Sleep-Wake Disorders Practice Questions

Q: A person wakes up from REM sleep frightened and remembering vivid, fearful dreams. Diagnosis is -

Nightmares. ***Nightmares*** - Nightmares are **frightening dreams** that typically occur during **REM sleep** and can be vividly recalled upon waking. - The individual wakes up feeling **fearful** and can remember the detailed content of the dream. *Narcolepsy* - This sleep disorder is characterized by **excessive daytime sleepiness** and sudden attacks of sleep, often with **cataplexy** (sudden loss of muscle tone). - While narcolepsy can involve vivid, frightening dreams, the primary complaint here is the dream itself, not the daytime sleepiness or cataplexy. *Night terrors* - Night terrors typically occur during **NREM sleep** (stages 3 and 4), not REM sleep, and are characterized by intense fear, screaming, and autonomic arousal. - The person usually has **no memory of the event** upon waking, in contrast to the vivid recall described in the question. *Somnambulism* - Also known as **sleepwalking**, somnambulism occurs during **NREM sleep** and involves complex behaviors performed while still asleep. - There is typically **no memory of the event**, and it is not associated with frightening dreams or waking up terrified.

Q: Which of the following is false about narcolepsy?

Typically occurs only during nighttime sleep. ***Typically occurs only during nighttime sleep*** - Narcolepsy is characterized by **excessive daytime sleepiness** and sudden, uncontrollable urges to sleep during the day, not exclusively nighttime sleep. - Patients with narcolepsy often experience disrupted nocturnal sleep, including **frequent awakenings** and vivid dreams. *Sudden loss of muscle tone (cataplexy)* - This statement accurately describes **cataplexy**, a hallmark symptom of narcolepsy, which is a sudden, brief loss of **muscle tone** triggered by strong emotions. - Cataplexy is a key diagnostic feature, though not all individuals with narcolepsy experience it. *Cataplexy is a common symptom* - **Cataplexy is indeed common** in narcolepsy, particularly in Narcolepsy Type 1, where it is caused by a deficiency in **hypocretin (orexin)**. - It is a defining characteristic for diagnosing narcolepsy with cataplexy. *Typical onset in the second decade of life* - The onset of narcolepsy symptoms, including excessive daytime sleepiness and cataplexy, often occurs during **adolescence or early adulthood**, typically between the ages of 10 and 25. - This timing can significantly impact education and social development.

Q: Hypnagogic hallucinations are seen in ?

Narcolepsy. ***Narcolepsy*** - **Hypnagogic hallucinations** are vivid, often terrifying perceptual experiences that occur right as a person is falling asleep (sleep onset). They are a common symptom of **narcolepsy**. - Other key symptoms of narcolepsy include **excessive daytime sleepiness**, **cataplexy** (sudden loss of muscle tone triggered by strong emotions), and **sleep paralysis**. *Schizophrenia* - While hallucinations are a hallmark of **schizophrenia**, they are typically **auditory** and occur in a clear state of consciousness, not specifically at sleep onset. - Schizophrenia is characterized by a broader range of symptoms including **delusions**, disorganization of thought, and negative symptoms. *Depression* - Depression can involve sleep disturbances like **insomnia** or **hypersomnia**, but it is generally not associated with hypnagogic hallucinations. - Core symptoms relate to **mood disturbance**, anhedonia, and vegetative symptoms. *Mania* - Mania, a feature of bipolar disorder, can lead to **reduced need for sleep** and racing thoughts, but not typically hypnagogic hallucinations. - Psychotic features like hallucinations can occur in severe mania, but they are not characteristically tied to sleep onset.

Q: Narcolepsy is due to abnormality in

Hypothalamus. ***Hypothalamus*** - **Narcolepsy** is primarily caused by the loss of neurons in the **hypothalamus** that produce **hypocretin (orexin)**. - Hypocretin plays a crucial role in regulating **wakefulness** and suppressing REM sleep. *Thalamus* - The thalamus acts as a **relay station** for sensory information and is involved in arousal and consciousness, but not the primary cause of narcolepsy. - Abnormalities in the thalamus are more commonly associated with conditions like **fatal familial insomnia** or **thalamic pain syndrome**. *Cerebellum* - The cerebellum is primarily involved in **motor control**, coordination, and balance. - Its dysfunction is associated with **ataxia** and movement disorders, not narcolepsy. *Medulla oblongata* - The medulla oblongata controls vital autonomic functions such as **breathing** and **heart rate**. - While important for overall physiological regulation, it is not directly implicated in the pathogenesis of narcolepsy.

