Neurology

• You are asked to review a patient on the acute medical ward as they appear to be jerking. They have no history of a movement disorder and are not on any medication. The patient has just gone to sleep and is easily rousable. You wonder if these were hypnagogic jerks.What is the most likely stage of sleep that this patient is in?


  Non-Rem stage 1
• A 44-year-old woman presents with a history of vivid, violent dreams accompanied by physical movements during her sleep for the past 12 months. Her husband reports being unintentionally struck and kicked during these episodes, which are becoming more frequent and intense.A full neurological examination during wakefulness is unremarkable. There are no signs of cognitive impairment or psychiatric symptoms.What stage of sleep is likely to be disordered?


  Rapid eye movement sleep
• A 68-year-old man presents to the clinic with his wife. His wife is very concerned about his behaviour during sleep. She states that he appears to be lucidly dreaming and acting out his dreams, which has resulted in him physically hurting her a few times.What stage of sleep does this phenomenon occur?


  REM
• A clinical study is conducted with 50 volunteers having their sleep patterns analysed. They are subjected to overnight electroencephalography (EEG) and electromyography (EMG).

  It is found that, on average, 25% of the volunteers' sleep is associated with beta-waves on EEG. This period corresponds with the observation of reduced muscle tone on EMG recordings.

  What stage of sleep is this most likely to be?

  REM
• A 21-year-old female is accompanied by her boyfriend at the GP surgery, who claims that his girlfriend sleep walks during the night.At what stage in the sleep cycle is this most likely to occur?

  Non-rem stage 3
• A 35-year-old man is referred to the sleep clinic by his general practitioner (GP). His partner said he sleepwalks at night and looks scared. He sometimes screams when he is sleeping and had an episode of nocturnal enuresis.Which sleep stage do the above symptoms occur at?


  Non rem sleep