Sleep-Wake Disorders Practice Questions

Q: Narcolepsy is characterized by all of the following except -

Snoring. ***Snoring*** - **Snoring** is a common symptom of **obstructive sleep apnea**, not a characteristic feature of narcolepsy. - While individuals with narcolepsy can snore, it is not a diagnostic criterion or a primary symptom differentiating it from other sleep disorders. *Sleep paralysis* - **Sleep paralysis**, the inability to move or speak while waking up or falling asleep, is a common symptom in narcolepsy. - It often occurs during the transitions between sleep and wakefulness, a manifestation of REM sleep intrusion into wakefulness. *Hallucination* - **Hypnagogic (at sleep onset) and hypnopompic (at sleep offset) hallucinations** are vivid, dream-like experiences that occur when falling asleep or waking up. - These can be frightening and are another sign of involuntary intrusion of REM sleep phenomena into wakefulness. *Cataplexy* - **Cataplexy** is the sudden, brief loss of voluntary muscle tone, often triggered by strong emotions like laughter or anger. - It is a highly specific symptom of narcolepsy, particularly in type 1, due to a deficiency in **hypocretin** (orexin) in the brain.

Q: Sleep drunkenness is otherwise called as:

Confusional arousal. ***Confusional arousal*** - This term directly describes a state of **disorientation** and impaired mental and motor activity upon waking from sleep, which is the definition of **sleep drunkenness**. - It is classified as an **NREM parasomnia**, occurring during stages N2 or N3 of sleep. *Somnambulism* - Also known as **sleepwalking**, this parasomnia involves complex motor behaviors performed during sleep, but the individual is typically not conscious or lucid during the episode. - While both are NREM parasomnias, **sleepwalking** involves more purposeful movement rather than just confusion and disorientation upon waking. *Hypnotism* - This refers to a **trance-like state** induced by another person or by self-suggestion, where the individual is highly responsive to suggestion. - It is an **induced state of consciousness**, completely different from a spontaneous sleep-wake transition disorder. *Automatism* - This is a broad term for actions performed **unconsciously** or involuntarily. It can occur in various medical conditions, including seizures or certain psychiatric disorders. - While sleep drunkenness involves automatic behaviors, **automatism** itself isn't a specific synonym, but rather a characteristic that can be observed within a confusional arousal episode.

Q: Hallucinations which occur at the start of sleep are:

Hypnagogic hallucinations. ***Hypnagogic hallucinations*** - These are **vivid, dream-like experiences** that occur as a person is falling asleep (the ingress of sleep). - They are common in the general population, often benign, and can involve visual, auditory, or tactile sensations. *Hypnopompic hallucinations* - These hallucinations occur when a person is **waking up from sleep** (the egress of sleep). - They are similar in nature to hypnagogic hallucinations but are experienced upon awakening. *Non-specific hallucination* - This term is too broad and does not specify the **timing** or **context** of the hallucination. - Medical terminology generally uses more precise terms to describe different types of hallucinations based on their characteristics and temporal relationship to sleep or wakefulness. *Jactatio nocturna capitis* - This refers to **rhythmic head or body rocking** during sleep or sleep onset. - It is a type of parasomnia, not a hallucination, and is related to repetitive motor movements.

Q: Kleine-Levin syndrome, which of the following is NOT true?

Hyposexuality. ***Hyposexuality*** - Patients with Kleine-Levin syndrome typically experience **hypersexuality**, not hyposexuality, during their episodes. - This symptom, along with **compulsive eating** (megaphagia), distinguishes the syndrome. *Also called sleeping beauty syndrome* - This is a well-known alternative name for **Kleine-Levin syndrome**, reflecting the prominent symptom of episodic hypersomnia. - The duration of these sleep episodes can be prolonged, leading to patients sleeping for **days or weeks** at a time. *Spontaneous resolution* - Kleine-Levin syndrome often resolves spontaneously, usually within **8-12 years** from its onset. - The frequency and severity of episodes tend to decrease over time until they cease altogether. *Hypersomnia* - **Recurrent episodes of hypersomnia** are a hallmark symptom of Kleine-Levin syndrome, where individuals sleep for excessively long periods. - This severe sleepiness is often accompanied by cognitive and behavioral changes when awake, such as **confusion, irritability**, and **megaphagia**.

Q: What is the primary characteristic of narcolepsy?

