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NBME 20 Answers

nbme20/Block 1/Question#6

A 16-year-old student has uncontrollable ...

Direct transition from wakefulness to REM sleep

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 +8  upvote downvote
submitted by drdoom(230),

This is an interesting one. I like to remember it this way: in people with narcolepsy, all the “right kinds” of sleep are happening at all the “wrong times” of day. During the day, when a power nap would typically throw you immediately into REM, this kid is only entering Stage 1 or 2 (lightest sleep = slightest noises jar him back to reality). At night, when he should peacefully drift into Stage 1, 2, and so on, he instead completely zonks out. Classic narcolepsy.

From UpToDate: “Narcolepsy can be conceptualized as a disorder of sleep-wake control in which elements of sleep intrude into wakefulness and elements of wakefulness intrude into sleep.”

chextra  Isn't REM a rather light sleep stage? Brain waves during REM are very similar to awake states. I think you even wake up briefly in the middle of REM sleep. I don't think FA gave me a great understanding of narcolepsy, but I see it as going from awake to REM (light) for any kind of sleep, daytime or night time. +  

 +7  upvote downvote
submitted by hayayah(447),

In narcolepsy, there is a direct transition from wakefulness to REM sleep. Basically instead of going through the early stages and gradually falling into a deep sleep, you just suddenly go from being awake to being in a deep sleep.

Narcolepsy has one of the following 3 chraracter - 1. Cataplexy 2. dec orexin in csf 3. REM latency <15 min

its ass with (not dx criteria( Hypnagogin/pompic hallcination. Sleep paralysis

charcot_bouchard  oh dx criteria must also include excessive daytime slepeiness for 3 time per week over 3 month +