Sleep Disorders
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Questions and Answers

Which treatment is commonly used for Restless Legs Syndrome (Willis-Ekbom disease)?

  • Citalopram
  • Fluoxetine
  • Pramipexole (correct)
  • Lithium

    • What is a characteristic feature of sleep paralysis?

  • Awareness without movement (correct)
  • Constant leg movement
  • Loud snoring
  • Inability to remember dreams

    • Which stage of sleep is associated with the occurrence of startles during the transition from NREM to REM?

  • Stage 2 NREM
  • Stage 1 NREM
  • Stage 3 NREM
  • REM stage (correct)

    • Which treatment is NOT a first-line option for sleep disorders like Restless Legs Syndrome?

    <p>Antidepressants</p> Signup and view all the answers

    What is the primary method used to measure brain activity during sleep?

    <p>Electroencephalogram (EEG)</p> Signup and view all the answers

    Which of the following is a characteristic feature of obstructive sleep apnea?

    <p>Excessive daytime sleepiness</p> Signup and view all the answers

    Which type of episodes are NOT associated with cataplexy?

    <p>Cessation of breathing</p> Signup and view all the answers

    What is the drug of choice for treating cataplexy?

    <p>Sodium oxybate</p> Signup and view all the answers

    Which of the following factors is NOT typically associated with the etiology of obstructive sleep apnea?

    <p>Major depressive disorder</p> Signup and view all the answers

    Which of the following is a common clinical feature of obstructive sleep apnea?

    <p>Frequent awakenings</p> Signup and view all the answers

    What is a key characteristic of sleep terror disorder?

    <p>It involves frightening dreams that can cause distress.</p> Signup and view all the answers

    Which of the following statements about restless legs syndrome is accurate?

    <p>Movement alleviates the uncomfortable sensations in the legs.</p> Signup and view all the answers

    Which treatment is commonly used for sleepwalking disorder?

    <p>Education and reassurance.</p> Signup and view all the answers

    What is a typical feature related to nightmares?

    <p>Frightening dreams that cause functional impairment or distress.</p> Signup and view all the answers

    What population percentage is affected by sleepwalking disorder?

    <p>About 2% of adults and up to 20% of children.</p> Signup and view all the answers

    Which factor is often associated with parasomnias?

    <p>Sleep deprivation and irregular sleep schedules.</p> Signup and view all the answers

    What clinical feature is associated with sleep terror disorder?

    <p>The patient has a blank stare and difficulty being aroused.</p> Signup and view all the answers

    Which treatment is recommended for nightmare disorder?

    <p>Medication like Prazosin or antidepressants.</p> Signup and view all the answers

    Which non-benzodiazepine medication is commonly used for short-term treatment of insomnia?

    <p>Melatonin</p> Signup and view all the answers

    What is the primary side effect associated with higher doses of zolpidem in elderly patients?

    <p>Increased risk of falls</p> Signup and view all the answers

    Which symptom is commonly associated with chronic hypersomnolence disorder?

    <p>Nonrestorative sleep</p> Signup and view all the answers

    Which antidepressant is often prescribed off-label for insomnia in patients with coexisting depression?

    <p>Mirtazapine</p> Signup and view all the answers

    What is a potential cognitive effect of long-term use of zolpidem?

    <p>Cognitive impairment</p> Signup and view all the answers

    Which statement correctly defines one of the DSM-5 criteria for chronic hypersomnolence disorder?

    <p>Recurrent periods of sleep during the day.</p> Signup and view all the answers

    Which of the following is a recognized side effect of antidepressants used for sleep disorders?

    <p>Psychomotor impairment</p> Signup and view all the answers

    Which of these non-benzodiazepines is specifically known to cause daytime sleepiness?

    <p>Trazodone</p> Signup and view all the answers

    What is a potential consequence of untreated sleep-related hypoventilation?

    <p>Pulmonary hypertension</p> Signup and view all the answers

    Which age group has the highest prevalence of sleep-related hypoventilation?

    <p>Older adults</p> Signup and view all the answers

    What is a common treatment method for central sleep apnea associated with chronic opioid use?

    <p>Acetazolamide</p> Signup and view all the answers

    What behavioral strategy may be recommended for treatment of sleep-related issues?

    <p>Exercise and weight loss</p> Signup and view all the answers

    Which common symptoms might indicate sleep-related hypoventilation?

    <p>Daytime fatigue and morning headaches</p> Signup and view all the answers

    What type of sleep apnea is characterized by Cheyne–Stokes breathing?

    <p>Central sleep apnea</p> Signup and view all the answers

    What condition is often comorbid with sleep-related hypoventilation?

    <p>Obstructive sleep apnea</p> Signup and view all the answers

    Which treatment is indicated for managing central sleep apnea?

    <p>Continuous positive airway pressure (CPAP)</p> Signup and view all the answers

    What is the first-line therapy for chronic insomnia?

    <p>Cognitive-behavioral therapy</p> Signup and view all the answers

    Which of the following criteria is NOT included in the DSM-5 for diagnosing chronic insomnia?

    <p>Is secondary to another sleep disorder</p> Signup and view all the answers

    What side effect is NOT commonly associated with the use of benzodiazepines for insomnia?

