CCSH Exam Questions With 100% Correct Answers | Verified | Updated 2024, Exams of Advanced Education

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CCSH Exam Questions With 100%

Correct Answers | Verified | Updated

Benefits of proper mount of sleep - Correct Answer-- Improves memory

• Improves learning
• Improves concentration
• Improves health in general Does the body shut down when we sleep? - Correct Answer-no, sleep is an active process. We are just not conscious of what happens in our bodies. What controls the sleep-wake cycle? - Correct Answer-It is primarily controlled by the interaction of the Sleep Homeostatic Drive (Accumulation of adenosine and "somnogens" such as cytokines) and the Intrinsic Circadian Timekeeping System (The effect of light and darkness on the sleep wake cycle and timely release of hormones) How many types of sleep are there? - Correct Answer-There are two. NREM and REM NREM is broken into how many stages? - Correct Answer-3 stages. -N1 which is light sleep. Usually the first stage of sleep.
• N2 still fairly light sleep and covers the majority of sleep we get during the night.
• N3 Deep Sleep (AKA slow wave sleep) Physiological Variables in NREM sleep - Correct Answer-- Heart rate is regular
• Respiratory rate is regular
• BP is regular
• Skeletal muscle tone is preserved
• Brain O2 consumption is reduced.
• Response to CO2 is the same as wake
• Response to O2 is the same as W
• Penile tumescence, vaginal engorgement is infrequent
• Temperature is homeothermic Homeothermic - Correct Answer-having a body temperature that is constant and largely independent of the temperature of its surroundings. Stable body temperature of about 98.6F/ 37 C Physiological variables during REM sleep - Correct Answer-- Heart rate is irregular
• Respiratory Rate is irregular
• Blood Pressure is variable
• Skeletal muscle tone is absent
• Brain O2 consumption is increased

• Response to CO2 is depressed
• Response to O2 is same as W
• Penile tumescence, vaginal engorgement is frequent
• Temperature is poikilothermic. Poikilothermic - Correct Answer-Body temperature varies with environmental temperature. How many sleep cycles can we go through in one night? - Correct Answer-in a typical night, one may go through 4-5 cycles of sleep. When does the majority of deep sleep occur? - Correct Answer-Early in the sleep period (first third of the night). Periods of REM sleep - Correct Answer-Periods of REM sleep are initially short, but become longer in duration as the night progresses. What is NREM sleep believed to be for? - Correct Answer-NREM sleep is believed to help restore the body/ What is REM sleep believed to help? - Correct Answer-REM sleep is believed to help restore the mind When do we obtain the best sleep? - Correct Answer-When it is consolidated Does the amount of sleep we need throughout the life cycle changes? - Correct Answer-Yes, it does. Infant sleep - Correct Answer-- Not born with same sleep functions as adults.
• Sleep stages are not fully developed.
  • Quite sleep- NREM like
  • Active Sleep- REM like
  • Indeterminate sleep (mixed) Infant 0-3 months - Correct Answer--Trace alternant pattern of quite sleep (NREM) -Continuous medium activity (active sleep and wakefulness)(REM)
• Intermediate sleep
• Sleep onset REM is common and may continue up to 6 months of age
• Sleep is approximately 50% quite sleep, 50% active
• Cycle between active and quite sleep about every 45-60 minutes. Transitions may be difficult to identify. What is the cycle of sleep in an infant 0-3 months? - Correct Answer-Sleep is approximately 50% quite (NREM) and 50% Active (REM).

