Sleep Disorders. Answers based on DSM-IV-TR and Tasman and First unless otherwise stated. As of 1Aug07. ICD-9-CM.
Answers based on DSM-IV-TR and Tasman and First unless otherwise stated.
As of 1Aug07
Since DSM-IV-TR was published, ICD-9-CM had vastly increased the number of sleep disorder diagnoses. While DSM-IV-TR printings in 2006 and 2007 reflected a few of these additions, the board examiners are very unlikely to expect candidates to know most of the new ICD-9-CM additions, so we will not address them in our answers.
Q. The essential feature of primary insomnia is?
Ans. A complaint of difficulty initiating or maintaining sleep or of nonrestorative sleep that last for at least one month and causes significant distress or impairment in important areas of functioning – and is not part of any other medical [including psychiatric] disorder.
Q. Prevalence of primary insomnia?
Ans. 1 – 10 % of the population/year.
Q. What ages and which gender have the highest prevalence of primary insomnia?
Ans. More in women and increases with age.
Q. What is the typical course in primary insomnia?
Q. State the essentials to the dx of primary insomnia.
Ans. Almost daily excessive sleepiness for at least a month that is not part of any other disorder and cause significant distress or dysfunction.
Q. “Recurrent” specifier = ?
Ans. When there are periods of primary insomnia that last 3 days several times a year for at least two years.
Ans. Gradual onset in age group 15 – 30.
Q. Essential features?
Ans. Repeated irresistible attacks of refreshing sleep or/and cataplexy, and recurrent intrusions of elements of REM sleep daily for at least 3 months.
Q. What is cataplexy?
Ans. Episodes of sudden, bilateral reversible loss of muscle tone that last for a few seconds to minutes and usually precipitated by intense emotion.
Ans. 0.02-0.16% of pop. Genders equal.
Q. Essentials of this disorder?
Ans. Sleep disruption leading to insomnia or hypersomnia that is judged to be due to ventilation abnormalities during sleep and not better accounted for by another disorder.
Ans. Prevalence is 1-10% of adult population.
Q. Essential features?
Q. A mismatch between the individual’s endogenous circadian sleep-wake system and exogenous demands regarding the timing and duration of sleep.
Delayed sleep phase type
Jet lag type
Shift work type
Q. List the three parasomnias other than parasomnia NOS.
1] Nightmare disorder
2] Sleep terror disorder
3] Sleepwalking disorder
Q. Essential features of nightmare disorder?
Ans. Repeated occurrence of frightening dreams that lead to awakening from sleep.
Ans. Unknown, but between 10 and 50% of children, age 3-5 years, have nightmares that disturb their parents.
Q. Essential features of sleep terror disorder?
Ans. Essentials are repeated sleep terrors, consisting of abrupt awaking from sleep with a panicky cry, intense fear and difficult in being awakened and comforted.
[note difference between this disorder and nightmare disorder as to awaken in nightmare disorder, hard to awaken in sleep terror disorder as examiner or exam questions have focused on the difference.]
Ans. Estimates are 1-6% of children, 1% of adults.
Runs in families.
Ans. Repeated episodes of complex motor behavior initiated during sleep, including rising from bed and walking.
Ans. 10 to 30% of children have at least one episode and 2-3% have repeated episodes. Peak prevalence is about the age of 12. Rare in adults.