Q: Kleine-Levin syndrome is associated with:

Hypersomnia. ***Hypersomnia*** - **Kleine-Levin syndrome** is characterized by recurrent episodes of **hypersomnia**, meaning excessive sleepiness. - Patients can sleep for 16 to 20 hours a day during these episodes, which may last for days or weeks. *Depression* - While mood disturbances can occur, **Kleine-Levin syndrome** primarily involves sleep and behavioral changes, not core symptoms of **depression**. - **Depression** is typically characterized by persistent low mood, anhedonia, and other symptoms, rather than episodic hypersomnia alone. *Anxiety* - **Anxiety** is not a primary symptom or defining characteristic of **Kleine-Levin syndrome**. - Patients may experience frustration or irritability due to their condition, but generalized anxiety is not a core feature. *Chronic insomnia* - **Chronic insomnia**, which is difficulty falling or staying asleep, is actually the opposite of the key symptom in **Kleine-Levin syndrome**. - The hallmark of Kleine-Levin syndrome is **excessive sleepiness (hypersomnia)**, not difficulty sleeping.

Q: The term 'frigidity' (though outdated) traditionally refers to:

Inability to initiate sexual arousal in female. ***Inability to initiate sexual arousal in female*** - The term "frigidity," though now considered **outdated and pejorative**, traditionally referred to a woman's inability to experience **sexual arousal** or pleasure. - This term encompassed various forms of female sexual dysfunction, including **anorgasmia** and **hypoactive sexual desire disorder**, which are now described with greater precision. *Inability to conceive with a particular male* - This describes **infertility** or **subfertility**, which is a distinct medical condition related to reproductive capacity, not sexual pleasure or arousal. - While sexual activity is necessary for conception, the inability to conceive does not inherently mean a lack of sexual arousal or desire. *Ejaculation occurring immediately after penetration* - This describes **premature ejaculation**, a male sexual dysfunction characterized by rapid orgasm and ejaculation, typically before, during, or shortly after penetration. - This term is relevant to male sexual function and not to female sexual arousal. *Inability to initiate sexual arousal in male* - This condition is known as **erectile dysfunction** (ED) or **male hypoactive sexual desire disorder**, referring to a man's inability to achieve or maintain an erection or lack of sexual desire. - The term "frigidity" was specifically and historically applied to female sexual difficulties, not male ones.

Q: Classic tetrad of narcolepsy includes all, except:

Catalepsy. ***Catalepsy*** - Catalepsy refers to a **waxy flexibility** and maintenance of postures seen in **catatonia** (a psychiatric condition). - It is **NOT** part of the classic tetrad of narcolepsy. - The classic tetrad includes **cataplexy** (not catalepsy), which is sudden muscle weakness triggered by strong emotions, along with excessive daytime sleepiness, sleep paralysis, and hypnagogic/hypnopompic hallucinations. *Hypnagogic hallucination* - Vivid, often frightening, dream-like experiences that occur while **falling asleep** (hypnagogic) or upon awakening (hypnopompic). - This is a recognized component of the **classic tetrad of narcolepsy**. *Sleep paralysis* - Temporary inability to move or speak upon **waking up or falling asleep**. - One of the four key symptoms forming the **classic tetrad of narcolepsy**. *Sleep attacks* - Sudden, irresistible urges to sleep that can occur at any time, often without warning. - **Excessive daytime sleepiness** leading to these attacks is a core feature and part of the **classic tetrad of narcolepsy**.

Q: A 65-year-old woman presents with difficulty falling asleep and frequent awakenings. What is the most appropriate first-line treatment?

Cognitive-behavioral therapy for insomnia. ***Cognitive-behavioral therapy for insomnia (CBT-I)*** - **CBT-I** is considered the **first-line treatment** for chronic insomnia, as it addresses the underlying thoughts and behaviors contributing to sleep difficulties. - It involves techniques such as **sleep restriction**, **stimulus control**, and cognitive restructuring, with proven long-term efficacy and fewer side effects than medication. *Benzodiazepines* - While effective for short-term insomnia relief, **benzodiazepines** are generally not recommended as first-line due to risks of **dependence**, **tolerance**, and side effects, especially in older adults. - They can worsen sleep architecture, cause **daytime sedation**, and increase the risk of falls in the elderly. *Antipsychotics* - **Antipsychotics** are not indicated for primary insomnia and carry significant risks of **metabolic side effects**, **sedation**, and **extrapyramidal symptoms**. - Their use for insomnia is off-label and reserved for specific psychiatric conditions where insomnia is a comorbidity. *Melatonin* - **Melatonin** can be helpful for specific sleep disorders like **jet lag** or **circadian rhythm sleep-wake disorders**, but its efficacy for chronic insomnia is limited and inconsistent. - While generally safe, it is not as robust or comprehensive in addressing the behavioral and cognitive components of insomnia as CBT-I.

Q: A patient presents with severe daytime sleepiness, cataplexy, and hallucinations while falling asleep. What is the most likely diagnosis?

