Sleeping Disorders

Self-Study Examination

Instructions: After studying the text answer the following true/false or multiple choice questions.  Remember, there's only one answer to each question.

1. After working night shift for a period of time, the night shift worker can get used to sleeping during the day and working during the night without feeling sleepy.

a) True
b) False

2. Most sleep disorders go away even without treatment.

a) True
b) False

3. Many people can learn to function normally with one or two fewer hours of sleep a night than they need.

a) True
b) False

4. It's not necessary to actually sleep to satisfy your body's need for sleep as long as you rest in bed with your eyes closed.

a) True
b) False

5. Everyone dreams every night.

a) True
b) False

6. During sleep, we usually pass through five phases of sleep. Where do we spend the most time?

a) stage 1
b) stage 2
c) stage 3
d) stage 4
e) REM

7. Where do the infants spend most of their sleep time?

a) stage 1
b) stage 2
c) stage 3
d) stage 4
e) REM

8. In what phase of the sleep do we dream?

a) stage 1
b) stage 2
c) stage 3
d) stage 4
e) REM

9. How long is each sleep cycle on the average?

a) 5 to 10 minutes
b) 60 minutes
c) 90 to 110 minutes
d) 6 to 8 hours

10. The part of the brain where the body's biological clock rests is called

a) hypothalamus
b) pineal gland
c) retina
d) cerebral cortex

11. What is the common denominator among these three incidents: Exxon Valdez oil spill, the Three Mile Island, and Chernobyl nuclear power plant accident?

a) They all occurred in the U.S.
b) They were caused by workers while under the influence of alcohol.
c) They were partly the result of errors made by fatigued night-shift workers.
d) They all resulted in a great loss of life.

12. Studies have shown that many people with total blindness experience hardly any sleeping problems.

a) True
b) False

13. Problems like stroke and asthma attacks tend to occur more frequently during ____.

a) the day
b) night and early morning hours
c) sleep-deprived periods

14. Which of the following interventions would not be advisable in the case of patients with sleep apnea?

a) lose weight
b) prevent the person from sleeping on his or her back
c) surgery to correct the obstruction
d) take sedatives or sleeping pills

15. With respect to RLS and PLMD, select the correct response from below:

a) RLS, or restless legs syndrome, is more common than PLMD.
b) In RLS, the leg movements occur continually when the body is at rest. The movements of PLMD occur in sleep.
c) both of the above
d) none of the above

16. During sleep body and brain shut down for rest and restoration.

a) True
b) False

17. It has been estimated that drowsy driving may account for some 56.000 accidents each year. What's the best thing to do if you feel drowsy while driving?

a) open the car window
b) turn the radio up
c) drink strong coffee
d) pull over and get some sleep

18. People with narcolepsy fall asleep at any time of the day even though they had a good night's sleep the night before.

a) True
b) False

19. Older people need less sleep.

a) True
b) False

20. Primary insomnia is defined as

a) z
b) insomnia associated with medication and substance use;
c) insomnia associated with specific sleep disorders;
d) insomnia after all of the above conditions are ruled out.

21. Number of people complaining of chronic sleep problems is

a) 5 percent
b) 10 to 15 percent
c) 30 to 40 percent
d) over half the population

22. Person who has difficulty staying awake in the evening may be suffering from the following circadian rhythm sleep disorder:

a) delayed sleep phase syndrome
b) advanced sleep phase syndrome
c) shift worker

23. Which of the following measures is most conducive to good sleep?

a) caffeine no later than 4 to 6 hours before bedtime
b) no more than 2 drinks prior to going to bed
c) regular exercise in the late afternoon
d) avoiding any meals within 4 hours of sleep

24. There are various behavioral treatments recommended for insomnia. Select the correct statement from the following:

a) Poor sleepers should be encouraged to increase their time in bed to provide more opportunity for sleep.
b) Avoid getting out of bed and going into another room when unable to fall asleep.
c) Maintain a regular rise time in the morning regardless of sleep duration the previous night.
d) Go to bed at a set hour whether sleepy or not.

25. Which of the following medications, as part of pharmacological treatment for insomnia, has been shown to be effective in inducing, maintaining, and consolidating sleep?

a) herbal preparation (e.g., valerian root, herbal teas)
b) melatonin
c) antihistamines
d) sedating antidepressants
e) benzodiazepines

26. Antidepressants are ineffective or are contraindicative in the following patients with insomnia:

a) patients with psychiatric disorders
b) patients with a history of substance abuse
c) patients with major depression
d) nondepressed individuals

27. According to a study conducted by Dr. Kripke, exposure to bright light ________ some sleeping problems.

a) aggravates
b) eliminates

28. For healthy young adults who sleep at night, body temperature usually is lowest ______.

a) one hour prior to going to bed
b) at midnight
c) around 4 to 5 a.m.
d) upon awakening

