickian syndrome

Answer 26

weight loss, BiPAP, O2, tracheostomy if severe

Question 27

Non-REM parasomnias

Answer 27

sleep walking/eating, night terrors

Question 28

REM parasomnias

Answer 28

sleep paralysis, nightmare disorder

Question 29

Tx for night terrors

Answer 29

benzos, psychotherapy

Question 30

Tx for sleep paralysis

Answer 30

clonazepam taken at night

Question 31

Name the theory of sleep: neurotoxins are neutralized during sleep. cells divide, tissue synthesizes and growth hormones are released

Answer 31

Restorative Theory

Question 32

Name the theory of sleep: Unimportant information is “erased”, important information is locked into more permanent memory

Answer 32

Programming-Reprogramming Theory