Sleep-Wake Disorders Practice Questions

Q: Which of the following statements about somnambulism is incorrect?

The patient is in a fully conscious state.. ***The patient is in a fully conscious state.*** - Somnambulism, or **sleepwalking**, involves performing actions while an individual is in a state of **altered consciousness**, not fully conscious. - Individuals experiencing somnambulism are typically in **NREM stage 3 (deep sleep)** and are unaware of their actions with no memory of the event upon awakening. *It is characterized by sleepwalking.* - **Somnambulism** is the medical term for **sleepwalking**, encompassing a range of motor activities performed during sleep. - These activities can vary from sitting up in bed to walking, talking, or even more complex behaviors. *It is classified as a disorder of sleep arousal.* - Somnambulism falls under the category of **NREM sleep parasomnias**, specifically **Non-Rapid Eye Movement Sleep Arousal Disorders** per DSM-5. - These disorders occur during incomplete arousal from NREM sleep, when the brain is transitioning between sleep and wakefulness. *It occurs during NREM stage 3 sleep.* - Somnambulism typically occurs during the **first third of the night** when **NREM stage 3 (slow-wave sleep)** is most prominent. - This is the deepest stage of sleep, characterized by high arousal threshold and decreased responsiveness to external stimuli.

Q: Which of the following statements about sleep is incorrect?

REM sleep occurs before NREM sleep. ***REM sleep occurs before NREM sleep*** - This statement is incorrect as **NREM (Non-Rapid Eye Movement) sleep always precedes REM (Rapid Eye Movement) sleep** in a typical sleep cycle. - The sleep cycle begins with NREM stages (N1, N2, N3) and then progresses to REM sleep. *REM sleep is also called paradoxical sleep* - This statement is correct because during **REM sleep**, brain activity is very high, similar to wakefulness, yet the body experiences **muscle atonia (paralysis)**. - The paradoxical nature refers to the disconnect between an active brain and a paralyzed body. *Sleepwalking occurs during NREM sleep* - This statement is correct; **sleepwalking (somnambulism)** is a parasomnia that typically occurs during **deep NREM sleep**, specifically stage N3 (slow-wave sleep). - The brain state during NREM sleep allows for motor activity without full consciousness or memory of the event. *Dreams occur during REM sleep* - This statement is correct; while dreams can occur in NREM sleep, **vivid, detailed, and memorable dreams are most common and intense during REM sleep**. - The elevated brain activity and characteristics of REM sleep are conducive to the complex narrative and emotional content of dreams.

Q: Which of the following conditions is NOT typically associated with increased REM latency?

Narcolepsy. ***Narcolepsy*** - **Narcolepsy** is characterized by pathologically **decreased REM latency**, not increased. - Patients typically enter REM sleep within **15 minutes** of sleep onset (normal is 60-90 minutes). - **Sleep-onset REM periods (SOREMPs)** are a diagnostic hallmark of narcolepsy, seen on multiple sleep latency testing (MSLT). - Since narcolepsy is associated with *decreased* REM latency, it is definitively **NOT associated with increased REM latency**, making it the correct answer to this negation question. *First night effect* - The **first-night effect** refers to sleep disruption and increased REM latency during the first night of polysomnography in an unfamiliar environment. - This is a well-documented phenomenon that **increases REM latency** due to environmental stress and arousal. *SSRIs* - **Selective serotonin reuptake inhibitors (SSRIs)** significantly suppress REM sleep, leading to **increased REM latency** and decreased total REM sleep time. - This effect is mediated by increased serotonin, which inhibits cholinergic neurons involved in REM sleep generation. - SSRIs can increase REM latency by 30-90 minutes beyond normal values. *Restless leg syndrome* - **Restless leg syndrome (RLS)** primarily causes difficulty initiating sleep and sleep fragmentation due to uncomfortable leg sensations. - While RLS disrupts sleep architecture, its effect on REM latency is **variable and inconsistent** - some studies show minimal impact, while chronic sleep deprivation from RLS may actually decrease REM latency during rebound sleep. - However, RLS is not as clearly and consistently dissociated from increased REM latency as narcolepsy is.