Infant 0-3m. what is the timing for the cycle between active (REM) and quite (NREM) - Correct Answer-The cycle between active (REM) and quite (NREM) is about 45- minutes. Infant 0-3,. Are the cycle changes easy to identify? - Correct Answer-Transitions between the cycles can be difficult to identify. Newborns need how many hours of sleep? - Correct Answer-Between 16-18 hours per day What kind of sleep do newborns have? - Correct Answer-sleep is polyphasic What is polyphasic sleep? - Correct Answer-polyphasic sleep refers to sleeping multiple times - usually more than two How many hours of sleep does a 16 wk old. 4 month old need? - Correct Answer-14- hours. Infant sleep at 16 weeks - Correct Answer-sleep is reduced to 14-15 hours and levels off around that value for the first year of life. Sleep becomes less distributed, with primary sleep at night and naps during the day. Infants 3-5 months. - Correct Answer-- Trace alternant waves are replaced by continous slow waves (quite sleep).

• During this period, waveforms begin to look much more like they should.
• NREM (quite sleep): 60% of the night, REM (active sleep) is now 40% of the night. Infants 6 months - Correct Answer-- NREM can typically be differentiated (stages 1, and slow wave)
• REM should be recognizable
• NREM - 60% of the night.
• REM - 40% of the night. By 12 months of age, REM sleep equals about 30% of total sleep time. The decrease in REM slowly continues during childhood until REM % reaches the adult level. 12 months of age and REM sleep - Correct Answer-By 12 months of age, REM sleep equals about 30% of total sleep time. The decrease in REM slowly continues during childhood until REM % reaches the adult level. Pediatric sleep - Correct Answer-Refers to early to middle childhood During pediatric sleep (early to middle childhood) - Correct Answer-- slow, consistent change in EEG patterns occur
• Sleep cycles about every 90 minutes by 5 years of age
• REM sleep is 20-25% of total sleep time by 3-5 yrs of age.

How much sleep does a 0-2 month old need? - Correct Answer-12-18 hours How much sleep does a 3m- 1 yr old need? - Correct Answer-12-15 hours How much sleep does a 1-3 yr old need? - Correct Answer-12-14 hours how much sleep does a 3-5 yr old need? - Correct Answer-11-13 hours how much sleep does a 5-12 yr old need? - Correct Answer-10-11 hours how much sleep does a 12-18 year old need? - Correct Answer-8-10 hours How much sleep do adults need? - Correct Answer-7-9 hours What happens to sleep by age 10? - Correct Answer-Sleep becomes monophasic; duration of about 10 hours. What is monophasic sleep? - Correct Answer-One period of sleep What happens to the circadian phase during adolescence? - Correct Answer-Circadian phase delay (later bedtimes) What happens to sleep in older age? Geriatric - Correct Answer-- Sleep time is decreased

• Biphasic pattern may re-emerge
• circadian phase advance (earlier bedtimes) Changes in sleep with aging - Correct Answer-- Reduction in rhythm amplitude- Circadian, endocrine and metabolic.
• From early adulthood to midlife N3 decreases, replaced by N1, N2 sleep, with no significant decrease in REM or increased sleep fragmentation.
• A decrease in growth hormone (GH) parallels decrease in SWS (N3) from mid-life to late life.
• In late life there is increased wake at the expense of both NREM and REM sleep. How many hours of consolidated sleep should adults generally get? - Correct Answer- Adults should generally get between 7-9 hours of consolidated sleep. In adults, every how many minutes the sleep cycle starts? - Correct Answer-Sleep cycles - every 90 minutes In adults, what is the cycle distribution? - Correct Answer-90 minute cycles include:
• 5-10% of N