    <p>Increased energy</p> Signup and view all the answers

    What percentage of the general population is typically affected by chronic insomnia?

    <p>6-10%</p> Signup and view all the answers

    Which of the following is a common treatment measure for improving sleep hygiene?

    <p>Limiting caffeine intake</p> Signup and view all the answers

    Which condition is an indication that chronic insomnia might benefit from pharmacotherapy?

    <p>Insomnia persisting despite sleep hygiene measures</p> Signup and view all the answers

    Chronic insomnia often coexists with which type of disorders?

    <p>Subclinical mood and/or anxiety disorders</p> Signup and view all the answers

    What is a potential outcome of untreated chronic insomnia?

    <p>Tendency toward psychiatric illness</p> Signup and view all the answers

    Study Notes

    Restless Legs Syndrome

    • First-line treatments include dopamine agonists (pramipexole and ropinirole) and benzodiazepines.
    • Other treatments include muscle relaxants, opioids, and gabapentin/pregabalin.

    Sleep Startles

    • Occur during the transition from stage 3 NREM to REM sleep.
    • The motor center is excited, causing muscles to activate suddenly.
    • Characterized by a feeling of falling.

    Sleep Paralysis

    • A state of awareness where a person is unable to move or speak.
    • Triggered by sleep deprivation, psychological stress, or abnormal sleep cycles.
    • Experienced by 8% to 50% of people at some point in their lives.
    • Occurs during REM sleep.
    • Characterized by an imbalance in neural functions regulating sleep, causing overlap of sleep states.
    • Can be accompanied by hallucinations.

    How to Measure Brain Activity

    • An electroencephalogram (EEG) measures brain activity by recording electrical signals from the scalp.
    • 24 electrodes are placed on the scalp at standard positions.
    • Differences in electrical charges recorded by each electrode are plotted on a graph versus time.
    • While individual neuron activity cannot be measured, the activity of neuron groups can be observed.
    • Polysomnography (PSG) is used in sleep medicine to measure brain activity.

    Circadian Rhythm Sleep Disorders

    • Common features include insomnia, excessive daytime sleepiness, irritability, frequent waking during abnormal hours, headaches, and impaired concentration.

    Parasomnias

    • Include sleepwalking disorder, sleep terror disorder, and nightmare disorder.

    Sleepwalking Disorder (Somnambulism)

    • Occurs during non-REM sleep, resulting in no memory of the event.
    • Affects 2% of adults and 20% of children.
    • Etiology is unknown but thought to be genetic.
    • Characterized by sitting up, walking, or eating during sleep.
    • Patients often have a blank stare and difficulty arousing during episodes.
    • Treatment includes education and reassurance, and benzodiazepines (clonazepam).

    Sleep Terror Disorder

    • Occurs during non-REM sleep, resulting in no memory of the event.
    • Affects 7% of adults and 30% of children.
    • Associated with sleep deprivation, irregular sleep schedules, and medications like sedatives, hypnotics, lithium, and anticholinergics.
    • Etiology is either idiopathic or genetic (inherited in 80% of cases).
    • Characterized by recurrent episodes during the first third of the sleep cycle, including sitting up, walking, or eating.
    • Patients have a blank stare and difficulty arousing during the episode.
    • Treatment includes education and reassurance, and benzodiazepines (clonazepam).

    Nightmare Disorder

    • Occurs during REM sleep, causing the patient to remember the dream.
    • Affects 2% of adults, typically during early adulthood.
    • Characterized by recurrent frightening dreams during the second half of the sleep cycle.
    • Patients remember the dream after awakening.
    • Treatment includes therapy and antidepressants (prazosin and antidepressants).

    Narcolepsy

    • Characterized by excessive daytime sleepiness, cataplexy, sleep paralysis, and hallucinations.
    • More common in males than females.
    • Etiology is a decreased ability to regulate sleep-wake cycles due to low levels of orexin, a wakefulness-promoting neuropeptide.
    • Caused by lesions to the posterior hypothalamus and midbrain.
    • Treatment options include sodium oxybate (drug of choice), antidepressants, stimulants, and modafinil.

    Obstructive Sleep Apnea

    • A chronic breathing-related disorder characterized by repetitive episodes of breathing cessation or reduced airflow during sleep.
    • Affects 1-2% of children, 15% of middle-aged adults, and over 20% of older adults.
    • Etiology includes obesity, increased neck circumference, and airway narrowing.
    • Clinical features include excessive daytime sleepiness, snoring, frequent awakenings, nonrefreshing sleep or fatigue, morning headaches, and hypertension.
    • Treatment options include continuous positive airway pressure (CPAP), weight loss, exercise, and surgery.

    Non-benzodiazepines

    • Melatonin, zolpidem, eszopiclone, zaleplon, and suvorexant are effective for short-term insomnia treatment.
    • These medications have a low incidence of daytime sleepiness and orthostatic hypotension.
    • Zolpidem can increase the risk of falls in older adults and may cause cognitive impairment in women with doses over 10 mg.

