Looking for Sleep Pharmacology practice questions? If so, and if you’re a Respiratory Therapy student, then you’ve come to the right place. As a Respiratory Therapist (which you will soon be in the future), it will be required for you to know and understand all the different drugs and medications that affect human sleep patterns. To do so, you will need to be able to comprehend the neurophysiological mechanisms that promote wakefulness and brain arousal.  

So in order to help you with this, we put together this study guide that is loaded with helpful practice questions that will teach you everything that you need to know about Sleep Pharmacology. Are you ready to get started?

Sleep Pharmacology Practice Questions:

1. What are the stages of sleep?
Stage 1: light transitional sleep (where drowsiness and sleep begins). Stage 2: More stable sleep; neurotransmitters in brain block senses to make it difficult to awaken (most of sleep is this). Stage 3 and 4: Deep and very deep sleep; growth hormone is released during these; most of these stages occur in the first 1/3 of the night. REM: Revitalizes the memory; brain activity is very high and intense dreaming occurs; and, 90-minute patterns of NREM and REM sleep.

2. What is REM sleep?
A stage that helps the brain process and reorganize information.

3. What is non-REM sleep?
A stage that helps with the restoration of biological processes (protein synthesis, renewal of bone, etc.).

4. What are the functions of REM sleep?
Changes in cerebral blood flow (increased); cortical activity is increased; O2 consumption is increased; epinephrine is released; and, memory storage and learning.

5. What are the REM deprivation outcomes?
Increased appetite, increased anxiety, irritability, hyperactivity, difficulty concentrating and difficulty coping with stressors.

6. What is insomnia?
Trying to sleep but cannot.

7. What is sleep deprivation?
Intentionally not giving the body a chance to sleep.

8. What are the factors that affect sleep?
Lifestyle, emotional stress, fatigue, exercise, diet, sociocultural, alcohol/nicotine, medications, and illness.

9. What are the illnesses that affect sleep?
Respiratory disease, cardiac disease, hypertension, GI disorders, restless leg syndrome, pain, difficulty breathing, nausea, and mood alterations (anxiety and depression).

10. What is primary insomnia?
Difficulty falling and staying asleep or waking up too early.

11. What is comorbid insomnia?
Insomnia in relation to another medical or psychological diagnosis.

12. What is obstructive sleep apnea?
The absence of breathing for 10 seconds or longer occurring 5 times/hour and airway is obstructed by tongue and soft palate.

13. What are the risk factors for obstructive sleep apnea?
Overweight (more tissue in soft palate), jaw structure (small or sunken back jaw), alcoholics, tonsils can fall back and cause this, males over 50, HTN and snoring.

14. What is upper airway resistance syndrome?
Increased ventilation effort and snoring (precursor to obstructive sleep apnea).

15. What is central sleep apnea?
Decreased ventilation efforts and blood oxygen desaturation (something is changing their drive to breathe in the body- CNS, spinal cord changes).

16. What is hypersomnia?
Excessive sleepiness that interferes with daily functioning.

17. What is narcolepsy?
Rare chronic disabling autoimmune neurological disorder with an uncontrollable desire to sleep with a duration of 30 seconds to 30 minutes and almost immediately go to REM sleep.

18. What is restless leg syndrome?
Unpleasant sensations of the legs-desire to move legs leading to difficulty falling/staying asleep.

19. What are the families of drugs for sleep disorders?
Benzodiazepines, Benzodiazepine-like, Melatonin and melatonin-like, and Antihistamines.

20. What is the Benzodiazepine drugs mechanism of action?
It is a CNS depressant. It enhances the action of gamma-aminobutyric acid (GABA) in the CNS.

21. What is gamma-aminobutyric acid (GABA)?
It is an inhibitory neurotransmitter found throughout the CNS. Its effects are contained to the CNS.

22. What are the therapeutic effects of Benzodiazepines?
Reduce anxiety, muscle relaxation, some benzos used for seizure disorders, alcohol withdrawal and promote sleep.

23. What do all benzodiazepine names have in common?
They all end in –am.

24. What are the complications of Benzodiazepines?
Lightheaded, drowsy, uncoordinated movement and paradoxical response (insomnia, excitation, euphoria, anxiety, and rage) instead of inhibiting, it is exciting N/V, anorexia and
Anterograde amnesia.