- 40-50% N

• 20-25% N3 (decreases with age)
• 20-25% REM How much time of their lives do adults spend sleeping? - Correct Answer-Adults spend about 1/3 of their lives sleeping During sleep, what changes does the body undergo? - Correct Answer-Some systems show reduced activity, others increased activity. Important changes occur in the endocrine/hormone system and with temperature regulation, as well as changes in the autonomic nervous system such systems under involuntary control e.g heart rate, respiration. Geriatric sleep - Correct Answer-- Less hours needed
• N3 is reduced -Insomnia complains
• Overall increase in sleep complaints
• Medication effects Sleep homeostat and circadian rhythm connection - Correct Answer-- Light is a time giver
• Light is carried by retinohypothalamic tract (RHT) to the Suprachiasmatic nucleus (SCN).
• Coordinated by the SCN, light inhibits melatonin secretion during the dark cycle.
• Damage to the SCN elimiated the circadian rhythms of many behaviors, including sleep.
• Light, via the photoreceptor melanopsin, may exert its antidepressant effect through a modulation of the homeostatic process of sleep.
• One physiological marker: core body temperature. The timing of the "nadir" or minimum temp is in the early hours of the am around 4 am (high sleep propensity), with a peak around 6 pm (low sleep propensity).
• The proportion of N3 sleep is greatest in the first sleep cycle and dissipates over the course of the sleep period.
• The propensity for REM sleep is highest in the early morning
• There are "forbidden zones" for sleep which are times in the circadian phase when it is difficult to initiate sleep, such as in the 2-3 hours before the habitual sleep onset.

Sleep REGULATION: Sleep homeostat or process S - Correct Answer-- Sleep homeostasis- with a longer time awake, the drive for sleep builds up exponentially, and dissipates over the course of sleep.

• SWS/N3 decreasing over successive NREM sleep cycles reflects process S with higher N3 after sleep deprivation Sleep REGULATION: Circadian Rhythm or Process C - Correct Answer-- Endogenous circadian pacemaker is the suprachiasmatic nucleus SCN of the hypothalamus- the brain's "master clock", which directs the 24 hours cycle or endogenous (internal) biological rhythm.
• Body temperature is a marker of the circadian rhythm, as are the hormones cortisol and melatonin. Circadian rhythm- low body temp - Correct Answer-around 4 am with high sleep propensity Circadian rhythm- higher body temp - Correct Answer-around 6 pm with low sleep propensity. caffeine and sleep - Correct Answer-- works to prevent sleep by blocking adenosine. Caffeine is an adenosine receptor antagonist.
• During periods of wakefulness, adenosine levels accumulate in the basal forebrain as glycogen ( the body's principal store of energy) is depleted.
• Increased adenosine release accompanies the accumulation of the need to sleep. Thus, adenosine may be invovled in the homestatic control of sleep. With recovered sleep glycogen stores are replenished. Cortisol - Correct Answer-Stress hormone, under circadian control. Low during sleep rising towards early morning waking. Increases during the hour post awakening, steep decline over the next three hours after awakening followed by a more gradual decline over the remainder of the day, reaching the lowest point during the first half of the sleep period. When do cortisol levels reach the lowest point? - Correct Answer-During the first half of sleep period. When do cortisol levels reach their highest peak? - Correct Answer-During the early morning waking. Prolactin - Correct Answer-secretion highest during sleep. GH (growth hormone) - Correct Answer-- Peaks are associated with SWS/ N

• Peaks 90 minutes after sleep onset
• Sleep deprivation leads to decreased GH gonadotrophic hormones - Correct Answer-In pubertal boys and girls increase during sleep. Nocturnal urine - Correct Answer-during sleep, nocturnal urine volume decreases due to decrease of glomerular filtraton, alteration of renin release, water re-absorption Physiological difference between consolidated NREM sleep and REM sleep compared to wake. *NREM SLEEP - Correct Answer-NREM SLEEP/ REM SLEEP
• NREM: Respiration slow and regular. / REM: Irregular breathing, increased rate, brief hypopneas
• NREM: tidal volume 13-15% decrease due to increased duration of inspiration, and decreased minute ventilation by 0.5-1.5 L/min / REM: Minute ventilation decrease (by up to 1.6 L/min) Average respiratory rate, tidal volume, minute ventilation probably not different to NREM.
• Both in NREM and REM sleep: Blood gases: alveolar arterial PCO2 increase by 3. mmHg, decrease PO2 by 3-10 mmHg, oxygen saturation (SaO2) decrease by >2%
• NREM: Upper airway resistance increases 2x / REM: Faccid paralysis of all skeletal muscle activity. Activity of upper airway and genioglossus muscles decreases.
• NREM: Heart rate and BP decrease/ REM: bursts of eye movement often accompanied by sudden change in BP, HR, RR and respiratory amplitude. Sleep and energy balance: Orexigenic = Orexis - Correct Answer-appetite stimulating Sleep and energy balance: Anorexigenic - Correct Answer-appetite suppressing. Sleep and energy balance: Where are orexins produced? - Correct Answer-They are produced in the hypothalamus. (Narcolepsy). Sleep and energy balance: Ghrelin- peptide produced by stomach - Correct Answer-- Levels rise progressively during fasting and fall to a nadir within one hour of feeding.
• Inhibited by vagus nerve (parasympathetic)
• Links the gastrointestinal system and the hypothalamic orexigenic pathway.