Q: All are included in sleep hygiene except which of the following?

Exercising vigorously before sleep. ***Exercising vigorously before sleep*** - **Vigorous exercise** elevates body temperature, heart rate, and stimulates the central nervous system, making it harder to fall asleep and reducing sleep quality. - This practice directly contradicts the principles of sleep hygiene, which promote relaxing activities before bedtime. - While regular exercise is beneficial for sleep, it should be completed at least **3-4 hours before bedtime**. *Healthy diet* - A **balanced diet** and mindful eating patterns are important components of sleep hygiene. - Sleep hygiene recommendations include avoiding **heavy meals, caffeine, and alcohol** close to bedtime, as these can disrupt sleep quality. - Proper nutrition supports the physiological processes necessary for restorative sleep. *Sleeping on time* - Maintaining a **consistent sleep schedule**, even on weekends, helps regulate the body's natural **circadian rhythm**. - This consistency reinforces the sleep-wake cycle, making it easier to fall asleep and wake up naturally. - Going to bed and waking up at the same time daily is a cornerstone of good sleep hygiene. *Sleeping in a dark room* - A **dark environment** signals to the brain that it's time to release **melatonin**, the hormone that promotes sleep. - Exposure to light, especially blue light from screens, can suppress melatonin production and interfere with sleep onset. - Creating an optimal sleep environment (dark, quiet, cool) is a fundamental sleep hygiene principle.

Q: Child wakes up at night sweating and terrified, does not remember the episode - diagnosis?

Night terrors. ***Night terrors*** - **Night terrors** are characterized by partial arousals from **deep non-REM sleep** (typically N3 stage), often accompanied by loud screams, thrashing, and autonomic symptoms like sweating and tachycardia. - The child is very difficult to awaken or comfort during an episode and, crucially, has **no memory of the event** upon waking, which differentiates it from nightmares. *Narcolepsy* - **Narcolepsy** is a chronic neurological condition characterized by overwhelming daytime **sleepiness** and sudden attacks of sleep. - It often involves **cataplexy** (sudden loss of muscle tone triggered by strong emotions) and **hypnagogic/hypnopompic hallucinations**, which are not described. *Nightmares* - **Nightmares** are vivid, frightening dreams that occur during **REM sleep** and typically result in full awakening and the ability to **recall the dream content**. - While they cause fear and distress, episodes do not usually involve the terrified unresponsiveness or lack of recall seen in night terrors. *Somnambulism* - **Somnambulism** (sleepwalking) occurs during **deep non-REM sleep**, and affected individuals may perform complex actions while partially aroused. - While there is amnesia for the event, prominent features like **sweating and intense terror** are not typical components of sleepwalking.

Q: Which of the following parasomnias is characterized by sudden arousal from deep NREM sleep with intense fear and no memory of the event?

Night terrors. ***Night terrors*** - Night terrors are a **parasomnia** that occurs during **NREM sleep**, specifically during stage N3 (slow-wave sleep). - They are characterized by **sudden arousal from sleep** accompanied by screaming, intense fear, and autonomic activation, with **no recall of the event** upon waking. - This combination of features (arousal from deep sleep + intense fear + amnesia) distinguishes night terrors from other NREM parasomnias. *Sleepwalking* - Somnambulism is also a parasomnia occurring during **NREM stage N3** (slow-wave sleep). - However, it involves **complex motor behaviors** during sleep rather than the sudden fearful arousal characteristic of night terrors. - Unlike night terrors, there is usually no associated screaming or expression of intense fear during the episode. *Excessive daytime sleepiness (narcolepsy)* - **Narcolepsy** is a chronic neurological condition characterized by overwhelming daytime drowsiness and sudden sleep attacks. - It involves dysregulation of **REM sleep** processes, including direct entry into REM sleep (sleep-onset REM periods). - This is not a parasomnia and is not associated with NREM sleep phenomena. *Bruxism (teeth grinding)* - Bruxism can occur during **both NREM and REM sleep** but is most frequently observed during lighter NREM stages (N1 and N2). - It involves rhythmic jaw muscle activity without the arousal, fear response, or amnesia seen in night terrors. - While it occurs during NREM sleep, it lacks the characteristic sudden arousal with terror.

