Question 1

Which of the following are classified as sleep disorders?
1)Insomnia
2)Narcolepsy
3)Restless legs syndrome
4)Asthma
5)Parasomnias

Accepted Answer

Until the mid-1960s,the field of sleep medicine focused primarily on describing and treating insomnia,parasomnias (e.g. ,sleepwalking,night terrors),and hypersomnias such as narcolepsy.Patients experiencing these symptoms typically sought consultations from neurologists,psychiatrists,psychologists,or their family physician.Until more recently,treatments were generally based on empiric pharmaceutical intervention along with behavioral modification protocols or psychotherapy or both.In the future,respiratory therapists may find themselves in a position in which they are involved with the attending physician in determining appropriate pharmacotherapy for sleep-related disorders such as narcolepsy or periodic limb movement disorder.

Question 2

A chronic and progressive neurologic disorder characterized by unpleasant sensations in the legs and a compelling urge to move the legs while the patient is awake is referred to as

Accepted Answer

Restless legs syndrome (RLS)is a chronic,progressive neurologic disorder characterized by unpleasant sensations in the legs and a compelling urge to move the legs while the patient is awake.These symptoms occur most frequently during the evening or at night and during periods of rest.Insomnia is characterized by difficulty in falling asleep (i.e. ,a sleep latency of >30 minutes),insufficient sleep (i.e. ,total sleep time <5.5 to 6 hours),multiple nocturnal awakenings,early morning awakening with inability to resume sleep,or nonrestorative sleep.Narcolepsy is characterized by a tetrad of clinical symptoms.Two features of the tetrad-persistent excessive daytime sleepiness and cataplexy-were documented in the original descriptions of the disorder and remain the only two clinical features essential for diagnosis.Two additional features-hypnagogic hallucinations (the onset of dreams while still awake)and sleep paralysis (a temporary loss of muscle tone or an inability to perform voluntary movements either at sleep onset or on awakening)-were added later.Another common symptom of narcolepsy is fragmented sleep with multiple arousals and awakenings at night.Parasomnias are undesirable motor,sensory,or behavioral phenomena that occur primarily during sleep.

Question 3

Pharmacologic treatment of insomnia includes
1)estazolam.
2)eszopiclone.
3)zolpidem.
4)ramelteon.

Accepted Answer

All options listed, estazolam, eszopiclone, zolpidem, and ramelteon, are pharmacologic treatments used for insomnia.

Question 4

What are the two phases of REM sleep?

Accepted Answer

The term for REM sleep is derived from the periodic bursts of rapid eye movements during sleep.REM sleep has both tonic (persistent)and phasic (episodic)components.

Question 5

The prototypic chronobiotic is

Accepted Answer

Drugs that directly influence circadian mechanisms are often referred to as chronobiotics.The prototype for this type of drug is melatonin (N-acetyl-5-methoxytryptamine),a pineal hormone that has been identified as an important endogenous regulatory factor,with levels that vary with circadian time.Valium and Klonopin are benzodiazepines.Phenobarbital is a barbiturate.

Question 6

Reduced extracellular levels of which neurotransmitter can contribute to the symptoms of restless legs syndrome (RLS)?

Accepted Answer

Research has focused on determining if reductions in extracellular dopamine levels within the central nervous system or deficiencies in postsynaptic responsivity to dopamine might contribute to the symptoms of RLS.Reduced levels of extracellular dopamine are central to several hypotheses regarding neurochemical substrates contributing to RLS.Elucidation of any actual dopaminergic dysfunction has remained enigmatic,however.

Question 7

The onset and duration of sleep is orchestrated through
1)hypothalamic-pituitary-adrenal (HPA)axis.
2)multiple brain structures.
3)neurotransmitter substrates.
4)mast cells.

Accepted Answer

The onset and duration of sleep is orchestrated through multiple brain structures and neurotransmitter substrates,and pathology within those structures or neurotransmitter systems becomes manifest as a sleep disorder.

Question 8

Treatment for NREM and REM sleep parasomnias frequently includes

Accepted Answer

Treatment for NREM and REM sleep parasomnias frequently includes avoidance of potential triggers and in the case of somnambulism and REM behavior disorder also necessitates a safe,well-monitored sleeping environment.The most common pharmaceutical treatment for REM and NREM sleep parasomnias is usually one of the longer acting benzodiazepines.

