From Alzheimer Disease to Zolpidem: What Do You Know About Sleep?

Question 1:

Americans are a sleep-deprived population, with close to three-fourths failing to meet the recommended 8 hours per night. Three-fourths experience a sleep-related problem at least 3 days per week, and one-third of adults report having fallen asleep at work in the previous month.

These pervasive restless nights have increased the use of prescription medication to induce sleep. Results from the National Health and Nutrition Examination Survey (NHANES), 2005–2010, revealed that approximately 4% of US adults aged 20 years and older had used prescription sleep aids in the past month.

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Question 2:

There are approximately 21 million Americans engaged in shiftwork at any given time. Working while “the rest of the world” sleeps is associated with significant morbidity.

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Question 3:

A 50-year-old man presents with complaints of excessive sleepiness during the day; in fact he has put his head on his desk at work to rest for a moment and fallen asleep on several occasions. His general health is good although he has recently recovered from infection with H1N1 influenza.

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Question 4:

A 28-year-old graduate student complains of the recent onset of episodes of sudden jaw weakness following heightened emotions such as laughter or anger. She is very distressed, and has been avoiding emotionally laden situations to prevent the occurrence of these spells. Her advisor recently revealed that colleagues had complained that she appeared “drunk,” as she had slurred speech in class following an argument in the hall.

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Question 5:

A key protein that has been linked to the body’s natural circadian rhythms may provide insight into how the body regulates vital metabolic functions and what happens when that regulation fails. This “clock gene” appears to modulate the communication between the brain and the rest of the organs in the body. The protein may one day be a therapeutic target for diseases in which circadian rhythms are altered, such as sleep disorders.

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Question 6:

Female gender has been consistently identified as an independent predictor of sleep problems, including excessive daytime sleepiness, difficulty in initiating or maintaining sleep, and nighttime awakening. Many issues are linked to reproductive stages in a woman's life cycle.

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Question 7:

The parents of a 17-year-old student complain that he has no energy, is getting poor grades, seems unmotivated, and appears depressed. He stays awake until 3 am and can’t fall asleep even if he tries to go to bed earlier; then he can’t wake up in time for school the next day. On weekends he sleeps in until 2 pm.

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Question 8:

Restless legs syndrome (RLS) is associated with many chronic illnesses, including type 2 diabetes mellitus (DM). There is considerable overlap between RLS and DM, especially among comorbidities that commonly result from long-standing, poorly controlled hyperglycemia.

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Question 9:

A 43-year-old man with a significant weight problem (BMI 47 kg/m²) and hypertension (BP 140/95 mm Hg) is in your office for monthly follow-up. He admits that his sleep has been increasingly poor and that he’s feeling very sleepy during the day. He also has noticed more and more bouts of moodiness that are straining his relationship with his wife. You send him to a sleep center for an evaluation for potential obstructive sleep apnea, which comes back negative.

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Question 10:

The parents of a 7-year-old boy are alarmed by his sudden loud screaming and crying shortly after he falls asleep. He sits up in bed, seems very distressed, and does not wake up when touched or gently shaken. On rare occasions, he wakes up, appears confused, and has no recollection for the events. His recent pediatric workup was all within normal limits and your physical evaluation is unrevealing.

ANSWER KEY »

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ANSWER KEY:

Question 1. C. The percentage of adults using a prescription sleep aid decreased with age and education.

Question 2. F. All of the above

Question 3. B. Narcolepsy

Question 4. C. Cataplexy

Question 5. E. All of the above

Question 6. A. Zolpidem

Question 7. C. Morning bright light therapy

Question 8. E. All of the above

Question 9. E. A and B

Question 10. A. Sleep terror

Question 1:

Americans are a sleep-deprived population, with close to three-fourths failing to meet the recommended 8 hours per night. Three-fourths experience a sleep-related problem at least 3 days per week, and one-third of adults report having fallen asleep at work in the previous month.

These pervasive restless nights have increased the use of prescription medication to induce sleep. Results from the National Health and Nutrition Examination Survey (NHANES), 2005–2010, revealed that approximately 4% of US adults aged 20 years and older had used prescription sleep aids in the past month.

