Sleep-Wake Disorders Practice Questions

Q: Somnambulism is seen in

NREM 3. ***NREM 3*** - Somnambulism, or **sleepwalking**, primarily occurs during **non-rapid eye movement (NREM) sleep stage 3 (N3)**, which is the deepest stage of sleep. - During NREM 3, brain activity shows **slow-wave activity**, and individuals are difficult to arouse, making it ideal for complex behaviors without conscious awareness. *REM* - **Rapid Eye Movement (REM) sleep** is characterized by vivid dreaming and **muscle atonia** (paralysis). - Muscle atonia prevents individuals from acting out their dreams, so somnambulism does not typically occur during REM sleep. *NREM 1* - **NREM stage 1 (N1)** is the lightest stage of sleep, serving as a transition from wakefulness. - It is characterized by slow eye movements and easily aroused states, making complex behaviors like sleepwalking unlikely. *NREM 2* - **NREM stage 2 (N2)** is a slightly deeper stage than N1, characterized by **sleep spindles** and **K-complexes** on an EEG. - While brief movements can occur, somnambulism is not characteristic of N2 and is much more prevalent in N3.

Q: In narcolepsy, the polysomnographic recording typically shows which of the following patterns?

REM intrusion during inappropriate periods. ***REM intrusion during inappropriate periods*** - In narcolepsy, the hallmark polysomnographic finding is **sleep-onset REM periods (SOREMPs)** - the occurrence of REM sleep within 15 minutes of sleep onset. - The **Multiple Sleep Latency Test (MSLT)** in narcolepsy typically shows **≥2 SOREMPs** along with a mean sleep latency of ≤8 minutes. - Clinically, this **REM sleep intrusion** manifests as **sudden, irresistible sleep attacks** during the day, **cataplexy** (sudden muscle weakness triggered by strong emotions), **sleep paralysis**, and **hypnagogic/hypnopompic hallucinations**. - These represent features of REM sleep (muscle atonia, dreams) occurring at inappropriate times. *An absence of REM sleep in midcycle* - This statement is incorrect as narcolepsy is characterized by an **abnormal presence and early onset of REM sleep**, not its absence. - Individuals with narcolepsy enter REM sleep much faster than normal (often within minutes rather than the typical 90 minutes). *Extreme muscular relaxation* - While **cataplexy** (present in Type 1 narcolepsy) involves sudden loss of muscle tone due to REM-related atonia during wakefulness, this is a clinical symptom rather than a continuous polysomnographic finding. - Polysomnography focuses on **sleep architecture** and the timing of **REM sleep onset**, not general muscle relaxation patterns. *Spike-and-wave EEG recording* - **Spike-and-wave patterns** on EEG are characteristic of **absence seizures** (a form of epilepsy), not narcolepsy. - Narcolepsy is a primary **sleep disorder** with distinct polysomnographic features related to **REM sleep dysregulation**, not epileptiform activity.

Q: Drug of choice for night terrors:

Clonazepam. ***Clonazepam*** - **Clonazepam**, a benzodiazepine, is the **drug of choice** for night terrors due to its ability to suppress Stage 3 and 4 **slow-wave sleep**, where night terrors occur. - Its sedative and anxiolytic effects help to calm the patient and reduce the frequency and severity of these episodes. *Tricyclic antidepressant* - While some **tricyclic antidepressants** (TCAs) have sedative properties, they are generally not the first-line treatment for night terrors. - Their side effect profile and potential to alter other sleep stages make them less suitable than benzodiazepines for this specific parasomnia. *Meprobamate* - **Meprobamate** is an anxiolytic and sedative drug that is largely historical and has been replaced by safer and more effective alternatives like benzodiazepines. - It has a higher risk of dependence and side effects compared to modern treatments for sleep disorders. *Diazepam* - **Diazepam** is another benzodiazepine, but **clonazepam** is generally preferred for night terrors due to its longer half-life and specific efficacy in suppressing slow-wave sleep. - While diazepam could offer some relief, clonazepam is considered more effective for sustained management of this condition.

Q: A 32-year-old man comes to the physician complaining of excessive sleepiness for the past several months. He reports falling asleep while dealing with customers and had a near accident when he fell asleep while driving. The patient reports that he occasionally hears voices while falling asleep and finds himself "temporarily frozen" and unable to move upon awakening. Which of the following is the most appropriate treatment for this patient?

