ILE 10 - Sleep Disorders Dr. Jackson's Poll Everywhere

Lack of sleep is lethal

A. True

B. False

A. True

How long must you have trouble with sleep to have insomnia according to the DSM?

A. One night

B. One night a month for four months

C. Two nights a month for three months

D. Three nights a week for three months

D. Three nights a week for three months

Why do the elderly have difficulty with sleep maintenance insomnia (SMI) more than other age groups?

A. They have greater production of histamine than younger individuals

B. They have less production of histamine than younger individuals

C. They have greater production of melatonin than younger individuals

D. They have less production of melatonin than younger individuals

D. They have less production of melatonin than younger individuals

For the first half of the night, alcohol increases REM sleep

A. True

B. False

B. False

For the second half of the night, alcohol causes nightmares and increased awakenings.

A. True

B. False

A. True

If the blood level of a sleep agent peaks in 4 hours how would you use it in a patient?

A. To help the patient fall asleep

B. To help the patient sleep during the first half of the night

C. To help the patient with middle of the night awakening

D. To prevent the patient from sleeping during the day

C. To help the patient with middle of the night awakening

A patient asks you if the medication that they are picking up causes sleep hangover. The half-life is 6 hours, How do you counsel them?

A. This medication will only help you fall asleep

B. This medication will cause sedation during the work day

C. Most of this medication will be out of your system after 6-7 hours

D. No this medication will not cause sleep hangover

C. Most of this medication will be out of your system after 6-7 hours

Which non-benzodiazepine agent treats both insomnia and anxiety?

A. Zolipdem

B. Zaleplon

C. Rozerem

D. Eszopiclone

D. Eszopiclone

Which benzodiazepine can be used in elderly patients? (Select all that apply)

A. Diazepam

B. Oxazepam

C. Temazepam

D. Flurazepam

E. Lorazepam

B. Oxazepam

C. Temazepam

E. Lorazepam

Think LOT!

A 75 year old male is complaining of insomnia and his physician wants to use a benzodiazepine. Which of the following do you recommend?

A. Diazepam

B. Zolpidem

C. Temazepam

D. Chlordiazepoxide

C. Temazepam

What percentage of time is spent in REM sleep?

A. 25

B. 50

C. 75

D. 100

A. 25

What percentage of time is spent in N-REM Sleep?

A. 25

B. 50

C. 75

D. 100

C. 75

What is the goal of treating insomnia? (Select all that apply)

A. Improve daytime functioning

B. Improve sleep consolidation

C. Avoid ADRs of sedative hypnotic agents

D. Correct the underlying sleep complaint

E. All of the above

E. All of the above

Which of the following activities should you do once you are in your bed?

A. Sleep

B. Have sex

C. Eat

D. Watch tv

E. Read book, magazine, DiPiro

F. Look at your phone

G. Keep the lights on

A. Sleep

B. Have sex

The best time to exercise is in the evening before bedtime

A. True

B. False

B. False

Name a sedative-hypnotic that is used for sleep maintenance insomnia?

A. Quazepam

B. Zolpidem CR

C. Eszopiclone

D. Doxepine

E. All of the above

E. All of the above

Name a sedative-hypnotic that IS NOT indicated for sleep onset insomnia

A. Estazolam

B. Zolpidem CR

C. Eszopiclone

D. Doxepine

D. Doxepine

Which benzodiazepine sedative hypnotic can be used to treat sleep maintenance insomnia?

A. Estazolam

B. Flurazepam

C. Quazepam

D. Temazepam

E. All of the above

E. All of the above

Which benzodiazepine sedative hypnotic is NOT indicated for sleep maintenance insomnia?

A. Zolpidem

B. Zaleplon

C. Triazolam

D. Doxepin

C. Triazolam

Respiratory depression could be caused by combining a benzodiazepine sedative hypnotic with which of the following medications?

A. Non-steroidal

B. Opioid

C. Acetaminophen

D. Gold

B. Opioid

How do you define a recurrent sleep complaint?

A. Insomnia lasting 3 months or more

B. Insomnia lasting from one to three months

C. Experiencing 2 or more episodes during 1 year

D. Experiencing 3 or more episodes of insomnia during one year

C. Experiencing 2 or more episodes during 1 year

What is the correct starting dose of zolpidem to use in women versus in men? Why?

A. 2.5 mg, women need a smaller dose

B. 5 mg, women need a smaller dose

C. 10 mg; men and women use the same dose

D. 25 mg; women need more to respond

E. None of the above

B. 5 mg, women need a smaller dose

Which of the secondary medical disorders can increase the risk of developing insomnia?

A. HTN

B. Hyperglycemia

C. GERD

D. Tension HA

C. GERD

Which of the following is a tenant of sleep hygiene?

A. Use the bed only for sleep

B. Eat dinner at bedtime in bed

C. Exercise right before bedtime

D. Drink alcohol at bedtime

A. Use the bed only for sleep

A 72 year old man with frequent middle of the night awakenings was recently diagnosed with hyperthyroidism. Should you recommend over the counter therapy for the patients insomnia? Why or why not?

A. Yes, he is an appropriate age

B. No, he is too old and has a chronic illness

B. No, he is too old and has a chronic illness

A 10 year old female is complaining of difficulty sleeping. Should you recommend an over the counter sleep aid? Why or why not?

A. Yes because her parents are tired

B. Yes because she is old enough to be a self-care candidate

C. No because she is too young to be a self-care candidate

D. No because insomnia is a chronic medical condition

C. No because she is too young to be a self-care candidate

A 25 year old pharmacy student states they need something for sleep because they have a big journal club presentation on Friday, and a cumulative final exam on Tuesday. They have no medical conditions. Can you recommend an OTC for sleep?