NEXT QUESTION »

For the discussion, click here.

For the answer, click here.

Question 2:

There are approximately 21 million Americans engaged in shiftwork at any given time. Working while “the rest of the world” sleeps is associated with significant morbidity.

NEXT QUESTION »

For the discussion, click here.

For the answer, click here.

Question 3:

A 50-year-old man presents with complaints of excessive sleepiness during the day; in fact he has put his head on his desk at work to rest for a moment and fallen asleep on several occasions. His general health is good although he has recently recovered from infection with H1N1 influenza.

NEXT QUESTION »

For the discussion, click here.

For the answer, click here.

Question 4:

A 28-year-old graduate student complains of the recent onset of episodes of sudden jaw weakness following heightened emotions such as laughter or anger. She is very distressed, and has been avoiding emotionally laden situations to prevent the occurrence of these spells. Her advisor recently revealed that colleagues had complained that she appeared “drunk,” as she had slurred speech in class following an argument in the hall.

NEXT QUESTION »

For the discussion, click here.

For the answer, click here.

Question 5:

A key protein that has been linked to the body’s natural circadian rhythms may provide insight into how the body regulates vital metabolic functions and what happens when that regulation fails. This “clock gene” appears to modulate the communication between the brain and the rest of the organs in the body. The protein may one day be a therapeutic target for diseases in which circadian rhythms are altered, such as sleep disorders.

NEXT QUESTION »

For the discussion, click here.

For the answer, click here.

Question 6:

A 62-year-old Vietnam Army veteran presents to your office complaining of increasing bouts of severe anxiety. He also struggles with recurrent episodes of post-traumatic stress disorder (PTSD) for which he sees a psychotherapist. He says he has trouble falling asleep and staying asleep during the night and is prone to daytime sleepiness. He wonders if the anxiety would abate if he could “get some decent sleep.” You are hesitant to prescribe anything right away to help this patient sleep based on a paper you read that found certain prescription sleep aids appear to selectively improve consolidation of negative and high-arousal memories, which for this veteran with PTSD and anxiety would be counterproductive.

NEXT QUESTION »

For the discussion, click here.

For the answer, click here.

Question 7:

The parents of a 17-year-old student complain that he has no energy, is getting poor grades, seems unmotivated, and appears depressed. He stays awake until 3 am and can’t fall asleep even if he tries to go to bed earlier; then he can’t wake up in time for school the next day. On weekends he sleeps in until 2 pm.

NEXT QUESTION »

For the discussion, click here.

For the answer, click here.

Question 8:

Restless legs syndrome (RLS) is associated with many chronic illnesses, including type 2 diabetes mellitus (DM). There is considerable overlap between RLS and DM, especially among comorbidities that commonly result from long-standing, poorly controlled hyperglycemia.

NEXT QUESTION »

For the discussion, click here.

For the answer, click here.

Question 9:

A 43-year-old man with a significant weight problem (BMI 47 kg/m²) and hypertension (BP 140/95 mm Hg) is in your office for monthly follow-up. He admits that his sleep has been increasingly poor and that he’s feeling very sleepy during the day. He also has noticed more and more bouts of moodiness that are straining his relationship with his wife. You send him to a sleep center for an evaluation for potential obstructive sleep apnea, which comes back negative.

NEXT QUESTION »

For the discussion, click here.

For the answer, click here.

Question 10:

The parents of a 7-year-old boy are alarmed by his sudden loud screaming and crying shortly after he falls asleep. He sits up in bed, seems very distressed, and does not wake up when touched or gently shaken. On rare occasions, he wakes up, appears confused, and has no recollection for the events. His recent pediatric workup was all within normal limits and your physical evaluation is unrevealing.

ANSWER KEY »

For the discussion, click here.

ANSWER KEY:

Question 1. C. The percentage of adults using a prescription sleep aid decreased with age and education.

Question 2. F. All of the above

Question 3. B. Narcolepsy

Question 4. C. Cataplexy

Question 5. E. All of the above

Question 6. B. γ-aminobutyric acid

Question 7. C. Morning bright light therapy

Question 8. E. All of the above

Question 9. E. A and B

Question 10. A. Sleep terror