Glen Greenough

Dr. Greenough is an Associate Professor at The Geisel School of Medicine at Dartmouth as well as Director of the Sleep Medicine Fellowship Program at DHMC

[Glen Greenough @DrGGSleep]

#BoardReview for #Sleep Medicine answer. While methadone, stroke and renal failure are all associated with central sleep apnea, the majority of patients with CSA-CSB have heart failure (ICSD3)

[Glen Greenough @DrGGSleep]

#BoardReview for #Sleep Med question: The majority of patients found to have Central Sleep apnea with Cheyne-Stokes breathing have which of the following conditions?
A Methadone use
B Stroke
C Renal failure
D Congestive heart failure

[Adi @IDdocAdi]

Trying to find the right time to travel in the pandemic https://t.co/ETXcGIN5Ah

[Glen Greenough @DrGGSleep]

#Boardreview for #Sleep Medicine: according to the 2017 best practice guidelines for nightmare disorder in adults the answer is B Prazosin. Velafexine is not recommended. Clonidine and hypnosis may be considered. Deep muscle relaxation may help idiopathic nightmares.

[Glen Greenough @DrGGSleep]

#Boardreview for #Sleep Medicine Question:
Which treatment has the most data to support its use in the treatment of PTSD related nightmares?
A-Venlafexine
B-Prazosin
C-Clonidine
D-Hypnosis
E-Deep muscle relaxation

[Glen Greenough @DrGGSleep]

Answer B is correct. Patients with myotonic dystrophy, Prader-Willi syndrome and other conditions may have a hypersomnia associated with SOREMs which meets criteria for narcolepsy type 2

[Glen Greenough @DrGGSleep]

#Boardreview for #Sleep Medicine
In which of the following conditions might patients have an associated hypersomnia that meets criteria for narcolepsy type 2?
A Alzheimer’s Disease
B Myotonic Dystrophy
C Amyotrophic Lateral Sclerosis
D Kleinfelter’s Syndrome

[Glen Greenough @DrGGSleep]

#Boardreview question for #Sleep Medicine answer. A is correct. Sleep spindles usually appear between 4-6 weeks of age and are maximal over the vertex.

[Glen Greenough @DrGGSleep]

#Boardreview question for #Sleep Medicine:
At what age do sleep spindles first appear?
A 4-6 weeks
B 8-12 weeks
C 6-9 months
D 1-2 years

[Glen Greenough @DrGGSleep]

Answer
B is correct. Disorders of arousal improve around adolescence, have a variable appearance, and end with a gradual return to consciousness. Nocturnal seizures tend to have a stable course, are stereotyped and end more abruptly

[Glen Greenough @DrGGSleep]

Board Review Q
When distinguishing nocturnal seizures from disorders of arousal which of the following is more characteristic of nocturnal seizures?
A-Frequency declines around adolescence
B-Event ends abruptly
C-Variable behaviors observed
D-Usually only occur once a night

[Glen Greenough @DrGGSleep]

Answer A
While a ferritin < 75 and a PLMI of 15 or higher may be associated with RLS neither is required for diagnosis. The urge to move begins at rest and is at least partially relieved by movement. The urge occurs in the evening or st night. RLS is a clinical diagnosis.

[Glen Greenough @DrGGSleep]

Weekly Board Review Q
Which of the following is required to make the diagnosis of RLS in adults?
1-Urge to move occurs primarily in the evening or at night
2-Ferritin level < 75 ng/ml
3-PLMI > or= 15 on PSG
4-Urge to move not effected by movement
5-Positive SIT test

[Glen Greenough @DrGGSleep]

Histamine containing neurons of the tuberomammillary nucleus are active during wake, quieter in NREM and silent in REM. Histamine therefore promotes wake and blockade of the H1 receptor induces sleep. Think about how Benadryl makes us sleepy. The correct answer is D.

[Glen Greenough @DrGGSleep]

Sleep Review Q1
Which of the following statements are true about histamine?
A. Histamine release promotes sleep
B. Histamine is secreted by the dorsal raphe
C. Histamine secreting neurons are active in REM sleep
D. H1 receptor blockade induces sleep

[Glen Greenough @DrGGSleep]

Histamine containing neurons of the tuberomammillary nucleus are active during wake, quieter in NREM and silent in REM. Histamine therefore promotes wake and blockade of the H1 receptor induces sleep. Think about how Benadryl makes us sleepy. The correct answer is D.

[Glen Greenough @DrGGSleep]

Sleep Review Q1
Which of the following statements are true about histamine?
A. Histamine release promotes sleep
B. Histamine is secreted by the dorsal raphe
C. Histamine secreting neurons are active in REM sleep
D. H1 receptor blockade induces sleep