Insomnia
Which class of medications used to treat insomnia is most associated with parasomnias?
NBRAs (Z Drugs)
Name 2 potential secondary causes of RLS.
Medications: D2 receptor antagonists, caffeine, antihistamines, antidepressants, lithium, phenytoin, beta blockers
Narcolepsy may be caused by a deficiency in which neurotransmitter?
Hypocretin (orexin)
What is the difference between apnea and hypopnea?
Apnea is complete airway obstruction. Hypopnea is partial airway obstruction
Name 2 principles of good sleep hygiene.
Set regular time to go to bed and wake up
Regular, moderate exercise daily
Make bedroom cool, dark, and quiet
Sleep only as much as needed to feel refreshed and alert
Avoid or minimize caffeine and tobacco in afternoon/evening
Limit alcohol to 1-2 drinks per day
Cover clock to minimize risk of focusing on it during the night
Light snack or beverage before bedtime if hungry
Which of the following would be the best pharmacologic option for a patient with problems falling asleep only?
A.Zolpidem IR
B.Eszopiclone
C.Zolpidem CR
D.Zolpidem SL
Zolpidem IR
Which of the following is most likely to lead to augmentation with prolonged use?
A.Carbidopa/levodopa
B.Clonazepam
C.Gabapentin enacarbil
D.Methadone
A. Carbidopa/levodopa
What is a first-line treatment option for excessive daytime sleepiness associated with narcolepsy?
Sodium oxybate
Pitolisant
Modafinil
Solriamfetol
What are three symptoms of OSA?
•Concentration, memory problems
•EDS
•Morning headaches
•Loud snoring
•Gasping/choking while sleeping
•Nausea
•Frequent nighttime urination
•Irritability/feelings of depression
People who sleep < 7 hours per night are more likely to:
A.Be current smokers
B.Have active AUD
C.Develop COPD
D.Develop ESRD
Be current smokers (also have obesity, be sedentary)
To meet diagnostic criteria for insomnia, symptoms need to occur > ____ nights per week for > ______ months.
> 3 nights per week for > 3 months
Oral iron supplementation should be recommended for patient with RLS and a ferritin level < _____ mcg/L.
75 mcg/L
Name the 4 components of the narcolepsy tetrad.
1.Excessive daytime sleepiness
2.Cataplexy
3.Hallucinations
4.Sleep paralysis
What is the weight loss goal for an obese patient with OSA?
Goal BMI < 25 kg/m2
10% weight loss may reduce Apnea Hypopnea Index score by > 20%
What are the three most common sleep wake disorders?
Insomnia, OSA, RLS
Which of the following is least likely to contribute to s/s of insomnia?
A.Armodafinil
B.Benztropine
C.Carbamazepine
D.Lisinopril
D. Lisinopril
What is the minimum daily dose of pregabalin that would be expected to improve RLS symptoms?
150 mg
Which medication for narcolepsy is dosed at bedtime and then again 2.5-4 hours later?
Sodium oxybate
What does CPAP stand for?
Continuous Positive Airway Pressure
Which sleep stage accounts for approximately half of total sleep time?
Stage N2
Which medication used to treat insomnia may decrease testosterone in men?
Ramelteon
Which of the following is the best first-line treatment option for an obese elderly patient with RLS?
A.Methadone
B.Pramipexole
C.Pregabalin
D.Carbidopa/levodopa
B. Pramipexole
Which medication used for RLS may decrease the effectiveness of oral contraceptives?
Armodafinil, modafinil
A 62 year old female patient is complaining of excessive tiredness during the day. Her husband says that she snores and often stops breathing for short periods during the night. She has hypertension. Her BMI is 32 and her neck circumference is 18 inches. What is her STOP-band score?
6 (snoring, tired, observed apnea, high blood pressure, age, neck circumference)
= high risk
How many REM cycles do most people go through each night?
4-5