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Day # 159: Sleep Disorders Review Quiz

Writer's picture: Marcus HuntMarcus Hunt

Today will be our review quiz on the sleep disorders theme. Take a few minutes to check your learning.



1) Which circadian rhythm sleep disorder (CRSD) would you treat with early morning light exposure?

a) Advanced Sleep Phase Disorder (ASPD)

b) Delayed Sleep Phase Disorder (DSPD)

c) Shift-Work Type



2) Which of the following combinations best represents diagnostic criteria for insomnia disorder?

a) Difficulty initiating or maintaining sleep, symptoms lasting for at least 3 weeks, and distress explained by a coexisting mental disorder.

b) Early-morning awakenings, symptoms persisting for at least 3 months, and impairment despite adequate sleep opportunity.

c) Sleep dissatisfaction with significant distress, symptoms attributed to environmental factors, and episodic occurrence.

d) Difficulty falling asleep, linked to substance use, with symptoms causing minimal functional impairment.



3) Patients with narcolepsy may have intense emotions that can cause sudden muscle weakness, often linked to brief episodes of bilateral muscle tone loss. What is this called?

a) Periodic limb movements

b) Hypnopompic movements

c) Hypnogogic movements

d) Cataplexy

e) Catalepsy

f) Sleep paralysis



4) Which of the following accurately highlights a difference between Restless Legs Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD)?

a) RLS occurs exclusively during sleep, while PLMD can occur both during rest and sleep.

b) PLMD is often associated with an urge to move the legs, whereas RLS involves only involuntary leg movements.

c) RLS symptoms are relieved by voluntary movement, while PLMD movements persist without conscious control during sleep.

d) Individuals with RLS are typically unaware of their symptoms, while those with PLMD are fully conscious of their movements.



 


Answers


Question 1:

From day #152


Answer: b

Delayed Sleep Phase Disorder (DSPD)


Explanation:


Light therapy

  • Bright lights (>10,000 lux) can adjust the internal biological clock.

  • Delayed sleep phase (and irregular type) –treat with early morning light exposure.

  • Advanced phase – treat with evening light exposure.

  • Shift-work type – treat with light exposure prior to starting their shift and bright lights continued from early in the night shift through 2 hours before shift ends.

  • Light therapy is being investigated in non-24.



Question 2:

From day #153


Answer: b

Early-morning awakenings, symptoms persisting for at least 3 months, and impairment despite adequate sleep opportunity.


Explanation:


Diagnostic Criteria of Insomnia Disorder

A predominant complaint of dissatisfaction with sleep quantity or quality, associated with ≥1 of the following symptoms:

  • Difficulty initiating sleep (initial or sleep-onset insomnia).

  • Difficulty maintaining sleep, characterized by frequent awakenings or problems returning to sleep after awakenings (middle or sleep-maintenance insomnia).

  • Early-morning awakenings with inability to return to sleep (late or sleep-offset insomnia).

  • Occurs ≥ 3 days a week for ≥ 3 months

  • Causes clinically significant distress or impairment in functioning.

  • Occurs despite adequate opportunity to sleep.

  • Does not occur exclusively during the course of another sleep-wake disorder.

  • Not due to the physiologic effects of a substance or medication.

  • Coexisting mental and medical disorders do not adequately explain the insomnia.


Acute insomnia: < 3 months. Often linked to stress or changes in sleep patterns and typically resolves on its own.


Chronic insomnia: ≥3 months to years. Linked to lower quality of life and higher psychiatric illness risk.



Question 3:

From day #155


Answer: d

Cataplexy


Explanation:


Narcolepsy is characterized by excessive daytime sleepiness and falling asleep at inappropriate times. You may also see cataplexy, hypnogogic or hypnopompic hallucinations, and sleep paralysis.

  • Cataplexy: Intense emotions can cause sudden muscle weakness, often linked to brief episodes of bilateral muscle tone loss. Narcolepsy has two main subtypes: Type 1 (with cataplexy) and Type 2 (without cataplexy).

  • Do not confuse cataplexy with catalepsy, which is not seen in Narcolepsy. Catalepsy is a phenomenon see in patients with catatonia, in which they maintain certain rigid postures, sometimes awkward or unusual, for prolonged periods.

  • Hypnogogic and hynopompic hallucinations: Occur during the transitional state between wakefulness and sleep (hypnogogic = when going to sleep; hypnopompic = when popping awake). They involve all senses and can include visual, auditory, tactile, olfactory, and taste sensations. Linked to narcolepsy, sleep paralysis, and insomnia. They are generally harmless and fade as a person fully awakens. Factors like stress, sleep deprivation, and certain medications can increase their frequency and intensity.

  • Sleep paralysis: Phenomenon where a person is temporarily unable to move or speak when falling asleep or waking up. It can be distressing, with feelings of pressure on the chest, a presence in the room, fear, and anxiety. It may involve hallucinations like seeing shadowy figures or feeling touched.

  • Hallucinations and/or sleep paralysis at the beginning or end of sleep episodes are common, but not necessary for diagnosis in the DSM-5.



Question 4:

From day #157


Answer: c

RLS symptoms are relieved by voluntary movement, while PLMD movements persist without conscious control during sleep.


Explanation:


Key features of RLS:

  • Urge to Move: The urge to move the legs is commonly associated by uncomfortable sensations described as tingling, burning, creeping, or crawling feelings in the legs.

  • Triggered by Rest: The discomfort usually intensifies during inactivity, especially while sitting or lying down, affecting activities like reading, watching TV, or traveling long distances.

  • Disrupts Sleep: Symptoms typically peak in the evening or at night, leading to difficulties in falling asleep, fragmented sleep, and resultant daytime fatigue. Movements do not occur during sleep.

  • Relief from Movement: Most people find temporary relief through activities like walking, stretching, or even standing up.


Key features of PLMD:

Involuntary Limb Movements: Involuntary repetitive flexing and extending of the legs (kicking movements) are most common.

Disrupts Sleep: PLMD occurs only during sleep, with movements happening in bursts, often multiple times per hour, causing sleep disturbances. This often results in frequent awakenings and daytime fatigue.

Lack of Awareness: Individuals may be unaware of the movements; a bed partner may notice them.



 


Conclusion


Great job. To view all the weekly quizzes, click here. We have completed the sleep disorders lessons, and next, we will explore substance use disorders.


If you are looking for more reading materials then check out our recommended resources.

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