29. According to a clinical study reported in Sleep, people with trouble falling asleep might benefit from taking hot baths about 90 minutes before bedtime.

a) True
b) False

30. Regarding melatonin, select the correct statement:

a) Melatonin is a drug approved by the FDA and requires a physician's prescription to purchase.
b) Melatonin is a dietary supplement.
c) Few studies have been done on melatonin's safety, side effects, interactions with drugs and long-term effects.
d) Melatonin is a natural hormone made by body's pineal gland.
e) all but a

31. Melatonin levels in the body are at lowest levels

a) in the early morning
b) in the evening
c) before going to sleep
d) at midnight

32. In one behavioral approach to manage insomnia, the patient is instructed not to fall asleep with the expectation that efforts to avoid sleep will in fact induce it.

a) True
b) False

33. Which of the following behavioral treatments was found least effective in producing improvements in some aspects of sleep?

a) sleep hygiene
b) sleep restriction
c) stimulus control
d) paradoxical intention

34. All of the following are barriers to the successful application of behavioral and relaxation techniques in the treatment of insomnia except

a) over diagnosis of insomnia
b) lack of insurance reimbursement
c) time intensive nature of psychosocial interventions
d) paucity of qualified and trained practitioners

35. About 60 to 70 percent of shift workers complain of sleep difficulty or problem sleepiness. However, those working permanent night shifts are able to make a full nocturnal adjustment.

a) True
b) False

36. For most shift workers, the main exposure to increased risk from problem sleepiness occurs

a) on the job
b) on the way to work
c) on the commute home

37. According to one survey, more college-age respondents had driven while impaired by excessive sleepiness than while impaired by alcohol.

a) True
b) False

38. Effective countermeasures for problem sleepiness in adolescents and young adults require a multifaceted approach. Which of the following strategies is unproven and should not be recommended?

a) education on the importance of adequate sleep for optimal functioning and well-being;
b) daily classes should begin later for adolescents;
c) melatonin;
d) regulate sleep patterns using behavioral methods.

39. Women report insomnia more frequently than do men.

a) True
b) False

40. Which of the following primary sleep disorders is most prevalent in the population?

a) obstructive sleep apnea
b) insomnia
c) restless legs syndrome
d) narcolepsy

41. For the diagnosis of restless legs syndrome, there's no specific laboratory test.

a) True
b) False

42. The diagnosis of restless legs syndrome can be done by

a) patient history
b) polysomnography
c) laboratory tests
d) asking the bed partner

43. Which of the following behaviors has not been demonstrated to be effective to improve alertness when sleepy?

a) planning to get sufficient sleep;
b) not drinking even small amounts of alcohol when sleepy;
c) limiting driving between midnight and 6 a.m.
d) opening a car window

44. Which of the following factors may help reduce the need for sleep?

a) training
b) occupation
c) education
d) motivation
e) none of the above

45. What is the best way to reduce "sleep debt?"

a) physical exercise
b) sleep
c) dietary stimulants
d) all of the above

46. Which of the following tools is used to assess situational (acute) sleepiness in a person?

a) Epworth Sleepiness Scale (ESS)
b) Pittsburgh Sleep Quality Index
c) Stanford Sleepiness Scale (SSS)
d) Sleep-Wake Activity Inventory

47. Which of the following is not a characteristic associated with drowsy-driving crashes?

a) Crash occurs during late-night hours.
b) Fall-asleep crashes are likely to be serious.
c) The driver does not attempt to avoid crashing.
d) There are other passengers in the car.

48. Which of the following population groups is at the highest risk for drowsy-driving crashes?

a) young males
b) young females
c) shift workers
d) people with untreated sleep apnea syndrome and narcolepsy

49. Older shift workers appear to have more sleep-related difficulties than do younger workers.

a) True
b) False

50. People with steady night work shifts experience more severe sleep disruptions than those working rotating shifts.

a) True
b) False

51. Which of the following untreated sleep disorders carries a greater risk for crashes?

a) sleep apnea syndrome
b) narcolepsy

52. When a driver becomes drowsy studies have found certain remedial actions that can make a short-term difference. Which of the following, however, was found least effective?

a) short nap
b) consuming caffeine
c) getting out of the car and walking around for a few minutes
d) nicotine, smoking tobacco
e) sitting in an uncomfortable seat

53. To date, research has validated only one type of device that alarms or awakens drivers who are drowsy or asleep (select the correct answer):

a) brain wave monitors
b) eye-closure monitors
c) devices that detect steering variance
d) tracking devices that detect lane drift
e) shoulder rumble strips

54. Which of the following is not a symptom of narcolepsy?

a) excessive daytime sleepiness
b) clenching of the teeth
c) cataplexy
d) sleep paralysis
e) hypnagogic hallucinations

55. Symptoms of narcolepsy generally begin after the age of 50.

a) True
b) False

56. Which of the following is a correct statement about people with narcolepsy?

a) In people with narcolepsy REM sleep phase is entirely absent.
b) In people with narcolepsy NREM sleep phase is absent.
c) REM sleep occurs at sleep onset instead of after a period of NREM sleep.
d) In narcoleptic persons NREM and REM sleep phases are intertwined.

