Sleepy Science
Which brain nucleus regulates circadian rhythm and melatonin release?
Suprachiasmatic nucleus (SCN) in the hypothalamus.
DSM-5 definition of chronic insomnia requires symptoms for how long?
≥3 months, at least 3 times per week
Gold standard test for diagnosing OSA?
Polysomnography
Four essential diagnostic features of RLS?
Urge to move, worse at rest, relieved by movement, worse at night.
Which parasomnia is most associated with neurodegenerative disease?
REM Behavior Disorder.
Which hypnotics are on the Beers Criteria list to avoid in older adults?
Long-acting benzos, diphenhydramine, TCAs.
This is the first-line pharmacologic class recommended for treating late-life depression due to favorable side-effect profile and efficacy.
What are SSRIs?
Which sleep stage decreases most with aging?
Slow-wave sleep (Stage N3)
Name one validated scale to assess sleep quality.
Pittsburgh Sleep Quality Index (PSQI)
Classic triad of OSA symptoms?
Loud snoring, witnessed apneas, daytime sleepiness
First-line pharmacologic therapy for RLS?
Dopamine agonists (pramipexole, ropinirole).
What medication is most effective for RBD?
Clonazepam is most effective but melatonin for our elderly adults!
What medication helps with both sleep and mood?
Mirtazipine and trazadone
Elderly adults with late-onset depression are at increased risk of this neurodegenerative condition, making cognitive screening important.
Dementia
What hormone is released at night to promote sleep?
Melatonin
Most common insomnia complaint in elderly?
Difficulty maintaining sleep / early morning awakening
First-line treatment for moderate-severe OSA?
CPAP (Continuous Positive Airway Pressure)
Lab test to check in all RLS patients?
Serum ferritin
Which parasomnia involves dream enactment behaviors during REM?
REM Behavior Disorder.
Which melatonin receptor agonist is FDA-approved for blind patients with non-24-hour sleep-wake disorder?
Tasimelteon
Which psychotherapy has proven effective for depressed older adults, including those with cognitive impairment and executive dysfunction?
Problem-solving therapy
How many minutes is one typical adult sleep cycle?
90–110 minutes
What first-line therapy is recommended for chronic insomnia in older adults?
Cognitive Behavioral Therapy for Insomnia (CBT-I)
OSA is associated with what major comorbid conditions?
Hypertension, cardiovascular disease, stroke
PLMD typically occurs during which sleep stage?
NREM.
Which NREM parasomnia is rare in older adults but common in kids?
Sleepwalking.
Which short-acting hypnotics are considered safer in the elderly for short-term use?
Zolpidem, eszopiclone.
What is the most effective treatment for severe or refractory late-life depression, especially when patients are suicidal or have not responded to antidepressants?
Electroconvulsive therapy (ECT)
Which neurotransmitter is excitatory in the ascending arousal system?
Acetylcholine
What comorbid psychiatric condition is most associated with insomnia in older adults?
Depression
Which screening questionnaire assesses daytime sleepiness?
Epworth Sleepiness Scale
Name one alternative to dopamine agonists for RLS.
Gabapentin, pregabalin.
What is the safest treatment option for elderly patients with RBD?
Melatonin.
What’s the first-line pharmacologic therapy for moderate to severe RLS?
Dopamine agonists.
What is a common electrolyte abnormality associated with SSRI use in older adults?
Hyponatremia