Sleep-Wake Disorders Practice Questions

Q: Narcolepsy is associated with?

Hypnagogic hallucination. ***Hypnagogic hallucination*** - **Hypnagogic hallucinations** are vivid, dream-like perceptual experiences occurring at **sleep onset** and are one of the **classic tetrad features** of narcolepsy. - They occur in **30-60% of narcolepsy patients** and result from the intrusion of **REM sleep phenomena** into the transition from wakefulness to sleep. - These hallucinations reflect the **REM sleep dysregulation** that is central to narcolepsy pathophysiology. - Other tetrad features include **excessive daytime sleepiness, cataplexy, and sleep paralysis**. *Late age of onset* - Narcolepsy typically has an **early age of onset**, most commonly between **10-25 years** (adolescence and young adulthood). - Peak onset is around **15 years of age**. - Late-onset narcolepsy is uncommon and may suggest secondary causes. *Normal sleep architecture* - Narcolepsy is characterized by **disrupted sleep architecture**, not normal architecture. - Key abnormalities include **sleep-onset REM periods (SOREMPs)**, where patients enter REM sleep within **15 minutes** of sleep onset, bypassing normal NREM stages. - Nocturnal sleep is **fragmented** with frequent awakenings. *Decreased NREM sleep* - While narcolepsy involves **REM sleep dysregulation** with premature REM entry, characterizing it simply as "decreased NREM sleep" is not the standard clinical description. - The primary pathology is **abnormal REM sleep timing and distribution**, including SOREMPs during daytime naps and nighttime sleep. - The focus is on **REM sleep intrusion** rather than NREM reduction per se.

Q: Cataplexy is characterized by?

Sudden loss of muscle tone. ***Sudden loss of muscle tone*** - **Cataplexy** is specifically defined by a sudden, brief loss of **muscle tone** while awake, often triggered by strong emotions like laughter or anger. - This loss of muscle tone is similar to the muscle paralysis experienced during **REM sleep**, but occurs while the individual is fully conscious. *Hypnopompic hallucinations* - **Hypnopompic hallucinations** are vivid, dream-like experiences that occur when waking up from sleep. - While frequently associated with **narcolepsy**, they are not the defining characteristic of **cataplexy** itself. *Generalized muscle weakness* - While cataplexy involves muscle weakness, it is a **sudden and transient loss of tone** rather than a sustained, generalized weakness. - **Generalized muscle weakness** can be a symptom of many other conditions and does not accurately describe the abrupt, emotion-triggered nature of cataplexy. *Nocturnal penile tumescence* - **Nocturnal penile tumescence (NPT)** is the occurrence of spontaneous erections during sleep and is a normal physiological process. - It is used in the differential diagnosis of erectile dysfunction to distinguish between organic and psychogenic causes, and has no direct relation to **cataplexy**.

Question 1

Narcolepsy is associated with?

Accepted Answer

Hypnagogic hallucination

Answer

Late age of onset

Answer

Decreased NREM sleep

Answer

Normal sleep architecture

Question 2

Cataplexy is characterized by?

Accepted Answer

Sudden loss of muscle tone

Answer

Generalized muscle weakness

Answer

Hypnopompic hallucinations

Answer

Nocturnal penile tumescence

Question 3

An 11-year-old boy is brought to the physician with a complaint that he gets up at night and while sleeping, he walks around the house for a few minutes before returning to bed. When his parents try to wake him up, he is confused and disoriented. Which of the following is the most appropriate treatment for him?

Accepted Answer

Tell the parents to maintain a safe environment and monitor the patient's symptoms

Answer

Start the patient on a low dose of a tricyclic antidepressant

Answer

Tell the parents that the child would benefit from cognitive behavioral therapy

Answer

Start the patient on a low dose of benzodiazepines at night

Sleep-Wake Disorders — MCQs

Sleep-Wake Disorders — MCQs

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