Normal Sleep
Which stage of sleep occupies the most amount of time?
Stage 2
What are the 4 main features of narcolepsy?
cataplexy, hypnogogic hallucinations, sleep attacks, and sleep paralysis
What medication is used to treat nightmares in PTSD and what is the mechanism of action?
Prazosin
alpha 1 agonist
Which treatment has the best outcomes for treatment of insomnia?
CBT
A 34 year old obese main has difficulty falling asleep at night until 3am and is unable to wake up until the afternoon. This has caused him to lose several jobs and created difficulty in his relationships. What is the most likely diagnosis?
How often do normal people cycle between REM and non-REM sleep?
90 minutes
Cataplexy is present in what % of patients with narcolepsy?
60%
True or False: REM sleep latency is shortened during schizophrenia exacerbations
True
According to DSM, how often and for how long must sleep difficulty be present to meet criteria for insomnia?
at least 3 nights a week for at least 3 months
What are 4 treatments for obstructive sleep apnea?
weight loss, CPAP, surgery, stimulants (modafanil)
Which neurotransmitter ceases to fire during sleep? Where does it originate?
Histamine
tuberomammillary nucleus
What are 4 drugs approved to treat narcolepsy?
sodium oxybate, modafanil (and armodafanil), methylphenidate, amphetamine
decreased slow wave sleep
decreased REM latency
decreased total sleep time
increased sleep-onset latency
What sleep disorder is prodromal in 80% of patients with Lewy body dementia?
REM sleep behavior disorder
Also a risk factor for other alpha-synuclein neuropathologies: Parkinson’s (33-50%), multiple system atrophy (80-95%)
How is muscle tone normally suppressed during REM sleep? In which disease is this disrupted?
Activation of cholinergic neurons in the brainstem → inhibition of spinal motor neurons
disrupted in REM sleep behavior disorder
Which brain structure regulates circadian rhythm?
suprachiasmatic nucleus in the anterior hypothalamus
What pathway is dysfunctional in narcolepsy?
Hypocretin (orexin) peptide pathway
Hypocretin neurons in the lateral hypothalamus project to NE, DA, Ach neurons, modulates wide range of outputs related to arousal and motivated behavior
How is sleep change with alcohol use (increased or decreased sleep latency and REM sleep)? What happens to stage 4 sleep?
decreased sleep latency
decreased REM sleep
fragmentation of stage 4 sleep
A 15 year old male comes to the clinic endorsing excessive daytime sleepiness, cognitive impairment. Per mom, he has been eating a lot more lately, apathetic, and hypersexual. What is the most likely diagnosis?
Kleine-Levin Syndrome
Recurrent episodes of hypersomnia associated with cognitive an behavioral disturbances such as confusion, derealization, apathy, compulsive eating, and hypersexuality. Episodes last days-weeks and are separated by weeks-months of normal sleep/behavior. Associated with abnormal birth history (long labor, hypoxia, prematurity), genetic factors (Ashkenazi Jews), infectious/immune-mediated theories, Klinefelter syndrome, von Willebrand disease, polycystic kidneys, and ASD.
Which TCA is least likely to cause sedation and is used off-label for narcolepsy and somnolence related to sleep apnea?
Protryptiline