Narcolepsy. ***Correct Option: Narcolepsy*** - The classic triad of symptoms—**excessive daytime sleepiness**, **cataplexy** (sudden loss of muscle tone triggered by strong emotions), and **hypnagogic/hypnopompic hallucinations** (hallucinations while falling asleep or waking up)—is highly characteristic of narcolepsy. - These symptoms result from a dysfunction in the brain's sleep-wake cycles, often due to a deficiency in **hypocretin/orexin** neurons in the lateral hypothalamus. - Narcolepsy type 1 specifically includes cataplexy, while narcolepsy type 2 lacks this feature. *Incorrect Option: Sleep apnea* - While it causes **excessive daytime sleepiness**, it typically lacks **cataplexy** and the vivid hallucinations associated with narcolepsy. - Patients often present with **snoring**, **witnessed breathing pauses**, and **fragmented sleep** due to repeated upper airway obstruction. - Diagnosed via polysomnography showing apnea-hypopnea index (AHI) ≥5. *Incorrect Option: Insomnia* - Characterized by difficulty falling or staying asleep, leading to **daytime fatigue**, but not typically associated with sudden sleep attacks, cataplexy, or vivid dream-like hallucinations. - It involves a lack of sufficient sleep quantity or quality, whereas narcolepsy involves issues with **sleep-wake regulation** and REM intrusion into wakefulness. *Incorrect Option: Restless legs syndrome* - Involves an **irresistible urge to move the legs**, often accompanied by uncomfortable sensations (paresthesias), typically worse in the evening or at rest, and relieved by movement. - While it can disrupt sleep and cause some daytime grogginess, it does not feature **cataplexy** or the specific types of hallucinations seen in narcolepsy. - Associated with dopaminergic dysfunction and often iron deficiency.

Q: A 30-year-old woman complains of difficulty falling asleep and frequent awakenings at night for the past 3 months. She feels tired during the day. What is the most likely diagnosis?

Insomnia. ***Insomnia*** - Chronic difficulty **falling asleep**, **staying asleep**, or **early morning awakening** leading to daytime impairment for at least **3 months** is the hallmark of insomnia. - The patient's presentation of difficulty falling asleep, frequent awakenings, and daytime tiredness perfectly aligns with the diagnostic criteria for insomnia. *Sleep apnea* - Characterized by recurrent episodes of **upper airway obstruction** during sleep, typically leading to **loud snoring**, gasping, and daytime sleepiness. - While it causes daytime tiredness and fragmented sleep, the primary complaint here is difficulty initiating and maintaining sleep, without mention of typical obstructive breathing symptoms. *Narcolepsy* - A chronic neurological condition defined by **irresistible daytime sleep attacks** and often accompanied by **cataplexy** (sudden muscle weakness triggered by strong emotions). - The patient's symptoms are of difficulty sleeping at night, not overwhelming daytime sleepiness and sleep attacks. *Restless leg syndrome* - Involves an **unpleasant sensation** in the legs, typically occurring in the evening or night, that creates an **uncontrollable urge to move them**. - While it can interfere with sleep onset, the primary complaint is not a specific unpleasant leg sensation but rather general difficulty falling and staying asleep.

Question 1

A person wakes up from REM sleep frightened and remembering vivid, fearful dreams. Diagnosis is -

Accepted Answer

Nightmares

Answer

Narcolepsy

Answer

Night terrors

Answer

Somnambulism

Question 2

Which of the following is false about narcolepsy?

Accepted Answer

Typically occurs only during nighttime sleep

Answer

Sudden loss of muscle tone (cataplexy)

Answer

Cataplexy is a common symptom

Answer

Typical onset in the second decade of life

Question 3

Hypnagogic hallucinations are seen in ?

Accepted Answer

Narcolepsy

Answer

Schizophrenia

Answer

Depression

Answer

Mania

Question 4

Narcolepsy is due to abnormality in

Accepted Answer

Hypothalamus

Answer

Thalamus

Answer

Cerebellum

Answer

Medulla oblongata

Question 5

Kleine-Levin syndrome is associated with:

Accepted Answer

Hypersomnia

Answer

Depression

Answer

Anxiety

Answer

Chronic insomnia

Question 6

The term 'frigidity' (though outdated) traditionally refers to:

Accepted Answer

Inability to initiate sexual arousal in female

Answer

Inability to conceive with a particular male

Answer

Ejaculation occurring immediately after penetration

Answer

Inability to initiate sexual arousal in male

Question 7

Classic tetrad of narcolepsy includes all, except:

Accepted Answer

Catalepsy

Answer

Hypnagogic hallucination

Answer

Sleep paralysis

Answer

Sleep attacks

Question 8

A 65-year-old woman presents with difficulty falling asleep and frequent awakenings. What is the most appropriate first-line treatment?

Accepted Answer

Cognitive-behavioral therapy for insomnia

Answer

Antipsychotics

Answer

Benzodiazepines

Answer

Melatonin

Question 9

A patient presents with severe daytime sleepiness, cataplexy, and hallucinations while falling asleep. What is the most likely diagnosis?

Accepted Answer

Narcolepsy

Answer

Sleep apnea

Answer

Insomnia

Answer

Restless legs syndrome

Question 10

A 30-year-old woman complains of difficulty falling asleep and frequent awakenings at night for the past 3 months. She feels tired during the day. What is the most likely diagnosis?

Accepted Answer

Insomnia

Answer

Sleep apnea

Answer

Narcolepsy

Answer

Restless leg syndrome

Sleep-Wake Disorders — MCQs

Sleep-Wake Disorders — MCQs

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