Question 9

The sleep disorder characterized by difficulty falling asleep,insufficient sleep,or nonrestorative sleep is

Accepted Answer

Insomnia is characterized by difficulty in falling asleep (i.e. ,a sleep latency of >30 minutes),insufficient sleep (i.e. ,total sleep time <5.5 to 6 hours),multiple nocturnal awakenings,early morning awakening with inability to resume sleep,or nonrestorative sleep.RLS is a chronic,progressive neurologic disorder characterized by unpleasant sensations in the legs and a compelling urge to move the legs while the patient is awake.These symptoms occur most frequently during the evening or at night as well as during periods of rest.Narcolepsy is characterized by a tetrad of clinical symptoms.Two features of the tetrad-persistent excessive daytime sleepiness and cataplexy-were documented in the original descriptions of the disorder and remain the only two clinical features essential for diagnosis.Two additional features-hypnagogic hallucinations (the onset of dreams while still awake)and sleep paralysis (a temporary loss of muscle tone or an inability to perform voluntary movements either at sleep onset or on awakening)-were recognized later.Another common symptom of narcolepsy is fragmented sleep with multiple arousals and awakenings at night.Parasomnias are undesirable motor,sensory,or behavioral phenomena that occur primarily during sleep.

Question 10

Most ascending activating system (AAS)projections that mediate electroencephalographic (EEG)arousal and wakefulness synapse in which brain region?

Accepted Answer

Most AAS projections that mediate EEG arousal and wakefulness synapse in the thalamus,which is an essential center for the organization of EEG arousal and for maintaining activation at a cortical level.Thalamic mechanisms at a cellular level influence the differences between wakefulness and NREM sleep.

Question 11

The sleep disorder characterized by undesirable motor,sensory,or behavioral phenomena is referred to as

Accepted Answer

Parasomnias are undesirable motor,sensory,or behavioral phenomena that occur primarily during sleep.Insomnia is characterized by difficulty in falling asleep (i.e. ,a sleep latency of >30 minutes),insufficient sleep (i.e. ,total sleep time <5.5 to 6 hours),multiple nocturnal awakenings,early morning awakening with inability to resume sleep,or nonrestorative sleep.RLS is a chronic,progressive neurologic disorder characterized by unpleasant sensations in the legs and a compelling urge to move the legs while the patient is awake.These symptoms occur most frequently during the evening or at night and during periods of rest.Narcolepsy is characterized by a tetrad of clinical symptoms.Two features of the tetrad-persistent excessive daytime sleepiness and cataplexy-were documented in the original descriptions of the disorder and remain the only two clinical features essential for diagnosis.Two additional features-hypnagogic hallucinations (the onset of dreams while still awake)and sleep paralysis (a temporary loss of muscle tone or an inability to perform voluntary movements either at sleep onset or on awakening)-were recognized later.Another common symptom of narcolepsy is fragmented sleep with multiple arousals and awakenings at night.

Question 12

The sleep disorder characterized by persistent excessive daytime sleepiness,cataplexy,hypnagogic hallucinations,and sleep paralysis is

Accepted Answer

RLS is recognized as a chronic,progressive neurologic disorder characterized by unpleasant sensations in the legs and a compelling urge to move the legs while the patient is awake.These symptoms occur most frequently during the evening or at night and during periods of rest.Insomnia is characterized by difficulty in falling asleep (i.e. ,a sleep latency of >30 minutes),insufficient sleep (i.e. ,total sleep time <5.5 to 6 hours),multiple nocturnal awakenings,early morning awakening with inability to resume sleep,or nonrestorative sleep.Narcolepsy is characterized by a tetrad of clinical symptoms.Two features of the tetrad-persistent excessive daytime sleepiness and cataplexy-were documented in the original descriptions of the disorder and remain the only two clinical features essential for diagnosis.Two additional features-hypnagogic hallucinations (the onset of dreams while still awake)and sleep paralysis (a temporary loss of muscle tone or an inability to perform voluntary movements either at sleep onset or on awakening)-were added later.Another common symptom of narcolepsy is fragmented sleep with multiple arousals and awakenings at night.Parasomnias are undesirable motor,sensory,or behavioral phenomena that occur primarily during sleep.