Modafinil. ***Modafinil*** - The patient's symptoms of **excessive daytime sleepiness** (EDS), **hypnagogic hallucinations** (hearing voices while falling asleep), and **sleep paralysis** are classic signs of **narcolepsy**. - **Modafinil** is a **non-amphetamine stimulant** that promotes wakefulness and is a first-line treatment for narcolepsy, improving alertness and reducing EDS. *Melatonin* - **Melatonin** is a hormone involved in regulating the **sleep-wake cycle** and is primarily used for **insomnia**, **jet lag**, or **circadian rhythm disorders**. - It is not effective for treating the hallmark symptoms of narcolepsy, such as cataplexy or excessive daytime sleepiness. *Clonazepam* - **Clonazepam** is a **benzodiazepine** that acts as a central nervous system depressant, primarily used for **anxiety disorders**, seizures, and some sleep disorders like **REM sleep behavior disorder**. - While it can help with some parasomnias, it would worsen daytime sleepiness in a patient with narcolepsy and is not a primary treatment for its core symptoms. *Continuous positive airway pressure* - **Continuous positive airway pressure (CPAP)** is the standard treatment for **obstructive sleep apnea (OSA)**, a condition characterized by recurrent upper airway collapse during sleep. - Although OSA can cause excessive daytime sleepiness, the patient's additional symptoms of hypnagogic hallucinations and sleep paralysis are not typical of OSA, making narcolepsy and its specific treatments more appropriate.

Q: A person wakes up from REM sleep frightened and remembering vivid, fearful dreams. Diagnosis is -

Nightmares. ***Nightmares*** - Nightmares are **frightening dreams** that typically occur during **REM sleep** and can be vividly recalled upon waking. - The individual wakes up feeling **fearful** and can remember the detailed content of the dream. *Narcolepsy* - This sleep disorder is characterized by **excessive daytime sleepiness** and sudden attacks of sleep, often with **cataplexy** (sudden loss of muscle tone). - While narcolepsy can involve vivid, frightening dreams, the primary complaint here is the dream itself, not the daytime sleepiness or cataplexy. *Night terrors* - Night terrors typically occur during **NREM sleep** (stages 3 and 4), not REM sleep, and are characterized by intense fear, screaming, and autonomic arousal. - The person usually has **no memory of the event** upon waking, in contrast to the vivid recall described in the question. *Somnambulism* - Also known as **sleepwalking**, somnambulism occurs during **NREM sleep** and involves complex behaviors performed while still asleep. - There is typically **no memory of the event**, and it is not associated with frightening dreams or waking up terrified.

Q: Which of the following is false about narcolepsy?

Typically occurs only during nighttime sleep. ***Typically occurs only during nighttime sleep*** - Narcolepsy is characterized by **excessive daytime sleepiness** and sudden, uncontrollable urges to sleep during the day, not exclusively nighttime sleep. - Patients with narcolepsy often experience disrupted nocturnal sleep, including **frequent awakenings** and vivid dreams. *Sudden loss of muscle tone (cataplexy)* - This statement accurately describes **cataplexy**, a hallmark symptom of narcolepsy, which is a sudden, brief loss of **muscle tone** triggered by strong emotions. - Cataplexy is a key diagnostic feature, though not all individuals with narcolepsy experience it. *Cataplexy is a common symptom* - **Cataplexy is indeed common** in narcolepsy, particularly in Narcolepsy Type 1, where it is caused by a deficiency in **hypocretin (orexin)**. - It is a defining characteristic for diagnosing narcolepsy with cataplexy. *Typical onset in the second decade of life* - The onset of narcolepsy symptoms, including excessive daytime sleepiness and cataplexy, often occurs during **adolescence or early adulthood**, typically between the ages of 10 and 25. - This timing can significantly impact education and social development.

Q: Which of the following best describes female sexual interest/arousal disorder?

Reduced sexual interest/arousal in female. ***Reduced sexual interest/arousal in female*** - This accurately defines **female sexual interest/arousal disorder**, characterized by a significant decrease in **sexual interest**, **arousal**, or both. - Diagnostic criteria include diminished or absent **sexual thoughts**, **fantasies**, and **receptivity to sexual activity**, as well as reduced **genital** or **nongenital sensations** during sexual activity. - This is the **correct answer** as per DSM-5 criteria for this disorder. *Inability to initiate sexual arousal in male* - This describes a **male sexual dysfunction**, specifically related to **erectile difficulties** or **low libido** in men, not female sexual interest/arousal disorder. - It refers to problems with **achieving** or **maintaining an erection**, or a lack of **sexual desire** in a male, which is distinct from the female condition. *Ejaculation occurring immediately after penetration* - This describes **premature ejaculation**, a **male sexual dysfunction**, not related to female sexual interest/arousal disorder. - **Premature ejaculation** involves a persistent pattern of ejaculation occurring within approximately one minute of vaginal penetration and before the individual wishes it. *None of the options* - This option is **incorrect** because "Reduced sexual interest/arousal in female" accurately and completely describes female sexual interest/arousal disorder. - Since a correct option exists among the choices, this statement is false.

Q: Hypnagogic hallucinations are seen in ?

