00:00 / 00:00
Amnesia, dissociative disorders and delirium: Pathology review
Childhood and early-onset psychological disorders: Pathology review
Dementia: Pathology review
Developmental and learning disorders: Pathology review
Drug misuse, intoxication and withdrawal: Alcohol: Pathology review
Drug misuse, intoxication and withdrawal: Hallucinogens: Pathology review
Drug misuse, intoxication and withdrawal: Other depressants: Pathology review
Drug misuse, intoxication and withdrawal: Stimulants: Pathology review
Eating disorders: Pathology review
Malingering, factitious disorders and somatoform disorders: Pathology review
Mood disorders: Pathology review
Personality disorders: Pathology review
Psychiatric emergencies: Pathology review
Psychological sleep disorders: Pathology review
Schizophrenia spectrum disorders: Pathology review
Trauma- and stress-related disorders: Pathology review
Psychological sleep disorders: Pathology review
0 / 6 complete
A 31 year old male named Hercules comes to the clinic complaining of excessive daytime sleepiness over the past year, despite getting a regular 7 to 9 hour sleep every night. This has recently started to interfere with his job, since he keeps dozing off at his desk, during meetings, or even while talking on the phone. Hercules is also concerned because he sometimes has very vivid dream-like sensations right before falling asleep, like seeing other people in the room. On further questioning, Hercules also mentions that when he gets really nervous or excited about something, he feels as if he cannot move his legs and might even fall down. Past medical history and physical examination are both unremarkable.
Based on the initial presentation, Hercules seems to have some form of sleep disorder. Many of us can have trouble falling asleep or may sleep too much from time to time, usually because of stress or a temporary illness. But when sleep problems become a regular occurrence and interfere with daily life, that’s a sign of a sleep disorder. For your exams, remember that sleep disorders are usually caused by factors that interrupt the sleep cycle, which is a period of sleep that lasts about 90 minutes and is divided into four stages. The first three stages make up non-REM or NREM sleep, which stands for non-rapid eye movement. So usually during non-REM sleep, our eyes don’t move much or at all. However, keep in mind that the voluntary muscles of the body may still be active. NREM sleep accounts for roughly 80% of the sleep cycle, and across the three stages of NREM, we move from very light sleep during Stage 1, to very deep sleep in Stage 3. This is followed by Stage 4, which is known as rapid eye movement or REM sleep, and accounts for the last 20% of the sleep cycle. During REM sleep, the eyes dart around really fast, and this is where dreaming occurs and memories are consolidated. During REM sleep, the voluntary muscles of the body are paralyzed, probably to prevent people from acting out their dreams. Now, REM sleep is then followed again by non-REM sleep, and over the course of the night, there are four or five of these sleep cycles.
Let’s start with sleep terror disorder.
For your exams, remember that this is typically triggered by stress or fatigue, fever, or sleep deprivation, and is most common in children. So, in sleep terror disorder, individuals partially wake up during deep sleep or stage 3 of NREM sleep, and suddenly start screaming or crying. And this turns on the sympathetic nervous system, which can lead to mydriasis or dilated pupils, tachycardia or rapid heart rate, tachypnea or rapid breathing, and sweating. What’s extremely high yield is that individuals usually return to sleep right afterwards, and the next day they have no recollection of the episode. For your exams, make sure you're able to set sleep terrors apart from nightmares, which typically occur during REM sleep, and individuals wake up right away and the next day, they are able to recall the episode! Okay, now, because sleep is disrupted, people with sleep terror disorder often feel chronically fatigued, which can lead to distress and impairment in a person’s life. Good news is that sleep terror disorder is typically self limited and tends to resolve spontaneously by puberty, so no treatment is needed.
Copyright © 2023 Elsevier, its licensors, and contributors. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Cookies are used by this site.
USMLE® is a joint program of the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME). COMLEX-USA® is a registered trademark of The National Board of Osteopathic Medical Examiners, Inc. NCLEX-RN® is a registered trademark of the National Council of State Boards of Nursing, Inc. Test names and other trademarks are the property of the respective trademark holders. None of the trademark holders are endorsed by nor affiliated with Osmosis or this website.