Q: What is the primary characteristic feature of Klein-Levin syndrome?

Hypersomnia. ***Hypersomnia*** - **Hypersomnia** is the cardinal and primary characteristic feature of Klein-Levin syndrome, characterized by recurrent episodes of excessive sleepiness lasting days to weeks. - During these episodes, individuals may sleep for **16 to 20 hours a day** and are extremely difficult to awaken. - Episodes are often accompanied by **cognitive disturbances** (confusion, derealization), **behavioral changes** (apathy, hyperphagia, hypersexuality), but **hypersomnia remains the defining feature**. - Normal functioning returns between episodes. *Insomnia* - **Insomnia** (difficulty falling or staying asleep) is the opposite of the key symptom seen in Klein-Levin syndrome. - Klein-Levin syndrome is a disorder of excessive sleep, not sleep deprivation. *Anxiety* - **Anxiety** may occur as a secondary feature or during the distress of episodes, but it is not the primary characteristic feature. - The core pathology manifests as profound sleep disturbance, not an anxiety disorder. *Depression* - **Depression** is sometimes observed during or after episodes of Klein-Levin syndrome, but it is not the primary defining feature. - The diagnostic hallmark is the **recurrent hypersomnia with associated cognitive and behavioral symptoms**, not mood disturbance.

Q: Which of the following statements about narcolepsy is false?

Sleep architecture normal. ***Sleep architecture normal*** ✓ **This is the FALSE statement** - Narcolepsy is characterized by **abnormal sleep architecture**, specifically an **abbreviated latency to REM sleep** (often <15 minutes, compared to normal 90 minutes). - Patients experience **fragmented nighttime sleep** with frequent awakenings and difficulty maintaining continuous sleep. - Sleep studies show **disrupted sleep-wake cycles** and **premature entry into REM sleep**. *Loss of muscle tone* - TRUE statement - **Loss of muscle tone** is the defining feature of **cataplexy**, a hallmark symptom of narcolepsy type 1. - Sudden emotional triggers (laughter, surprise, anger) lead to muscle weakness or paralysis without loss of consciousness. - This reflects neurological dysfunction affecting muscle control regulation during wakefulness. *Hallucination* - TRUE statement - **Hypnagogic hallucinations** (upon falling asleep) and **hypnopompic hallucinations** (upon waking) are common in narcolepsy. - These vivid, dream-like experiences occur during sleep-wake transitions due to intrusion of REM sleep phenomena into wakefulness. - Can involve visual, auditory, or tactile sensations. *Cataplexy* - TRUE statement - **Cataplexy** is a hallmark symptom of **narcolepsy type 1** (narcolepsy with cataplexy). - Involves sudden, brief episodes of bilateral muscle weakness or paralysis triggered by strong emotions. - Results from loss of hypocretin (orexin) neurons in the hypothalamus.

Q: Cataplexy is characterized by?

Sudden loss of muscle tone. ***Sudden loss of muscle tone*** - **Cataplexy** is specifically defined by a sudden, brief loss of **muscle tone** while awake, often triggered by strong emotions like laughter or anger. - This loss of muscle tone is similar to the muscle paralysis experienced during **REM sleep**, but occurs while the individual is fully conscious. *Hypnopompic hallucinations* - **Hypnopompic hallucinations** are vivid, dream-like experiences that occur when waking up from sleep. - While frequently associated with **narcolepsy**, they are not the defining characteristic of **cataplexy** itself. *Generalized muscle weakness* - While cataplexy involves muscle weakness, it is a **sudden and transient loss of tone** rather than a sustained, generalized weakness. - **Generalized muscle weakness** can be a symptom of many other conditions and does not accurately describe the abrupt, emotion-triggered nature of cataplexy. *Nocturnal penile tumescence* - **Nocturnal penile tumescence (NPT)** is the occurrence of spontaneous erections during sleep and is a normal physiological process. - It is used in the differential diagnosis of erectile dysfunction to distinguish between organic and psychogenic causes, and has no direct relation to **cataplexy**.

