DBSM EXAM QUESTIONS AND ANSWERS
Sleep needs by age:
Newborns
Infants
Toddlers
Preschoolers
School age
Teens
Young adults
Adults
Older adults - Correct Answers -Newborns (0-3 months): 14-17 hours (11-13 and 18-19
ok)
Infants (4-11 months): 12-15 hours (10-11, 16-18 may be ok)
Toddlers (1-2 years): 11-14 hours (9-10, 15-16 may be ok)
Preschoolers (3-5): 10-13 hours (8-9, 14 may be ok)
School age children (6-13): 9-11 hours (7-8, 12 may be ok)
Teenagers (14-17): 8-10 hours (7, 11 may be ok)
Younger adults (18-25): 7-9 hours (6, 10-11 may be ok)
Adults (26-64): 7-9 hours (6, 10 may be ok)
Older adults (65+): 7-8 hours (5-6, 9 may be ok)
Two-process model of sleep regulation - Correct Answers -Process C: Circadian
rhythm, 24-hour cycle
Process S: Homeostatic drive for sleep, accumulates the longer you are awake, will
reset when go to sleep again (adenosine builds up)
Difference between these processes: Sleep pressure (largest at 11pm)
Cognitive performance and sleep rhythms - Correct Answers -Sleep inertia: Groggy
within first 10-15 minutes of waking
Afternoon slump when both circadian and sleep homeostatic processes go down
Circadian performance peaks at late afternoon/early evening
Sleep deprivation: Acute versus chronic - Correct Answers -Acute: Melatonin and
cortisol levels the same, but growth hormones decreases (usually secreted during
SWS) whereas thyroid stimulating hormones increases
Chronic: After 2 weeks with <6 hours/night, performance levels fall to same as level with
24-hr sleep deprivation
With 4 hours in bed per night, after 7 days levels fall to 24-hr sleep deprivation levels,
and after 4 hrs/night for 2 weeks, effects are same as 2-3 days without any sleep
,Acute + chronic sleep deprivation (total deprivation and then failure to recover): level of
impairment 10x worse (or more)
Ascending arousal system - Correct Answers -Default for brain is wakefulness
Begins in the brainstem and goes to cortical region
Wake promoting centers: histamine (Benadryl inhibits); orexin; dopamine;
noradrenaline; serotonin
Sleep promoting center: GABA turns everything off-- sends inhibitory signals to wake
promoting regions; adenosine accumulates longer you are awake and then drops during
sleep
Sleep architecture plus waves - Correct Answers -Wake: beta waves
Relaxed: alpha wakes
NREM (non rapid eye movement sleep):
-N1, 5% of sleep time, theta waves
-N2, 45% of sleep time, theta, spindles, and K-complexes
-N3/SWS, 25% of sleep time, delta & theta waves
REM: atonia/sleep paralysis/ "paradoxical sleep" because EEG and NT appear as if
brain is awake
25% of sleep time, beta waves
SWS versus REM sleep - Correct Answers -SWS: First half of night
Slow oscillation (neocortex)
Sleep spindles (thalamus)
Sharp wave ripple(hippocampus)
Acetylcholine goes down
Noradrenaline/serotonin stable
Cortisol goes down
REM: Second half of night, looks similar to waking
PGO wave (brainstem)
Theta activity (hippocampus)
Acetylcholine goes up
Noradrenaline/serotonin go down
Cortisol goes up
Developmental changes in sleep (architecture; timing) - Correct Answers -Tolerance to
sleep loss increases with age
Sleep cycle is 50-60 minutes in infancy; 75 minutes by age 2, and 90 minutes by age 6--
remains at this length through adulthood
,REM is 50% of infant sleep, 25-30% in children, 20-25% in adolescents
Children spend more time in SWS compared to adults; adolescents spend less. SWS
declines as aging brain loses grey matter
Sleep in pregnancy (characteristics) - Correct Answers -Can cause onset of: insomnia,
hypersomnia, RLS, and OSA
First trimester: Increase in sleep duration, potentially due to progesterone
Sleep disruption increases with pregnancy, with reductions in SWS and REM at end
RLS impacts 1/5th of pregnant women; treatment with iron and folate supplements
Fetal rhythms are synced with mother's; fetus has active and quiet sleep by 32 weeks
Sleep in infancy (characteristics) - Correct Answers -Initially ultradian pattern (no
rhythm); circadian rhythm not stabilized until 2-6 months (12 weeks or so). Sleep
consolidates overnight between 6 and 9 months.
Infants take 2 naps/day y age 1 year.
Breastfed babies tend to wake more frequently than formula-fed babies due to
breastmilk digesting more quickly
Sleep cycle 50-60 minutes; 50% REM/Active sleep and 50% quiet sleep, enter into
REM at sleep onset
Sleep in early childhood (toddlers and preschoolers) - Correct Answers -Daytime sleep
declines across first 3 years of life; 92% of 3-year-olds nap once per day, many children
stop napping by age 5, although 1 in 4 still do at this point. Black children more likely to
nap at ages 6 (>50%) and 8 (40%) compared to White children.
