Podcast
Questions and Answers
Which of the following substances can disrupt sleep?
Which of the following substances can disrupt sleep?
Excessive daytime sleepiness is more likely to occur in stimulating situations.
Excessive daytime sleepiness is more likely to occur in stimulating situations.
False
What scale is commonly used to quantify sleepiness subjectively?
What scale is commonly used to quantify sleepiness subjectively?
Epworth Sleepiness Scale
Excessive daytime sleepiness can lead to accidents, such as when operating __________.
Excessive daytime sleepiness can lead to accidents, such as when operating __________.
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Match the following sleep disorders with their descriptions:
Match the following sleep disorders with their descriptions:
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What are the two tests used for measuring sleepiness objectively?
What are the two tests used for measuring sleepiness objectively?
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Taking long naps during the day can improve sleep hygiene.
Taking long naps during the day can improve sleep hygiene.
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The MSLT measures the tendency to __________ in quiet situations.
The MSLT measures the tendency to __________ in quiet situations.
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What is a common cause of chronic insomnia in elderly patients?
What is a common cause of chronic insomnia in elderly patients?
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Obstructive sleep apnea (OSA) occurs less frequently in the elderly compared to younger adults.
Obstructive sleep apnea (OSA) occurs less frequently in the elderly compared to younger adults.
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What is the typical range of sleep hours for most normal adults?
What is the typical range of sleep hours for most normal adults?
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Chronic insomnia is often characterized by difficulty falling asleep and __________ sleep.
Chronic insomnia is often characterized by difficulty falling asleep and __________ sleep.
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Which of the following medications can potentially cause insomnia?
Which of the following medications can potentially cause insomnia?
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Match the following terms related to sleep disturbances with their descriptions:
Match the following terms related to sleep disturbances with their descriptions:
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A common problem in patients with chronic insomnia is adequate sleep hygiene.
A common problem in patients with chronic insomnia is adequate sleep hygiene.
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Name one psychosocial factor that may contribute to insomnia.
Name one psychosocial factor that may contribute to insomnia.
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What does a score of 10 or more on the Epworth Sleepiness Scale indicate?
What does a score of 10 or more on the Epworth Sleepiness Scale indicate?
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NREM sleep behavior disorder (RBD) is classified under REM parasomnias.
NREM sleep behavior disorder (RBD) is classified under REM parasomnias.
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Name one sleep-related movement disorder mentioned in the content.
Name one sleep-related movement disorder mentioned in the content.
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The primary purpose of the Epworth Sleepiness Scale is to assess __________ during the day.
The primary purpose of the Epworth Sleepiness Scale is to assess __________ during the day.
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Which of the following sleep disorders is most commonly associated with children?
Which of the following sleep disorders is most commonly associated with children?
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Sleep questionnaires are not useful in documenting sleep-wake patterns.
Sleep questionnaires are not useful in documenting sleep-wake patterns.
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What is the primary symptom of periodic limb movement disorder (PLMD)?
What is the primary symptom of periodic limb movement disorder (PLMD)?
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Study Notes
Sleep Disorders Definition
- Sleep is a recurring state characterized by a loss of responsiveness to the external environment.
- It's now known as an active physiologic state involving changes in neural, metabolic, and cardiorespiratory function.
- Sleep disorders encompass a wide array of conditions categorized in the International Classification of Sleep Disorders (ICSD-2).
- The ICSD-2 lists over 80 distinct sleep disorders, grouped into categories like insomnia, sleep-related breathing disorders, hypersomnias, circadian rhythm disorders, parasomnias, and sleep-related movement disorders.
Sleep Pathophysiology
- Normal sleep and wake cycles are generated by a complex neuronal network in the brain, regulated by homeostatic and circadian mechanisms.
- Sleep stages include REM (rapid eye movement) and NREM (non-REM) sleep.
- REM sleep is characterized by desynchronized EEG activity, REM bursts, and dreaming.
- NREM sleep features synchronized EEG activity and muscle relaxation.