Q: Narcolepsy is associated with?

Hypnagogic hallucination. ***Hypnagogic hallucination*** - **Hypnagogic hallucinations** are vivid, dream-like perceptual experiences occurring at **sleep onset** and are one of the **classic tetrad features** of narcolepsy. - They occur in **30-60% of narcolepsy patients** and result from the intrusion of **REM sleep phenomena** into the transition from wakefulness to sleep. - These hallucinations reflect the **REM sleep dysregulation** that is central to narcolepsy pathophysiology. - Other tetrad features include **excessive daytime sleepiness, cataplexy, and sleep paralysis**. *Late age of onset* - Narcolepsy typically has an **early age of onset**, most commonly between **10-25 years** (adolescence and young adulthood). - Peak onset is around **15 years of age**. - Late-onset narcolepsy is uncommon and may suggest secondary causes. *Normal sleep architecture* - Narcolepsy is characterized by **disrupted sleep architecture**, not normal architecture. - Key abnormalities include **sleep-onset REM periods (SOREMPs)**, where patients enter REM sleep within **15 minutes** of sleep onset, bypassing normal NREM stages. - Nocturnal sleep is **fragmented** with frequent awakenings. *Decreased NREM sleep* - While narcolepsy involves **REM sleep dysregulation** with premature REM entry, characterizing it simply as "decreased NREM sleep" is not the standard clinical description. - The primary pathology is **abnormal REM sleep timing and distribution**, including SOREMPs during daytime naps and nighttime sleep. - The focus is on **REM sleep intrusion** rather than NREM reduction per se.

Question 1

Which of the following statements about somnambulism is incorrect?

Accepted Answer

The patient is in a fully conscious state.

Answer

It is characterized by sleepwalking.

Answer

It is classified as a disorder of sleep arousal.

Answer

It occurs during NREM stage 3 sleep.

Question 2

Which of the following statements about sleep is incorrect?

Accepted Answer

REM sleep occurs before NREM sleep

Answer

Sleepwalking occurs during NREM sleep

Answer

Dreams occur during REM sleep

Answer

REM sleep is also called paradoxical sleep

Question 3

Which of the following conditions is NOT typically associated with increased REM latency?

Accepted Answer

Narcolepsy

Answer

First night effect

Answer

SSRIs

Answer

Restless leg syndrome

Question 4

All are included in sleep hygiene except which of the following?

Accepted Answer

Exercising vigorously before sleep

Answer

Healthy diet

Answer

Sleeping on time

Answer

Sleeping in dark room

Question 5

Child wakes up at night sweating and terrified, does not remember the episode - diagnosis?

Accepted Answer

Night terrors

Answer

Narcolepsy

Answer

Nightmares

Answer

Somnambulism

Question 6

Which of the following parasomnias is characterized by sudden arousal from deep NREM sleep with intense fear and no memory of the event?

Accepted Answer

Night terrors

Answer

Sleepwalking

Answer

Excessive daytime sleepiness (narcolepsy)

Answer

Bruxism (teeth grinding)

Question 7

What is the primary characteristic feature of Klein-Levin syndrome?

Accepted Answer

Hypersomnia

Answer

Insomnia

Answer

Anxiety

Answer

Depression

Question 8

Which of the following statements about narcolepsy is false?

Accepted Answer

Sleep architecture normal

Answer

Loss of muscle tone

Answer

Hallucination

Answer

Cataplexy

Question 9

Cataplexy is characterized by?

Accepted Answer

Sudden loss of muscle tone

Answer

Generalized muscle weakness

Answer

Hypnopompic hallucinations

Answer

Nocturnal penile tumescence

Question 10

Narcolepsy is associated with?

Accepted Answer

Hypnagogic hallucination

Answer

Late age of onset

Answer

Decreased NREM sleep

Answer

Normal sleep architecture

Sleep-Wake Disorders — MCQs

Sleep-Wake Disorders — MCQs

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