Excessive daytime sleepiness. **Excessive daytime sleepiness** - **Excessive daytime sleepiness (EDS)** is the hallmark symptom of narcolepsy, often manifesting as an irresistible urge to sleep, even after adequate nighttime sleep. - This **sleepiness** can lead to sudden sleep attacks during inappropriate times, impacting daily activities and safety. - EDS is present in virtually all cases of narcolepsy and is the **primary diagnostic criterion**. *Sleep terrors* - **Sleep terrors** are a parasomnia characterized by sudden awakening in a state of fear and confusion, often accompanied by screaming or thrashing, and are distinct from narcolepsy. - They typically occur during **non-rapid eye movement (NREM) sleep** and the individual usually has no memory of the event. *Sleep walking* - **Sleepwalking** (somnambulism) is another parasomnia where individuals perform complex behaviors while asleep, such as walking or talking, without conscious awareness. - It occurs during **deep NREM sleep** and is not a primary characteristic of narcolepsy. *Sleeptalking* - **Sleeptalking** (somniloquy) involves speaking while asleep and is a common, generally benign parasomnia that can occur during any sleep stage. - While it can be a symptom of various sleep disorders, it is not the defining feature of narcolepsy.

Q: Not seen in Narcolepsy:

Catalepsy. ***Catalepsy*** - **Catalepsy** is a trancelike state with **muscle rigidity** and **waxy flexibility**, often seen in conditions like **catatonic schizophrenia** or **epilepsy**. - It is **NOT a feature of narcolepsy** and is distinct from cataplexy, which involves sudden muscle weakness (not sustained rigidity). *Sleep attack* - **Sleep attacks ARE seen in narcolepsy** - they are a primary symptom characterized by **sudden, irresistible bouts of sleepiness** during waking hours. - These attacks can occur without warning and are a defining feature of the disorder. *Cataplexy* - **Cataplexy IS seen in narcolepsy** - it is a hallmark symptom of **narcolepsy type 1**, involving sudden, **brief episodes of muscle weakness** triggered by strong emotions like laughter or anger. - Despite muscle weakness, the individual remains conscious throughout the episode. *Sleep paralysis* - **Sleep paralysis IS seen in narcolepsy** - characterized by a **temporary inability to move or speak** when waking up or falling asleep. - This occurs due to a dissociation of REM sleep features into wakefulness.

Q: Somnambulism is mostly seen in which age group?

Children. ***Correct Option: Children*** - Somnambulism (sleepwalking) is **most commonly seen in children**, with peak incidence between **4-12 years of age** - Approximately **15-40% of children** experience at least one episode of sleepwalking - Occurs during **slow-wave sleep (NREM stage 3)**, which is more prominent in childhood - Episodes typically **decrease and resolve by adolescence** as sleep architecture matures *Incorrect Option: Adolescents* - While sleepwalking can persist into adolescence, the **prevalence significantly decreases** during teenage years - Most children who sleepwalk stop by the time they reach adolescence *Incorrect Option: All age groups* - Though somnambulism can technically occur at any age, it is **NOT equally distributed** across age groups - The frequency is **significantly higher in children** compared to other age groups *Incorrect Option: Adults* - Adult-onset sleepwalking is **relatively rare (1-4% prevalence)** - When it occurs in adults, it may be associated with underlying conditions (medications, sleep deprivation, psychiatric disorders, or neurological conditions) - Childhood somnambulism has much higher prevalence rates

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.

Question 1

Narcolepsy is characterized by all of the following except -

Accepted Answer

Snoring

Answer

Sleep paralysis

Answer

Hallucination

Answer

Cataplexy

Question 2

Sleep drunkenness is otherwise called as:

Accepted Answer

Confusional arousal

Answer

Somnambulism

Answer

Hypnotism

Answer

Automatism

Question 3

Hallucinations which occur at the start of sleep are:

Accepted Answer

Hypnagogic hallucinations

Answer

Hypnopompic hallucinations

Answer

Non-specific hallucination

Answer

Jactatio nocturna capitis

Question 4

Kleine-Levin syndrome, which of the following is NOT true?

Accepted Answer

Hyposexuality

Answer

Also called sleeping beauty syndrome

Answer

Spontaneous resolution

Answer

Hypersomnia

Question 5

What is the primary characteristic of narcolepsy?

Accepted Answer

Excessive daytime sleepiness

Answer

Sleep terrors

Answer

Sleep walking

Answer

Sleeptalking

Question 6

Not seen in Narcolepsy:

Accepted Answer

Catalepsy

Answer

Sleep attack

Answer

Cataplexy

Answer

Sleep paralysis

Question 7

Somnambulism is mostly seen in which age group?

Accepted Answer

Children

Answer

Adolescents

Answer

All age groups

Answer

Adults

Question 8

Which of the following is not the right advice, with respect to sleep hygiene?

Accepted Answer

30 mL and lesser amount of alcohol could be useful to induce sleep over long term

Answer

Wake up at the same time

Answer

Avoid daytime nap

Answer

Use bed for sleep and sexual activity

Question 9

Somnambulism is seen in

Accepted Answer

NREM 3

Answer

REM

Answer

NREM 1

Answer

NREM 2

Question 10

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

Sleep-Wake Disorders — MCQs

Sleep-Wake Disorders — MCQs

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