Sleep in school-aged children - Correct Answers -Circadian preference starts to emerge
in middle childhood
Most sleep problems related to anxiety and nighttime fears; nocturnal enuresis also a
problem for 10% of 6-year-olds, 5% of 10-year-olds, and 3% of 12-year-olds
Sleep in adolescence - Correct Answers -Delay of 2-3 hours in circadian rhythm that is
closely correlated with pubertal development
Shift lasts from adolescence to early 20s, then begins to advance; males lag behind
females in this regard
, Older adolescents have less SWS and are slower to build up their homeostatic sleep
pressure
Delayed sleep phase prevalence highest (16%) during adolescence
Shifting school start times has been linked to more sleep, better grades, fewer tardies,
less substance abuse, fewer depressive symptoms, and less motor vehicle accidents
(up to 70%), but a number of political and logistic factors make a later time policy
difficult to implement. AAP recommends school start at 8:30am or later.
Sleep in middle age and menopause - Correct Answers -Sleep rhythm becomes more
morning type (lark)
Proportions of SWS and REM decrease
Decrease in robustness of homeostasic regulation sleep, making recovery from shift
work and sleep deprivation more challenging
Women have more complaints than men
Menopause:
Longer SOL and less SWS; nearly double rate of insomnia in post-menopausal women
compared to pre-menopausal women but only on subjective measures, suggesting
sleep state misperception
OSA risk greater due to hormone-related redistribution of fat; women taking hormone
replacement therapy protected
Sleep in the elderly - Correct Answers -Consolidation of sleep and wakefulness
decrease
Increased N1 and N2 sleep, less SWS and REM
Sleep timing continues to advance
Healthy older people are less affected by acute sleep deprivation than younger people
(surprising finding)
Difficulties with vision and temperature regulation also impact sleep in elderly (changes
in light receptors in the eyes and reduction of light exposure weaken the circadian clock)
Sleep in those with dementia - Correct Answers -Dementia impacts up to 50% over age
85
2/3 of cases are Alzheimer's
Very fragmented and/or irregular sleep-wake patterns
Addressing light-dark cycle can help--Dutch study increased lighting to 1000 lux 10am
to 6pm (instead of 300 lux) and found slower cognitive decline and better sleep
Morningness versus Eveningness types - Correct Answers -Morningness/Lark: Early to
bed, early to rise; tend to have a clock that is less than or equal to 24 hours; peak
performance time is in the morning, declines during day
Eveningness/Owl: Late to bed, late to rise; tend to have poor performance in the
morning and perform better later in the day
Sleep needs by age:
Newborns
Infants
Toddlers
Preschoolers
School age
Teens
Young adults
Adults
Older adults - Correct Answers -Newborns (0-3 months): 14-17 hours (11-13 and 18-19
ok)
Infants (4-11 months): 12-15 hours (10-11, 16-18 may be ok)
Toddlers (1-2 years): 11-14 hours (9-10, 15-16 may be ok)
Preschoolers (3-5): 10-13 hours (8-9, 14 may be ok)
School age children (6-13): 9-11 hours (7-8, 12 may be ok)
Teenagers (14-17): 8-10 hours (7, 11 may be ok)
Younger adults (18-25): 7-9 hours (6, 10-11 may be ok)
Adults (26-64): 7-9 hours (6, 10 may be ok)
Older adults (65+): 7-8 hours (5-6, 9 may be ok)
Two-process model of sleep regulation - Correct Answers -Process C: Circadian
rhythm, 24-hour cycle
Process S: Homeostatic drive for sleep, accumulates the longer you are awake, will
reset when go to sleep again (adenosine builds up)
Difference between these processes: Sleep pressure (largest at 11pm)
Cognitive performance and sleep rhythms - Correct Answers -Sleep inertia: Groggy
within first 10-15 minutes of waking
Afternoon slump when both circadian and sleep homeostatic processes go down
Circadian performance peaks at late afternoon/early evening
Sleep deprivation: Acute versus chronic - Correct Answers -Acute: Melatonin and
cortisol levels the same, but growth hormones decreases (usually secreted during
SWS) whereas thyroid stimulating hormones increases
Chronic: After 2 weeks with <6 hours/night, performance levels fall to same as level with
24-hr sleep deprivation
With 4 hours in bed per night, after 7 days levels fall to 24-hr sleep deprivation levels,
and after 4 hrs/night for 2 weeks, effects are same as 2-3 days without any sleep
,Acute + chronic sleep deprivation (total deprivation and then failure to recover): level of
impairment 10x worse (or more)
Ascending arousal system - Correct Answers -Default for brain is wakefulness
Begins in the brainstem and goes to cortical region
Wake promoting centers: histamine (Benadryl inhibits); orexin; dopamine;
noradrenaline; serotonin
Sleep promoting center: GABA turns everything off-- sends inhibitory signals to wake
promoting regions; adenosine accumulates longer you are awake and then drops during
sleep
Sleep architecture plus waves - Correct Answers -Wake: beta waves
Relaxed: alpha wakes
NREM (non rapid eye movement sleep):
