Mental Health Exam Ii Sleep Disorders

Front 1

Sleep complaints usually fall into what 4 categories

Back 1

-Difficulty initiating/staying asleep (insomnia)
-Difficulty staying awake during the day (hypersomnia)
-Abnormal movements/behaviors during sleep (parasomnia)
-Timing of sleep (circadian rhythm disorders)

Front 2

What is a key element in the sleep history

Back 2

Sleep diary

Front 3

Do sleep complaints need to be managed by a non-specialist

Back 3

No

Front 4

what conditions require a referral to a sleep disorder center

Back 4

-Sleep apnea
-Limb movements during sleep
-Narcolepsy
-Parasomnias w/ potential for injury
-Intractable insomnia

Front 5

Recording the pt's sleep overnight in the sleep lab is referred as

Back 5

Nocturnal polysomnography (PSG)

Front 6

REM sleep is also called

Back 6

Paradoxical sleep

Front 7

This stage of sleep is defined by presence of sleep spindles and K complexes.

Back 7

Stage 2

Front 8

Stage 3 and 4 sleep is also called ____ or ____

Back 8

Delta sleep or slow-wave sleep

Front 9

What is more common, chronic insomnia or transient difficulty sleeping

Back 9

Transient difficulty sleeping

Front 10

Diagnosis if this disorder involves c/o difficulty in initiating or maintaining sleep or of nonrestorative sleep for one month

Back 10

Chronic insomnia

Front 11

T or F: insomnia is more common with age and often associated w/ medical and psychiatric disorders or abuse of ETOH, drugs, and meds

Back 11

TRUE

Front 12

Primary insomnia in its "pure" form comprises a very small proportion because…

Back 12

It most often occurs as a comorbid dx

Front 13

What are the most widely used sedative-hypnotics

Back 13

Benzodiazepines

Front 14

What effects to benzos have on sleep

Back 14

-Shortening sleep latency
-Improvement of sleep continuity
-Decreased slow-wave sleep
-Decreased REM sleep

Front 15

Abuse of benzos is more often associated with simultaneous use of what substances

Back 15

ETOH and stimulants

Front 16

T or F: short-term use of benzos to treat insomnia nd long-term use to treat anxiety disorders are usually not associated with serious clinical problems

Back 16

TRUE

Front 17

What drugs are safer, benzodiazepines or barbiturates

Back 17

Benzodiazepines

Front 18

Small doses of these antidepressants have been helpful in treating insomnia

Back 18

Amitryptyline and Trazodone

Front 19

Withdrawal from prolonged administration of high dose benzos is associated with:

Back 19

-Insomnia
-Anxiety
-Seizures
-Psychosis
-Delirium tremens

Front 20

How can you reduce withdrawal sx of benzos

Back 20

Carefully tapering the dose

Front 21

Before complete discontinuation of benzos, pt should be kept on what % of initial dose for some days to weeks

Back 21

25% of initial dose

Front 22

Withdrawal sx from benzos can be treated w/ what drugs

Back 22

beta blockers - propranolol

Front 23

This condition has many forms, from atypical depression when person sleeps 14 hrs a day to a pt with narcolepsy

Back 23

Hypersomnia

Front 24

In hypersomnia, it is important to differentiate between what 3 states

Back 24

-Fatigue
-General tiredness
-Excessive daytime sleepiness (EDS)
-MI
-Sudden death

Front 25

What is the most common cause of EDS in the general population

Back 25

Chronic lack of sleep

Front 26

Conditions such as PLMS and obstructive sleep apnea may often present with what chief complaint

Back 26

EDS

Front 27

In this condition, respiratory drive "shuts off"

Back 27

Central sleep apnea

Front 28

What is the most common disease that causes EDS

Back 28

Obstructive sleep apnea

Front 29

What are general risks associated with EDS

Back 29

-Fatigue related accidents
-Inc. risk of pulmonary HTN
-Right sided heart failure
-Stroke
-MI
-Sudden death

Front 30

Obstructive sleep apnea (OSA) is most common in whom

Back 30

Overweight, middle aged men

Front 31

T or F: Snoring may disrupt sleep and lead to EDS

Back 31

TRUE

Front 32

Snoring can be controlled with what procedure

Back 32

Laser assisted uvulo-palatoplasty (LAUP)

Front 33

Uncontrollable sleep attacks where the pt abruptly falls asleep in inappropriate, embarrassing, and even dangerous situations is called

Back 33

Narcolepsy

Front 34

Most narcoleptics experience related symptoms including:

Back 34

-Cataplexy (sudden loss of muscle tone)
-Hypnagogic hallucinations (dreamlike experiences while falling asleep but not yet asleep)
-Sleep paralysis (brief paralysis w/ onset of sleep or wakefulness)

Front 35

T or F: Narcolepsy results from defective REM sleep regulation

Back 35

TRUE

Front 36

What is the treatment of OSA

Back 36

-Nasal continuous positive airway pressure (NCPAP)
-Bilevel positive airway pressure (BiPAP)

Front 37

Although some narcoleptics achieve reasonable control of their sleep attacks by structuring their days w/ scheduled naps, many require stimulants such as:

Back 37

-Methylphenidate
-Pemoline
-Modafinil

Front 38

Unusual events or behaviors occurring either during sleep or during sleep-wake transitions are called:

Back 38

Parasomnias

Front 39

Parasomnias associaed w/NREM sleep include

Back 39

-Sleep terrors
-sleepwalking
-sleep bruxism
-Confusional arousals

Front 40

Parasomnias associated w/ REM sleep include:

Back 40

-Nightmares
-Sleep paralysis

Front 41

What is another name for Jet Leg

Back 41

Asynchronosis

Front 42

Does eastward travel or westward travel take longer to adjust to and why

Back 42

Eastward due to a phase ADVANCE (of the biological clock)

Front 43

Alcohol initially increases _____ sleep and decreases _____ sleep

Back 43

(increases) Slow wave sleep; (decreases) REM sleep

Front 44

T or F: ETOH may exacerbate sleep-related respiratory disorders by potentiating sleep-related atonia during sleep

Back 44

TRUE

Front 45

Heavy alcohol dependence is associated w/ this sleep disorder

Back 45

Chronic Insomnia

Front 46

T or F: Alcohol induced sleep is usually characterized by shortened and framented sleep

Back 46

TRUE

Front 47

Benzos exhibit cross-tolerance with this substance, bearing the risk of abuse, and not likely to be helpful on a long-term basis

Back 47

Alcohol

Front 48

In the treatment of alcohol related insomnia, sedating antidepressants such as ___, ___, and ___ might be administered at low dosaged, but their therapeutic value has not been evaluated

Back 48

-Doxepin
-Trazodone
-Amitriptyline