    Antidepressants

    • Trazodone, amitriptyline, and doxepin can be used to treat insomnia but are off-label.
    • Mirtazapine in low doses is often prescribed for sleep in patients with co-existing depressive disorders.
    • Common side effects include sedation, dizziness, and psychomotor impairment.

    Hypersomnolence Disorder

    • Excessive daytime sleepiness despite sufficient sleep duration, characterized by:
      • Recurrent sleep episodes within the same day
      • Prolonged, non-restorative sleep exceeding 9 hours
      • Difficulty achieving full wakefulness after awakening
    • These symptoms must occur at least three times a week for three months.
    • Non-restorative sleep, automatic behaviors, and difficulty waking up in the morning are common complaints.

    Chronic Insomnia

    • Persists for at least three months and can extend to years.
    • Reduces quality of life and increases the risk of mental illness.
    • Often diagnosed with a subjective sleep tracking measure - Consensus Sleep Diary.
    • DSM-5 criteria includes:
      • Difficulty initiating or maintaining sleep, or early-morning awakenings with inability to return to sleep
      • Symptoms occur at least three days a week for at least three months.
      • Causes clinically significant distress or functional impairment.
      • Occurs despite adequate opportunity to sleep.
      • Not solely due to another sleep-wake disorder, substance, or medication.
      • Coexisting mental and medical conditions do not adequately explain the symptoms.

    Chronic Insomnia Epidemiology

    • Prevalence rates range from 6-10%.
    • The most common sleep-wake disorder.

    Chronic Insomnia Etiology:

    • Subclinical mood or anxiety disorders.
    • Preoccupation with perceived inability to sleep.
    • Unfavorable bedtime routines (poor sleep hygiene).
    • Idiopathic.

    Chronic Insomnia Treatment

    • First-line treatment is Cognitive Behavioral Therapy (CBT).
    • Sleep hygiene measures are essential.
    • Chronotherapy (bright light therapy) entrains the circadian rhythm and is supported for insomnia treatment.
    • Pharmacotherapy (hypnotic medications) should only be used in cases not responding to CBT.

    Benzodiazepines

    • Reduce sleep latency and nocturnal awakenings.
    • Effective for short durations (4-8 weeks).
    • Insufficient evidence to support long-term efficacy.
    • Side effects include tolerance, addiction, daytime sleepiness, and rebound insomnia.
    • Older adults are at risk for falls, confusion, and dizziness.

    Obstructive Sleep Apnea

    • The most common hypersomnia.
    • Characterized by repeated episodes where breathing is interrupted during sleep due to blockage of the upper airway.
    • Frequent awakenings, daytime sleepiness, snoring and witnessed apneas are key symptoms.
    • Diagnosis is made with Polysomnography.

    Obstructive Sleep Apnea Prevalence:

    • Most common in middle-aged men and women.
    • Male to female ratio is 2:1 to 4:1.
    • Incidence:
      • Children: 1-2%
      • Middle-aged adults: 2-15%
      • Older Adults: >20%

    Obstructive Sleep Apnea Treatment

    • Positive Airway Pressure (CPAP) continuous or bi-level (BiPAP).
    • Behavioral strategies (weight loss, exercise).
    • Surgical interventions: tonsillectomy and selective upper airway stimulation implants.

    Central Sleep Apnea

    • Characterized by five or more central apneas per hour of sleep.
    • Can be idiopathic or caused by:
      • Cheyne-Stokes breathing associated with heart failure, stroke, or renal failure.
      • Opioid use.
    • Insomnia and daytime sleepiness are associated symptoms.

    Central Sleep Apnea Prevalence

    • Idiopathic subtype is rare.
    • Cheyne-Stokes subtype is more prevalent in patients with reduced ejection fraction and acute stroke.
    • 30% of chronic opioid users experience central sleep apnea.
    • Higher frequency in men compared to women.

    Central Sleep Apnea Course

    • Tied to coexisting medical conditions and can be transient.
    • Chronic in opioid users.

    Central Sleep Apnea Treatment:

    • Treat the underlying condition.
    • CPAP/BiPAP.
    • Supplemental Oxygen.
    • Medications:
      • Acetazolamide (Diamox)
      • Theophylline
      • Sedative-hypnotics
    • Polysomnography shows decreased respiration and elevated CO2 levels.
    • Individuals experience frequent arousals, morning headaches, insomnia, and excessive daytime sleepiness.
    • Often co-occurs with medical or neurological disorders, medication use, or substance use disorders.
    • Long-term consequences include pulmonary hypertension, cor pulmonale, cardiac arrhythmias, polycythemia, neurocognitive dysfunction, and respiratory failure due to severe blood gas abnormalities.
    • Very uncommon.

    Sleep - Related Hypoventilation Course:

    • Slowly progressive
    • Treat underlying condition.
    • CPAP/BiPAP.
    • Medications to stimulate breathing:
      • Bronchodilators
      • Theophylline

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    Description

    This quiz delves into various sleep disorders such as Restless Legs Syndrome, Sleep Startles, and Sleep Paralysis, alongside methods for measuring brain activity like EEG. Explore the symptoms, causes, and treatments associated with these conditions to enhance your understanding of sleep science.

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