- Sleep homeostasis regulates the intensity and duration of sleep, with deprivation leading to increased sleep pressure.
- Sleep physiology varies with age, showing a decrease in deep sleep and increased awakenings in older adults.
Sleep Signs and Symptoms
- A practical approach to assessing sleep-related disturbances involves eliciting symptoms.
- Common symptoms include difficulty falling asleep, maintaining sleep, or experiencing non-refreshing sleep leading to daytime fatigue.
- Chronic insomnia, often due to medical or psychological factors, can impair social and occupational functioning.
- Excessive daytime sleepiness is the inability to stay alert and results in falling asleep inappropriately.
- Abnormal movements or behaviors during sleep can include sleepwalking, sleep terrors, nightmares, and REM sleep behavior disorder.
Insomnia
- Difficulty falling asleep, maintaining sleep, or experiencing non-refreshing sleep are common complaints.
- Chronic insomnia impacts daytime functioning, quality of life, and can be associated with medical, psychiatric conditions, and pain.
- Inadequate sleep hygiene such as excessive caffeine, alcohol, or mentally/ physically arousing activities before bedtime can contribute to problems.
- Psychophysiological insomnia is characterized by a heightened arousal state, while adjustment insomnia stems from a temporary stressor.
Excessive Daytime Sleepiness
- Difficulty staying alert during the major waking period is described as excessive daytime sleepiness.
- It’s more likely in monotonous situations.
- Associated with increased risks of accidents, quantified using the Epworth Sleepiness Scale.
Abnormal Movements or Behavior in Sleep
- NREM parasomnias: Disorders of arousal seen in children (confusional arousals, sleepwalking, and sleep terrors).
- REM parasomnias: Include nightmare disorder and REM sleep behavior disorder.
- Restless legs syndrome (RLS): Characterized by an urge to move the legs due to uncomfortable sensations, particularly at rest. Periodic limb movement disorder (PLMD): Leg movements during sleep, not usually associated with symptoms during wakefulness.
- Sleep-related epilepsy: Difficulty differentiating from related behaviors without proper documentation (EEG).
Diagnosis
- Comprehensive history gathering is crucial for sleep disorder diagnosis, including sleep habits, environment, daytime activities, and collateral information from others.
- Sleep logs, questionnaires & scales (like the Epworth Sleepiness Scale), are often useful.
- Pattern recognition of clinical characteristics from the history and physical examination are critical parts of the diagnostic procedure.
Sleep Disorders Manifesting with Excessive Daytime Sleepiness
- Excessive daytime sleepiness can be caused by multiple factors, including sleep deprivation, obstructive sleep apnea (OSA), narcolepsy, and shift work disorder.
- OSA is diagnosed using polysomnography (PSG) which measures multiple physiologic parameters, like EEG (electroencephalography), EMG (Electromyography), EOG (Electrooculography), airflow, respiratory effort, and pulse oximetry in a sleeping patient.
Sleep Disorder Testing
- Polysomnography (PSG) monitors multiple physiologic parameters during sleep to assess sleep quality, breathing patterns, and other related disturbances.
- The Multiple Sleep Latency Test (MSLT) is a gold standard for assessing daytime sleepiness.
- The Maintenance of Wakefulness Test (MWT) measures the ability to stay awake in quiet situations.
Sleep Disorder Treatment
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Lifestyle modifications, such as good sleep hygiene, are often recommended.
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Stimulus control & sleep restriction techniques are part of these modifications.
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Drug therapies may include sedative hypnotics, anxiolytics, antidepressants, and others, as indicated and monitored.
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Stimulant medications can also be used in instances of excessive daytime sleepiness.
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Positive airway pressure (PAP) therapy (CPAP, autoPAP, or BiPAP) is a mainstay for obstructive sleep apnea (OSA).
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Description
This quiz covers the definition and pathophysiology of sleep disorders. It explores various types of sleep disorders listed in the ICSD-2 and explains the complexities of sleep cycles, including REM and NREM stages. Test your knowledge on how sleep is regulated and the physiological changes that occur during sleep.