Question 13

Pharmacologic treatment for narcolepsy includes

Accepted Answer

In 2002,sodium oxybate (Xyrem),a central nervous system (CNS)depressant,was approved by the U.S.Food and Drug Administration (FDA)for the treatment of both excessive daytime sleepiness and cataplexy in narcoleptic patients.

Question 14

Melatonin is secreted

Accepted Answer

Melatonin is exclusively secreted during the subjective night,and its plasma level increases during the evening and declines in the early morning.The finding that melatonin is secreted primarily during the night and the close relationship between the nocturnal increase in endogenous melatonin and the timing of human sleep have suggested that melatonin might be important in sleep regulation.

Question 15

The suprachiasmatic nucleus (SCN)is localized to the

Accepted Answer

The SCN,which is localized to the anterior hypothalamus,acts as the "biologic clock" to coordinate the circadian rhythm.The SCN receives photic information via the glutamatergic retinohypothalamic tract and the geniculohypothalamic tract,which contains NPY and nonphotic information via serotoninergic neurons originating in the dorsal raphe nucleus.SCN neurons,which project to the dorsomedial and posterior hypothalamic areas and the ventrolateral preoptic area,actively promote and maintain wakefulness during the day and sleep at night.

Question 16

Your patient is experiencing worsening of symptoms associated with restless legs syndrome (RLS).Which medications could be causing this?

Accepted Answer

In addition to the intrinsic pathophysiologic mechanisms of RLS,certain extrinsic factors are associated with increased frequency and severity of symptoms.H₂ histamine antagonists such as ranitidine and cimetidine have been reported to worsen symptoms of RLS.In addition,caffeine,alcohol,and some antidepressants including fluoxetine are reported to worsen the frequency and severity of RLS symptoms.

Question 17

Lunesta is the trade name for

Accepted Answer

Medications Approved by U.S.Food and Drug Administration for Treatment of Insomnia
 11ea589b_08ac_aa2f_91e5_232bac592c86_TB3777_00

Question 18

Drugs that directly influence circadian mechanisms are often referred to as

Accepted Answer

Drugs that directly influence circadian mechanisms are often referred to as chronobiotics.Chronobiology is concerned with the mechanisms of periodic biologic influences on health and disease.Chronopharmacology,or the study of time-dependent variations in pharmacology,was developed from the inclusion of chronobiologic principles in the study of pharmacology.Traditionally,drug delivery has assumed that a chemical is absorbed predictably from the site of administration.A second-generation drug delivery goal has been the achievement of a continuous constant rate (i.e. ,zero-order)delivery of drugs.However,living organisms are not "zero-order" in their response to drugs.They are predictable resonating dynamic systems governed by intrinsic oscillators,so they require different amounts of drug at different times within the circadian cycle to maximize the desired and undesired (i.e. ,chronotoxicity)effects of the drug.

Question 19

Under normal circumstances,circadian rhythms become synchronized to the

Accepted Answer

Under normal circumstances,circadian rhythms become synchronized or entrained to the environmental light/dark cycle,which acts as a pervasive and prominent synchronizer,or zeitgeber.Chronobiology is concerned with the mechanisms of periodic biologic influences on health and disease.Chronopharmacology is the study of time-dependent variations in pharmacology.

Question 20

Restoril is the trade name for

Accepted Answer

Medications Approved by U.S.Food and Drug Administration for Treatment of Insomnia
 11ea589b_08ac_aa30_91e5_dd28372db1ae_TB3777_00

Quiz 23: Sleep and Sleep Pharmacology

Which of the following are classified as sleep disorders? 1) Insomnia 2) Narcolepsy 3) Restless legs syndrome 4) Asthma 5) Parasomnias

A chronic and progressive neurologic disorder characterized by unpleasant sensations in the legs and a compelling urge to move the legs while the patient is awake is referred to as

Pharmacologic treatment of insomnia includes 1) estazolam. 2) eszopiclone. 3) zolpidem. 4) ramelteon.