25. What is physical dependence?
Respiratory depression.

26. What are the considerations when giving benzodiazepines?
Do not give in combination with opioids, alcohol, pregnancy, breastfeeding, and sleep apnea (respiratory depression).

27. How do Benzodiazepines affect breathing?
They cause respiratory depression.

28. How do Benzodiazepines affect blood pressure?
When giving IV, it can cause hypotension and cardiac arrest.

29. How long should benzodiazepines be taken?
Limit use to 2-3 weeks as it is habit-forming; tolerance can form and need to be tapered from this medicine to avoid withdrawal.

30. What do antidepressants do for sleep?
Helps people fall asleep faster and stay asleep longer; do not build up tolerance or dependence (good to try this before other pharm management); and, usually given to older people.

31. What are the side effects of Trazodone?
Hangover next day, grogginess and postural hypotension.

32. What is Melatonin?
Hormone that regulates our circadian clock, triggers need to sleep, and do not need a prescription. Approved for chronic insomnia, helps with sleep onset and no abuse/dependency (but can develop reliance).

33. What is Modafinil?
CNS stimulant that is used for narcolepsy, shift work syndrome, obstructive sleep apnea; similar to amphetamines and interferes with P450 enzymes.

34. What is caffeine?
CNS stimulant that is used therapeutically for neonatal apnea, migraines, and narcolepsy; and, acute toxicity: excitation, restless, seizures, tachycardia, and sensory phenomenon (flashing lights, ringing in ears).

35. What are Amphetamines?
They are CNS stimulant like Methylphenidate (Ritalin). The clinical use is primarily for ADHD, paradoxical effect (does not actually stimulate them which help them focus) and taking these too late in the day can cause people to fall asleep.

36. How many sleep disorders are identified?
Over 80.

37. What can some sleep disorders be managed by?
Non-pharmacologic therapies or medical management.

38. What are the three most common sleep disorders?
Sleep apnea, restless leg syndrome (RSL) and narcolepsy.

39. What sleep disorder has the effect of difficulty falling asleep, multiple nocturnal awakenings, ear morning awakening with an inability to resume sleep?

40. What percent of the U.S adult population does insomnia affect?

41. How was insomnia first treated in the 1970s?
With Benzodiazepines.

42. What non-Benzodiazepines drugs are used to treat insomnia?
Lunesta, Sonata, and Ambien.

43. What disorders are chronic and progressive?
Restless Leg Syndrome (RLS) and Periodic Limb Movement Disorder (PLMD).

44. When do symptoms occur most frequently for RLS and PLMD?
During the evening or at night as well as during periods of rest.

45. How much of the population is affected by RLS and PLMD?

46. What deficiencies may contribute to RLS and PLMD?

47. What compounds can reduce symptoms of RLS by enhancing?

48. What are some potential side effects when enhancing dopamine compounds?
Nausea, GI distress, reduced BP and sleepiness.

49. What are some of the Dopamine agonist drugs?
Mirapex, Neupro, and Requip.

50. What does Dopamine agonist drugs do?
They act like a neurotransmitter dopamine in the brain.

51. What are some of the side effects in using Dopamine agonist drugs?
Sleepiness, nausea, and light headed.

52. What disorder has a persistent excessive daytime sleepiness and cataplexy?

53. In the US, what disorder is the third most frequently diagnosed primary sleep disorder?

54. When do narcolepsy symptoms start to occur?
Between ages 15 and 30 years.

55. Up to what percent of patients diagnosed report a close relative with similar symptoms?

56. What drug did the FDA approve to treat narcoleptic patients?
Oxybate (Xyrem).

57. What disorder is described as an undesirable motor, sensory, or behavioral phenomena that occurs during sleep?

58. Why is it important to look into at the pharmacology of sleep?
Because whatever we consume will interact with the neural processes involved in sleep.
The molecular mechanisms of stimulants or sedatives have an effect on sleep.

59. What do excitatory neurotransmitters do?
They all work in different ways to stimulate the cortex.

60. What is Acetylcholine?
Sends signals to the thalamus to promote wakefulness.

61. What is Hypocretin?
Neuromodulator that promotes wakefulness and can be blocked by adenosine.

62. What is Adenosine?
A by-product of brain activity, builds sleep pressure, particularly in the frontal lobe by blocking excitatory neuron activity.

63. What is the description of caffeine?
Most traded commodity, most widely used drug, boosts energy, alertness and increases heart rate and anxiety.

