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Chapter 41. Sleep Disorders

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AD is a 58-year-old man who presents to your clinic with the complaint that he “just can’t sleep at night.” Upon further questioning, he reports that he typically falls asleep without problem but wakes up multiple times throughout the night. Which of the following sleep disorders could AD possibly have?

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A. Insomnia

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B. Obstructive sleep apnea

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C. Narcolepsy

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D. Restless legs syndrome

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E. All of the above

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RS is a 28-year-old man with a history of obsessive-compulsive disorder who reports that he kicks his legs during the night, which wakes him up. He reports that he does not really have any symptoms of restless legs syndrome, but the leg kicking frequently awakens him in the middle of the night and causes him to be sleepy during the daytime. RS has a body mass index of 21 kg/m2 and is normotensive, and his wife says he does not snore or stop breathing during sleep. What would you recommend for RS?

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A. Temazepam 15 mg at bedtime

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B. Polysomnography

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C. Pramipexole 0.5 mg at bedtime

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D. Multiple sleep latency test

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E. Gabapentin 300 mg at bedtime

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Regarding therapies for the treatment of insomnia all of the following are correct except:

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A. Sedating antidepressants are commonly used to treat insomnia despite few good studies that document efficacy for insomnia.

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B. Nonbenzodiazepines (zolpidem, zaleplon, eszopiclone) are generally associated with less rebound insomnia than traditional benzodiazepines.

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C. Based on efficacy studies, BZDRAs and ramelteon are the drugs of choice for the treatment of insomnia.

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D. Suvorexant is an orexin receptor antagonist used for insomnia that is novel because it is not a controlled substance.

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E. All of the above are correct.

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Which of the following is a consequence of unidentified and untreated sleep disorders?

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A. Hypertension

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B. Motor vehicle accidents

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C. Excessive daytime sleepiness

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D. Irritability

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E. All of the above

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BB is a 48-year-old man with a ...

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