Sleep and energy balance: Anorexigenic = appetite suppressing - Correct Answer-appetite suppressing Sleep and energy balance: Leptin: - Correct Answer-Hormone released by adipocytes Sleep and energy balance: Leptin is released by what? - Correct Answer-leptin is a hormone released by adipocytes.

• levels increase in response to acute caloric surplus.
• Circadian fluctuation, peaks during sleep
• Provides information about energy balance to hypothalamic regulatory centers.
• Changes associated with reciprocal changes in hunger. Cardiovascular changes that occur during sleep drive by the dominant parasympathetic activity. Identify what normal changes are as summarized. - Correct Answer-- Hear rate.: NREM decrease, REM - variable.
• BP: Decrease 5-14% during NREM. Fluctuates in REM.
• Cardiac output: Falls during sleep and is lower in the last REM cycle in the early morning.
• Cerebral blood flow and metabolic rate for glucose and O2. Decrease NREM, but increases by 10-40% above wake in REM (especially hypothalamus and brainstem). How big of a role does sleep play in energy balance? - Correct Answer-Sleep plays a key role in energy balance, with adverse effects of sleep deprivation, sleep restriction and sleep fragmentation, for example due to OSA, having metabolic consequences. VARIATIONS IN NORMAL SLEEP: Medications - Correct Answer-Medications, in particular psychotropic and neurotropic medications, can influence sleep and wake. VARIATIONS IN NORMAL SLEEP: Medication Stimulants - Correct Answer-Stimulants -All effect sleep.
  • Increase: sleep latency, awakenings, N1 & N2, WASO, insomnia complains.
  • Decrease: TST, N3, REM
  • Examples: Caffeine, nicotine, theophylline, CNS stimulants (methamphetamines, cocaine)

Modafinil decreases EDS. Examples of stimulant medications - Correct Answer-- Caffeine, nicotine, theophylline, CNS stimulants (methamphetamines, cocaine) Modafinil decreases EDS VARIATIONS IN NORMAL SLEEP: Medication Sedative Hypnotics - Correct Answer-All facilitate sleep. May alter sleep architecture. Increase: TST, N2 (spindles), next day sleepiness, sense of hangover effect.

• Decrease WASO, awakenings, sleep latency
• Decreased REM with barbiturates
• Decreased N3 with benzodiazepines, slight decrease with barbiturates. Examples: ambien (zolpidem), ativan (lorazepam), halcion (triazolam), restoril (temazepam), sonata (zaleplon), xanax (alpraxolam), nebutal (pentobarbital, benadryl (diphenhydramine), unisom (doxylamine), ethanol (ethyl alcohol). What are some sedative hypnotics - Correct Answer-ambien (zolpidem), ativan (lorazepam), halcion (triazolam), restoril (temazepam), sonata (zaleplon), xanax (alpraxolam), nebutal (pentobarbital, benadryl (diphenhydramine), unisom (doxylamine), ethanol (ethyl alcohol). Antidepressants and sleep - Correct Answer-Vary widely from stimulating to sedating. Antidepressants and PLMS - Correct Answer-Most antidepressants have potential to exacerbate PLMS What does MAOI stand for? - Correct Answer-Monoamine oxidase inhibitors. were the first type of antidepressant developed Antidepressants: Monoamine oxidase inhibitors - Correct Answer-- significant reduction of REM
• Slight increase in WASO, slight decrease in TST
• Newer selective and reversible MAOI's have less pronounced effect on sleep. Antidepressants: Examples of Heterocyclics - Correct Answer-Heterocyclic antidepressants: amoxapine (Asendin) trazodone hydrochloride (Desyrel) maprotiline hydrochloride (Ludiomil) Antidepressants: Heterocyclics - Correct Answer-- REM suppression varies
• Slight increase N3, increase TST
• Some are sedating- decrease WASO, awakenings, sleep latency
• Some are stimulants- Increase waso, awakenings, sleep latency