-N1, 5% of sleep time, theta waves
-N2, 45% of sleep time, theta, spindles, and K-complexes
-N3/SWS, 25% of sleep time, delta & theta waves
REM: atonia/sleep paralysis/ "paradoxical sleep" because EEG and NT appear as if
brain is awake
25% of sleep time, beta waves
SWS versus REM sleep - Correct Answers -SWS: First half of night
Slow oscillation (neocortex)
Sleep spindles (thalamus)
Sharp wave ripple(hippocampus)
Acetylcholine goes down
Noradrenaline/serotonin stable
Cortisol goes down
REM: Second half of night, looks similar to waking
PGO wave (brainstem)
Theta activity (hippocampus)
Acetylcholine goes up
Noradrenaline/serotonin go down
Cortisol goes up
Developmental changes in sleep (architecture; timing) - Correct Answers -Tolerance to
sleep loss increases with age
Sleep cycle is 50-60 minutes in infancy; 75 minutes by age 2, and 90 minutes by age 6--
remains at this length through adulthood
,REM is 50% of infant sleep, 25-30% in children, 20-25% in adolescents
Children spend more time in SWS compared to adults; adolescents spend less. SWS
declines as aging brain loses grey matter
Sleep in pregnancy (characteristics) - Correct Answers -Can cause onset of: insomnia,
hypersomnia, RLS, and OSA
First trimester: Increase in sleep duration, potentially due to progesterone
Sleep disruption increases with pregnancy, with reductions in SWS and REM at end
RLS impacts 1/5th of pregnant women; treatment with iron and folate supplements
Fetal rhythms are synced with mother's; fetus has active and quiet sleep by 32 weeks
Sleep in infancy (characteristics) - Correct Answers -Initially ultradian pattern (no
rhythm); circadian rhythm not stabilized until 2-6 months (12 weeks or so). Sleep
consolidates overnight between 6 and 9 months.
Infants take 2 naps/day y age 1 year.
Breastfed babies tend to wake more frequently than formula-fed babies due to
breastmilk digesting more quickly
Sleep cycle 50-60 minutes; 50% REM/Active sleep and 50% quiet sleep, enter into
REM at sleep onset
Sleep in early childhood (toddlers and preschoolers) - Correct Answers -Daytime sleep
declines across first 3 years of life; 92% of 3-year-olds nap once per day, many children
stop napping by age 5, although 1 in 4 still do at this point. Black children more likely to
nap at ages 6 (>50%) and 8 (40%) compared to White children.
Sleep in school-aged children - Correct Answers -Circadian preference starts to emerge
in middle childhood
Most sleep problems related to anxiety and nighttime fears; nocturnal enuresis also a
problem for 10% of 6-year-olds, 5% of 10-year-olds, and 3% of 12-year-olds
Sleep in adolescence - Correct Answers -Delay of 2-3 hours in circadian rhythm that is
closely correlated with pubertal development
Shift lasts from adolescence to early 20s, then begins to advance; males lag behind
females in this regard
, Older adolescents have less SWS and are slower to build up their homeostatic sleep
pressure
Delayed sleep phase prevalence highest (16%) during adolescence
Shifting school start times has been linked to more sleep, better grades, fewer tardies,
less substance abuse, fewer depressive symptoms, and less motor vehicle accidents
(up to 70%), but a number of political and logistic factors make a later time policy
difficult to implement. AAP recommends school start at 8:30am or later.
Sleep in middle age and menopause - Correct Answers -Sleep rhythm becomes more
morning type (lark)
Proportions of SWS and REM decrease
Decrease in robustness of homeostasic regulation sleep, making recovery from shift
work and sleep deprivation more challenging
Women have more complaints than men
Menopause:
Longer SOL and less SWS; nearly double rate of insomnia in post-menopausal women
compared to pre-menopausal women but only on subjective measures, suggesting
sleep state misperception
OSA risk greater due to hormone-related redistribution of fat; women taking hormone
replacement therapy protected
Sleep in the elderly - Correct Answers -Consolidation of sleep and wakefulness
decrease
Increased N1 and N2 sleep, less SWS and REM
Sleep timing continues to advance
Healthy older people are less affected by acute sleep deprivation than younger people
(surprising finding)
Difficulties with vision and temperature regulation also impact sleep in elderly (changes
in light receptors in the eyes and reduction of light exposure weaken the circadian clock)
Sleep in those with dementia - Correct Answers -Dementia impacts up to 50% over age
85
2/3 of cases are Alzheimer's
Very fragmented and/or irregular sleep-wake patterns
Addressing light-dark cycle can help--Dutch study increased lighting to 1000 lux 10am
to 6pm (instead of 300 lux) and found slower cognitive decline and better sleep
Morningness versus Eveningness types - Correct Answers -Morningness/Lark: Early to
bed, early to rise; tend to have a clock that is less than or equal to 24 hours; peak
performance time is in the morning, declines during day
Eveningness/Owl: Late to bed, late to rise; tend to have poor performance in the
morning and perform better later in the day
