Sleep-wake d/o

Question 1

where is the “biological clock”

Answer 1

the suprachiasmatic nucleus

Question 2

REM vs NREM

REM characateristics

NMRE

Answer 2

REM – Pulse, BP, RR higher;
sexual arousal; skeletal paralysis, abstract dreams; last third of the night (deep)
Majority of infants sleep
25% of adult sleep

NREM-  
Decreased RR, Pulse, BP
Less sexual arousal
Skeletal muscles active
Dreams can be lucid and purposeful (acting out dreams) 
50% of adult sleep

Question 3

NTs involved in sleep

Answer 3

5HT, DA, ACH, NE

Question 4

Name a few sleep-wake d/o

Answer 4

Insomnia Disorder
Hypersomnolence Disorder
Narcolepsy
Breathing-Related Sleep Disorders

Circadian Rhythm Sleep-Wake Disorders
NREM Sleep Arousal Disorders
Nightmare Disorder
REM Sleep Behavior Disorder
Restless Legs Syndrome
Substance/Medication-Induced Sleep Disorder

Question 5

Criteria for ALL sleep wake d/o

Answer 5

linically significant distress or impairment in functioning

not attributable to the physiological effects of a substance

Coexisting mental disorders and medical conditions do not adequately explain the predominant complaint

Question 6

Insomnia

Criteria

Answer 6

Dissatisfaction with sleep quantity or quality, plus ≥ 1 sxs:

• can’t initiate sleep; can’t maintain sleep; early morning awakening
• 3nights/week x 3 months at least

Question 7

what is the most preveleant Sleep wake d/o

Answer 7

Insomnia

Question 8

Treatment for insomina

Answer 8

sleep hygeine
CBT
Benadryl, Melatonin

Rozerem – melatonin agonist

Short term -- BZDs (never for longer than 1 month --risk of withdrawal; amnesia) 
NEVER ALPRAZOLAM (short acting) 
Reduce slow wave sleep

Question 9

Z drug treatment

dose/course
side effects

Answer 9

Z Drugs – GABA-a agonists; preserve slow wave
take EVERY OTHER NIGHT

amnesia
halluciations
parasomnias

Question 10

Hypersomnolence Disorder

criteria

Treatment

Answer 10

excessive sleepiness
3x/week x 3 months

: Stimulants, or non-sedating SSRIs (buproprion)

Question 11

Narcolepsy

criteria –
other characteristics

Answer 11

REM sleep attacks which occur 2-6 times per day and last 10 to 20 minutes each

Hypocretin deficiency

hypnagogic and hypnopompic hallucinations, cataplexy (50%), and sleep paralysis

Question 12

Narcolepsy treatment

Answer 12

Modafinil (Provigil) reduces sleep attacks and improves psychomotor performance by stimulating α1-adrenergic receptors, with fewer side effects than traditional stimulants

Amphetamines

TCAs or SSRIs for cataplexy

Question 13

Obstructive Sleep Apnea Hypopnea

criteria –

Answer 13

five obstructive apneas or hypopneas per hour of sleep

+ sleep symptoms (snoring, snorting/gasping, or breathing pauses during sleep.
Daytime sleepiness, fatigue, or unrefreshing sleep)

Question 14

Obstructive Sleep Apnea Hypopnea

treatment

Answer 14

CPAP, weight loss, nasal surgery

SSRIs and TCAs may reduce amount of time in REM, (reduce REM apneic episodes)

Avoid sedatives, including alcohol

Question 15

Circadian Rhythm Sleep Disorder

Answer 15

Misalignment between desired and actual sleep periods

Question 16

NREM Sleep Arousal Disorders

name 2

general characteristics

Answer 16

Sleepwalking

Sleep terrors –

Recurrent episodes of incomplete awakening from sleep, usually occurring during the first third of the major sleep episode

usually cannot remember the dreams or the episodes themselves

Question 17

NREM Sleep Arousal Disorder: Sleepwalking

treatment:

Answer 17

perform perseverative motor tasks

Usually return to sleep without any recollection of the event

Enact measures to ensure safety and prevent injury (hide the car keys, block stairs). Medications which suppress NREM slow-wave sleep.

Question 18

NREM Sleep Arousal Disorder: sleep terrors

if these begin later in life, what could it be a sign of

Answer 18

Scream or cry + behavioral manifestations resembling panic

Temporal lobe epilepsy

Question 19

REM Sleep DIsorder: Nightmare Disorder

Criteria

Treatment

Answer 19

Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams

On awakening from the dysphoric dreams, the individual rapidly becomes oriented and alert.

Treat: No specific treatment is available. Agents that suppress REM sleep (TCAs, SSRIs

Question 20

REM Sleep Behavior Disorder

what disease might be associated?

Answer 20

Repeated episodes of arousal during sleep associated with vocalization and/or complex motor behaviors.

REM sleep without atonia on polysomnographic recording.

Motor activity, often violent in nature

., Parkinson’s disease, MSA

Question 21

Restless Legs Syndrome

criteria –

Answer 21

usually accompanied by or in response to uncomfortable and unpleasant sensations in the legs: urge to move legs;
3x/week x 3 months

Question 22

Treatment of RLS

Question 23

sleep changes in MDD

Answer 23

Reduced slow-wave sleep (SWS)

Sleep-onset REM