A. Yes because they have a journal club presentation

B. Yes because they are old enough and do not have a chronic medical condition

C. No they are not old enough

D. No because they have a chronic medical condition

B. Yes because they are old enough and do not have a chronic medical condition

A 32 year old female in the 26th week of pregnancy asks if you can recommend an over the counter medication to help her sleep. What do you recommend?

A. Yes because sleep is important in pregnancy

B. Yes because OTC sleep aids are safe in pregnancy

C. NO because she needs a prescription med

D. No because she is pregnant

D. No because she is pregnant

What is the mechanism of action for suvoxerant?

A. Histamine antagonism

B. Blockade of GABA receptor complex

C. Orexin receptor antagonist

D. Omega 1 receptor antagonist

C. Orexin receptor antagonist

What is the mechanism of action of ramelteon?

A. Melatonin receptor agonist

B. Melatonin receptor antagonist

C. Omega 1 receptor agonist

D. Omega 1 receptor antagonist

A. Melatonin receptor agonist

What is the mechanism of action of doxepin?

A. Omega 1 agonist

B. Omega 1 antagonist

C. Histamine 1 agonist

D. Histamine 1 antagonist

D. Histamine 1 antagonist

What is the mechanism of action of non-benzodiazepine receptor agonists?

A. Inhibits GABA transporter

B. Binds to the omega 1 receptor

C. Orexin agonist

D. Melatonin agonist

A. Inhibits GABA transporter

B. Binds to the omega 1 receptor

What is the mechanism of action of the antidepressant trazodone for sleep?

A. Omega 1 antagonist

B. Histamine 1 receptor antagonist

C. Melatonin 1 antagonist

D. Orexin 1 antagonist

B. Histamine 1 receptor antagonist

Which of the following types of sleep does suvorexant treat?

A. Difficulty falling asleep

B. Middle of the night awakenings

C. Difficulty staying asleep

D. Early morning awakening

E. All of the above

E. All of the above

Which of the following types of sleep does zaleplon treat?

A. Difficulty falling asleep

B. Middle of the night awakenings

C. Difficulty staying asleep

D. Early morning awakening

A. Difficulty falling asleep

Which of the following types of sleep does doxepin treat?

A. Difficulty falling asleep

B. Middle of the night awakening

C. Difficulty staying asleep

D. Early morning awakenings

B. Middle of the night awakening

C. Difficulty staying asleep

D. Early morning awakenings

Which of the following types of sleep does ramelteon treat?

A. Difficulty falling asleep

B. Middle of the night awakening

C. Difficulty staying asleep

D. Early morning awakenings

A. Difficulty falling asleep

A patient who has difficulty sleeping for at least 3 nights a week for three or more months has what kind of sleep disorder?

A. Insomnia

B. Hypersomnia

C. Chronic sleep latency disorder

D. Narcolepsy

A. Insomnia

Use the bed only for sleep and sex is sleep hygiene counseling that you should share with:

A. Individuals who sleep a solid 8 hours a night

B. Individuals who use their bed for eating, studying, and watching tv

C. Individuals who use the bed for sleep only

D. Individuals who use the bed for sex only

B. Individuals who use their bed for eating, studying, and watching tv

How do you calculate sleep efficiency?

A. Total amount of time in bed - total amount of time awake

B. Ratio of total sleep time divided by time spent in bed

C. Time spent awake after initial sleep onset until final awakening

B. Ratio of total sleep time divided by time spent in bed

Calculate sleep efficiency for a patient who goes to bed at 10 pm, falls asleep in one hour, and wakes up at 6 am.

7 hours of sleep/8 hours spent in bed = 0.875 = 87.5%

What is the treatment of choice for narcolepsy? (Select all that apply)

A. Divalproex sodium

B. Armodafanil

C. Sodium oxybate

D. Modafanil

B. Armodafanil

D. Modafanil

What is the most effective for treatment cataplexy?

A. Divalproex sodium

B. Armodafanil

C. Sodium oxybate

D. Modafanil

C. Sodium oxybate

What is included in the narcolepsy tetrad? (Select all that apply)

A. Excessive daytime sleepiness

B. Cataplexy

C. Hallucinations

D. Sleep paralysis

E. All of the above

E. All of the above

Which of the following describes the pathophysiology of restless leg syndrome?

A. Hyperactive dopamine neurotransmission

B. Low iron levels

C. Spinal cord injury

D. Hypoactive serotonin neurotransmission

B. Low iron levels

What is the treatment of choice for restless leg syndrome

A. Pramipexole

B. Zolpidem

C. Carbidopa/levodopa

D. Tramadol

A. Pramipexole

What are secondary conditions associated with restless leg syndrome? (Select all that apply)

A. Anemia

B. End stage renal disease

C. Pregnancy

D. MI

A. Anemia

B. End stage renal disease

C. Pregnancy

A patient is in the ICU with COVID-19. They are having difficulty breathing, and they team is trying to avoid intubating. Which medication should be avoided?

A. Ramelteon

B. Doxepin

C. Diazepam

D. Mirtazapine

C. Diazepam

Which sedative-hypnotic treats both anxiety and depression?

A. Zolpidem

B. Eszopiclone

C. Klonopin

D. Ramelteon

B. Eszopiclone

Which sedative hypnotic also works for post-traumatic stress disorder?

A. Diazepam

B. Zolpidem

C. Amitryptyline

D. Eszopiclone

D. Eszopiclone

Which activities can occur while someone is sleeping? (Choose all that apply)

A. Eating

B. Violence

C. Driving

D. Walking

E. All of the above

E. All of the above

Which class of sedative hypnotics are only approved by the FDA for short term use?

A. Non-benzodiazepines receptor agonists (NBRA)

B. Benzodiazepines

C. Orexin antagonists

D. Antidepressants

B. Benzodiazepines