64. What is the description of caffeine at the level of the brain?
Adenosine binds to receptors to cause tiredness.

65. What is the description of Nicotine and the brain?
Acetylcholine receptors in the basal forebrain open when acetylcholine binds open channel, an influx of ions which cause depolarization and excitation resulting to wakefulness.

66. How does alcohol affect sleep?
The relationship between sleep and alcohol is a complex one. The research found effects on adenosine and GABA activity, which results in sedative effects.

67. What are the CNS effects of sedative-hypnotics?
Sedatives are agents that induce calm anti-anxiolytic and hypnotics at higher dose helps people go and fall asleep.

68. What is the indication for use of benzodiazepines?
Short term for insomnia 7-10 days.

69. What is the pharmacokinetics of benzodiazepines?
Route of administration: Oral; and, short to intermediate half-lives.

70. What is the contraindication for use of benzodiazepines?

71. What benzodiazepines are used to help people fall asleep vs the maintenance of sleep?
Triazolam has a short half-life that helps fall asleep but not helps maintain sleep while Temazepam has an intermediate half-life which is better for maintenance of sleep.

72. What is the clinical indication for the use of Ramelteon?
Insomnia, particularly for the onset of sleep.

73. What are the contraindications for use of Ramelteon?
History of angioedema with Ramelteon and used with fluvoxamine (strong CYP1A2 inhibitor).

74. What is the therapeutic indication for use of Trazadone?
Insomnia and major depression.

75. What are Orexins?
Orexins are neuropeptides that are important in regulating and promoting wakefulness in the sleep-wake cycle specifically targeting the natural systems that are involved in wakefulness.

76. What is cataplexy?
Sudden onset of muscle weakness which is usually brought on by a strong emotion such as laughter.

77. What medications contribute to insomnia?
Steroids, beta agonists (albuterol), stimulants, SSRI’s, and ACEI.

78. What is the benzodiazepine hypnotics used to treat insomnia?
Estazolam (Prosom), Flurazepam (Dalmane), Quazepam (Doral), Temazepam (Restoril), and Triazolam (Halcion).

79. What rhythm is most dominant in non-REM sleep?
Delta waves.

80. What stage are delta waves predominant during?

81. What is Phenobarbital?
An anti-seizure drug with selective effects (anti-seizure without sedation), long duration of action, and lower solubility so longer latency to onset.

82. Why are barbiturates not safe?
Respiratory depressants; high suicide potential, high tolerance and dependence, and hepatic drug metabolism.

83. What are the cardiorespiratory effects of barbiturates and Benzodiazepines?
Barbiturates (at intended dosage) have increased BP and respiratory depression, and benzos have none.

84. What GABA receptor do barbiturates and Benzodiazepines bind to?
GABA-a receptors.

85. What is Lorazepam?
It is a benzodiazepine.

86. What are the characteristics of Lorazepam?
They are good for the elderly because of predictable elimination mechanism and no active metabolites with easy to control dosage.

87. What is Polysomnography used to detect?
Sleep apneas and not insomnia.

88. What symptoms must a patient have to be diagnosed with insomnia?
Insomnia for at least 3 nights per week for at least 3 months.

89. When are medications indicated for insomnia?
If the patient is having transient (1-3 days) or short-term insomnia (<4 weeks).

90. How long can patients are treated with insomnia?
1 month.

91. What population should avoid using antihistamine?
Elderly and patients with chronic insomnia.

92. What are examples of antihistamines?
Diphenhydramine and Doxylamine.

93. Will Ramelteon improve sleep quality?

94. What type of drug can change sleep architecture?

95. What drug causes next-day amnesia?

96. How long can benzodiazepines be used to treat insomnia?
2-4 weeks and after that, it loses efficacy as hypnotic.

97. What antidepressants can be used to treat insomnia?
Trazodone, TCA and Mirtazapine.

98. What antidepressant can be used by it to treat insomnia?

99. What drug is used to treat jet-lag?

100. What drug used to treat non-24 hour sleep-wake disorder (blindness)?

Final Thoughts

So there you have it. That wraps up our study guide on Sleep Pharmacology. I truly hope that these practice questions were helpful for you. By taking the time (and putting in the hard work and effort) to learn this information now, it will definitely pay off for you when it comes time to start preparing for boards. Thank you so much for reading and as always, breathe easy my friend.