57. Which test is used to diagnose narcolepsy?

a) polysomnogram
b) multiple sleep latency test
c) all of the above

58. Select the correct statement about narcolepsy from below:

a) After a successful treatment with medications, most people can lead a life free of narcolepsy.
b) There is strong evidence that narcolepsy may run in families.
c) Narcolepsy can be cured if it is diagnosed early and treated properly.
d) Primary treatment of narcolepsy involves lifestyle changes.

59. Restless legs syndrome symptoms worsen during periods of increased activity and movement.

a) True
b) False

60. Concerning restless legs syndrome, select the correct statement from below:

a) RLS is usually more common in young people than older people.
b) RLS is more prevalent in boys than girls.
c) RLS is known to run in some families-parents may pass the condition on to their children.
d) Some women after a difficult pregnancy will acquire the RLS condition and it only gets worse later.

61. Which of the following drugs are used in the treatment of RLS?a)

a) benzodiazepines
b) dopaminergic agents
c) opioids
d) all of the above

62. Of the three types of sleep apnea, which is the most common?

a) obstructive
b) central
c) mixed

63. In all three types of sleep apnea, the problem is caused by a blockage of the airway.

a) True
b) False

64. The index that measures the severity of the sleep apnea is called

a) Nasal continuous positive airway pressure (CPAP)
b) Apnea-hypopnea index (AHI)
c) Respiratory disturbance index (RDI)
d) all but a

65. Sleep apnea is more likely to occur in men than in women.

a) True
b) False

66. Which of the following is not a risk factor for sleep apnea?

a) family history of sleep apnea
b) False
c) African-Americans, Mexicans
d) smoking and alcohol
e) having a narrow neck

67. In choosing a mask for a CPAP machine, which of the following factors are important?

a) facial hair-beard or moustache
b) being overweight
c) size of the mask
d) all of the above

68. For obstructive sleep apnea (OSA) surgery ultimately is the best solution.

a) True
b) False

69. What is the most common surgery for obstructive sleep apnea?

a) tracheotomy
b) lingualplasty

70. Which is the most effective surgery for obstructive sleep apnea?

c) MMO or MMA
d) tracheotomy

71. Physicians who perform surgery for sleep apnea are most commonly

a) family physicians.
b) otolaryngolosits.
c) pulmonologists.
d) brain surgeons.

72. Select the correct statement from below:

a) Everyone who snores has sleep apnea.
b) Everyone who has untreated sleep apnea snores.
c) Snoring is a common symptom of sleep apnea.
d) Eliminating the snoring eliminates the apnea.

73. People who breathe through their ______ are more prone to snore.

a) nose
b) mouth

74. In the treatment of sleep apnea, which of the following is most effective?

a) nasal CPAP
b) oral/dental devices
c) surgical procedures (UPPP, nasal surgery, etc.)

75. Currently, there are no safe and effective medications indicated in the routine treatment of sleep apnea.

a) True
b) False

76. Infants with a history of ALTE or apnea of prematurity comprise only a very small proportion of total SIDS cases.

a) True
b) False

77. Which of the following recommendations can be made at present regarding the circumstances for use of home apnea monitoring in infancy?

a) Cardiorespiratory monitoring of all infants should be recommended to parents to help prevent death due to apnea.
b) All preterm infants, even though asymptomatic, should be routinely monitored.
c) infants with one or more severe ALTE's requiring mouth-to-mouth resuscitation, symptomatic preterm infants, siblings of two or more SIDS victims, and central hypoventilation.
d) Cardiorespiratory monitoring is not medically indicated for normal infants.
e) c and d

78. According to NASA, to regain normal rhythm and energy levels after crossing a 5-hour time difference zone, you'll need _____ days.

a) 1
b) 2.5
c) 5
d) 7

79. Who is likely to suffer jet lag the most on a long flight?

a) young children
b) people whose normal lives involve varied routines
c) people with a rigid daily routine
d) those flying north-south

80. Flying westwards causes less jet lag than flying eastwards.

a) True
b) False

81. Which of the following techniques is not recommended for avoiding jet lag?

a) get plenty of rest and exercise in the days prior to departure
b) drink plenty of nonalcoholic fluids on the flight
c) use sleeping pills to get as much sleep on the plane as possible
d) move about on the plane

82. Disturbances of sleep afflict more of older people who live at home than those who live in long-term care facilities with other older people.

a) True
b) False

83. What is the major cause of sleep disturbance in older individuals?

a) loss of effective circadian regulation of sleep
b) variety of medical and psychosocial problems

84. Hypnotic medication should not be the mainstay of management for most of the causes of disturbed sleep.

a) True
b) False