Narcolepsy. ***Narcolepsy*** - **Hypnagogic hallucinations** are vivid, often terrifying perceptual experiences that occur right as a person is falling asleep (sleep onset). They are a common symptom of **narcolepsy**. - Other key symptoms of narcolepsy include **excessive daytime sleepiness**, **cataplexy** (sudden loss of muscle tone triggered by strong emotions), and **sleep paralysis**. *Schizophrenia* - While hallucinations are a hallmark of **schizophrenia**, they are typically **auditory** and occur in a clear state of consciousness, not specifically at sleep onset. - Schizophrenia is characterized by a broader range of symptoms including **delusions**, disorganization of thought, and negative symptoms. *Depression* - Depression can involve sleep disturbances like **insomnia** or **hypersomnia**, but it is generally not associated with hypnagogic hallucinations. - Core symptoms relate to **mood disturbance**, anhedonia, and vegetative symptoms. *Mania* - Mania, a feature of bipolar disorder, can lead to **reduced need for sleep** and racing thoughts, but not typically hypnagogic hallucinations. - Psychotic features like hallucinations can occur in severe mania, but they are not characteristically tied to sleep onset.

Q: Narcolepsy is due to abnormality in

Hypothalamus. ***Hypothalamus*** - **Narcolepsy** is primarily caused by the loss of neurons in the **hypothalamus** that produce **hypocretin (orexin)**. - Hypocretin plays a crucial role in regulating **wakefulness** and suppressing REM sleep. *Thalamus* - The thalamus acts as a **relay station** for sensory information and is involved in arousal and consciousness, but not the primary cause of narcolepsy. - Abnormalities in the thalamus are more commonly associated with conditions like **fatal familial insomnia** or **thalamic pain syndrome**. *Cerebellum* - The cerebellum is primarily involved in **motor control**, coordination, and balance. - Its dysfunction is associated with **ataxia** and movement disorders, not narcolepsy. *Medulla oblongata* - The medulla oblongata controls vital autonomic functions such as **breathing** and **heart rate**. - While important for overall physiological regulation, it is not directly implicated in the pathogenesis of narcolepsy.

Q: Kleine-Levin syndrome is associated with:

Hypersomnia. ***Hypersomnia*** - **Kleine-Levin syndrome** is characterized by recurrent episodes of **hypersomnia**, meaning excessive sleepiness. - Patients can sleep for 16 to 20 hours a day during these episodes, which may last for days or weeks. *Depression* - While mood disturbances can occur, **Kleine-Levin syndrome** primarily involves sleep and behavioral changes, not core symptoms of **depression**. - **Depression** is typically characterized by persistent low mood, anhedonia, and other symptoms, rather than episodic hypersomnia alone. *Anxiety* - **Anxiety** is not a primary symptom or defining characteristic of **Kleine-Levin syndrome**. - Patients may experience frustration or irritability due to their condition, but generalized anxiety is not a core feature. *Chronic insomnia* - **Chronic insomnia**, which is difficulty falling or staying asleep, is actually the opposite of the key symptom in **Kleine-Levin syndrome**. - The hallmark of Kleine-Levin syndrome is **excessive sleepiness (hypersomnia)**, not difficulty sleeping.

Question 1

Somnambulism is seen in

Accepted Answer

NREM 3

Answer

REM

Answer

NREM 1

Answer

NREM 2

Question 2

In narcolepsy, the polysomnographic recording typically shows which of the following patterns?

Accepted Answer

REM intrusion during inappropriate periods

Answer

An absence of REM sleep in midcycle

Answer

Extreme muscular relaxation

Answer

Spike-and-wave EEG recording

Question 3

Drug of choice for night terrors:

Accepted Answer

Clonazepam

Answer

Tricyclic antidepressant

Answer

Meprobamate

Answer

Diazepam

Question 4

A 32-year-old man comes to the physician complaining of excessive sleepiness for the past several months. He reports falling asleep while dealing with customers and had a near accident when he fell asleep while driving. The patient reports that he occasionally hears voices while falling asleep and finds himself "temporarily frozen" and unable to move upon awakening. Which of the following is the most appropriate treatment for this patient?

Accepted Answer

Modafinil

Answer

Melatonin

Answer

Clonazepam

Answer

Continuous positive airway pressure

Question 5

A person wakes up from REM sleep frightened and remembering vivid, fearful dreams. Diagnosis is -

Accepted Answer

Nightmares

Answer

Narcolepsy

Answer

Night terrors

Answer

Somnambulism

Question 6

Which of the following is false about narcolepsy?

Accepted Answer

Typically occurs only during nighttime sleep

Answer

Sudden loss of muscle tone (cataplexy)

Answer

Cataplexy is a common symptom

Answer

Typical onset in the second decade of life

Question 7

Which of the following best describes female sexual interest/arousal disorder?

Accepted Answer

Reduced sexual interest/arousal in female

Answer

Inability to initiate sexual arousal in male

Answer

Ejaculation occurring immediately after penetration

Answer

None of the options

Question 8

Hypnagogic hallucinations are seen in ?

Accepted Answer

Narcolepsy

Answer

Schizophrenia

Answer

Depression

Answer

Mania

Question 9

Narcolepsy is due to abnormality in

Accepted Answer

Hypothalamus

Answer

Thalamus

Answer

Cerebellum

Answer

Medulla oblongata

Question 10

Kleine-Levin syndrome is associated with:

Accepted Answer

Hypersomnia

Answer

Depression

Answer

Anxiety

Answer

Chronic insomnia

Sleep-Wake Disorders — MCQs

Sleep-Wake Disorders — MCQs

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