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Chapter 34: Sleep Disorders

A 22-year-old patient presents to your clinic with several complaints. He states that he is sleepy all of the time, and his course work in college is suffering because of his inability to stay awake during class or exams. He has episodes when he wakes up during sleep and sees thing in the room that are not there. He also has periods when he wakes from sleep and cannot move his arms or legs. He noticed an episode last week where he could not stand up or keep his eyes open for several minutes after his roommate told him a joke. His disorder is associated with a reduction of neurons containing which neurotransmitter?

A. Norepinephrine

B. Orexin

C. Vasopressin

D. Enkephalin

E. Serotonin

B. The symptoms this patient describes are excessive daytime sleepiness, hypnopompic hallucinations, sleep paralysis, and cataplexy. These are the 4 cardinal features of narcolepsy with cataplexy. The neurotransmitter that is deficient in the brains of these patients is orexin, which is normally localized in the lateral hypothalamus.

For the past 3 months, a 72-year-old man has had episodes during sleep in which he exhibits violent behaviors, including kicking his bed partner and shouting out. He appears to be asleep or confused during these episodes. He is unable to recall what happened in the room, but he reports having dreams of fighting off an attacker on the nights that these episodes take place. Which of the following disorders is most likely to develop years later in this patient?

A. Amyotrophic lateral sclerosis

B. Schizophrenia

C. Obstructive sleep apnea (OSA)

D. Parkinson disease

E. Cataplexy

D. The patient describes episodes that are most consistent with rapid eye movement (REM) sleep behavior disorder. This is a condition that is characterized by the loss of normal atonia-producing mechanisms, leading to dream enactment behavior. Longitudinal studies following patients with this disorder demonstrate the later development of Parkinson disease and other α-synucleinopathies years after their sleep disorder manifests.

A 53-year-old woman reports over 5 year of abnormal sensations in her legs occurring mostly in the evening when she is trying to fall asleep. She describes the sensations as “crawling and tingling” in her calves. If she stands up and walks around, she gets immediate relief, but the symptoms recur when she lies down. The symptoms are becoming progressively more severe and are ...

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