What are some sedating heterocyclics antidepressants? - Correct Answer-Elavil (amitriptyline). Adapin (doxepin), Tofranil (imipramine) What are some stimulant heterocyclics antidepressants? - Correct Answer--Anafranil (Comipramine)

• Norpramine (desipramine)
• Pamelor (Nortriptyline)
• Vivactyl (Protriptyline) Other antidepressants: Desyrel (Trazodone) - Correct Answer-- Desyrel (Trazodone) SARI serotonin antagonist and reuptake inhibitor.
• Desyrel (Trazodone) SARI serotonin antagonist and reuptake inhibitor. - Correct Answer-- 5-45% report drowsiness
• Increased N3, TST, next day EDS
• Decreased sleep latency, WASO, slight decrease in REM. Serzone (nefazodone) SARI (Serotonin antagonist and reuptake inhibitor. - Correct Answer-6-24% report drowsiness
• Increased N3, TST Effexor (venlafaxine) SSNRI( Sel. serotonin norepinephrine reuptake inhibitor) - Correct Answer-- 4-18% report insomnia
• 12-31% report somnolence at higher dosage (>150 mg). Norepinephrine - Correct Answer-a hormone that is released by the adrenal medulla and by the sympathetic nerves and functions as a neurotransmitter. It is also used as a drug to raise blood pressure. Remeron (mirtazapine) Norepinephrine and Specific Serotonin antagonist - Correct Answer-- Up to 56% report sedation
• Increased TST, daytime sedation
• Decrased sleep latency Willbutrin (Bupropion) Norepinephrine and dopamine reuptake inhibitor - Correct Answer--5-9% report insomnia
• increased % of REM
• Decreased REM latency
• Promotes daytime alertness
• REM suppression and REM rebound upon D/C of antidepressants. Antidepressants: SSRI's - Correct Answer-SSRI:
• Increases: may increase sleep latency, WASO, insomnia, complaint, PLMS
• Decreases: REM, may significantly delay REM onset, TST
• Changes vary with medication

SSIRs- Prozac - Correct Answer-Prozac (Fluvoxetine)

• Increased insomnia reported in 5-19%

SSRIs- Luvox(Fluvoxamine), Paxil (Paroxetine) - Correct Answer-Sedation reported in 26% SNIR's Serotonin and norepinephrine reuptake inhibitors (SNRIs) - Correct Answer-- Increases: Daytime sedation, insomnia complaint, WASO, PLMS

• Decreases: REM, TST
• Medications: effexor (venlafaxine), Cymbalta (Duloxetine). Antipsychotics and sleep - Correct Answer--Increased: sleep latency, awakenings, WASO, restless sleep
• Decreased TST
• May increase or decrease N
• Clozaril (clozapine) and Zyprena (olanzapine) are some of the most sedating. mood stabilizers and sleep - Correct Answer-Lithium: increased sedations, TST, may increase N Decreased REM induced somnambulism has been reported Tegretol (carbamazepine) : Incrased sedation reported in up to 11%, TST Agitation, restlessness, and insomnia also reported. Depakote (valproic acid) slight increase in sedation Narcotics and sleep - Correct Answer-- Acute use: increased WASO, decreased REM, N
• Chronic use: Decreased REM