2026 CCSH UPDATED EXAMS TEST PAPER
QUESTIONS AND ANSWERS SURE A+
✔✔Respiration changes in NREM vs REM sleep - ✔✔NREM slow and regular, REM
sleep irregular w/increased rate and hypopneas
✔✔Changes in minute ventilation in NREM vs REM sleep - ✔✔decrease in both
✔✔Changes in PCO2, O2 and O2 sat in NREM vs REM sleep - ✔✔PCO2 increases,
O2 and sats decrease
✔✔Where are orexins produced - ✔✔in the hypothalamus
✔✔What hormone links the GI system and the hypothalamic orexiginic pathway -
✔✔Ghrelin
✔✔When do leptin levels peak - ✔✔during sleep
✔✔What is the timing of the nadir or minimum sleep temp? - ✔✔around 4 am
✔✔What time does body temp peak - ✔✔around 6pm
, ✔✔During what time is the propensity for REM sleep highest? - ✔✔During the early
morning
✔✔Wakefulness and consciousness are maintained by what part of the brain - ✔✔the
ascending reticular activating system
✔✔The main function of what part of the brain is to relay motor and sensory signals to
the cerebral cortex and regulate sleep, alertness and wakefulness - ✔✔the thalamus
✔✔In what mode does the thalamus function during NREM sleep? - ✔✔Oscillatory
which inhibits transmission of sensory information
✔✔In what mode does the thalamus function during Wake and REM sleep - ✔✔Relay
✔✔What are the key neurotransmitters in the arousal pathway - ✔✔ACh, noradrenaline,
serotonin, dopamine and histamine
✔✔How does caffeine work to block sleep - ✔✔it is an adenosine receptor antagonist
✔✔During periods of wakefulness, where does adenosine build up - ✔✔in the basal
forebrain
✔✔When is prolactin secretion the highest? - ✔✔during sleep
✔✔During what part of sleep do GH levels peak? - ✔✔N3/SWS
✔✔How long after sleep onset does GH release peak? - ✔✔90 minutes
✔✔Effect of sleep on gonadal hormones - ✔✔increase release in puberty
✔✔Changes in sensitivity to chemoreceptors (O2 and CO2) during sleep -
✔✔decreased
✔✔What are the 4 sleep related breathing disorders - ✔✔1. OSA
2. Central sleep apnea
3. Sleep related hypoventilation disorders
4. Sleep related hypoxemia disorders
✔✔. What is treatment emergent central sleep apnea - ✔✔When predominantly
obstructive events are replaced by central apneas or hypopneas on PAP w/o a backup
rate
✔✔What characterizes sleep related hypoventilation disorders - ✔✔An abnormal
increase in arterial PCO2 during sleep
QUESTIONS AND ANSWERS SURE A+
✔✔Respiration changes in NREM vs REM sleep - ✔✔NREM slow and regular, REM
sleep irregular w/increased rate and hypopneas
✔✔Changes in minute ventilation in NREM vs REM sleep - ✔✔decrease in both
✔✔Changes in PCO2, O2 and O2 sat in NREM vs REM sleep - ✔✔PCO2 increases,
O2 and sats decrease
✔✔Where are orexins produced - ✔✔in the hypothalamus
✔✔What hormone links the GI system and the hypothalamic orexiginic pathway -
✔✔Ghrelin
✔✔When do leptin levels peak - ✔✔during sleep
✔✔What is the timing of the nadir or minimum sleep temp? - ✔✔around 4 am
✔✔What time does body temp peak - ✔✔around 6pm
, ✔✔During what time is the propensity for REM sleep highest? - ✔✔During the early
morning
✔✔Wakefulness and consciousness are maintained by what part of the brain - ✔✔the
ascending reticular activating system
✔✔The main function of what part of the brain is to relay motor and sensory signals to
the cerebral cortex and regulate sleep, alertness and wakefulness - ✔✔the thalamus
✔✔In what mode does the thalamus function during NREM sleep? - ✔✔Oscillatory
which inhibits transmission of sensory information
✔✔In what mode does the thalamus function during Wake and REM sleep - ✔✔Relay
✔✔What are the key neurotransmitters in the arousal pathway - ✔✔ACh, noradrenaline,
serotonin, dopamine and histamine
✔✔How does caffeine work to block sleep - ✔✔it is an adenosine receptor antagonist
✔✔During periods of wakefulness, where does adenosine build up - ✔✔in the basal
forebrain
✔✔When is prolactin secretion the highest? - ✔✔during sleep
✔✔During what part of sleep do GH levels peak? - ✔✔N3/SWS
✔✔How long after sleep onset does GH release peak? - ✔✔90 minutes
✔✔Effect of sleep on gonadal hormones - ✔✔increase release in puberty
✔✔Changes in sensitivity to chemoreceptors (O2 and CO2) during sleep -
✔✔decreased
✔✔What are the 4 sleep related breathing disorders - ✔✔1. OSA
2. Central sleep apnea
3. Sleep related hypoventilation disorders
4. Sleep related hypoxemia disorders
✔✔. What is treatment emergent central sleep apnea - ✔✔When predominantly
obstructive events are replaced by central apneas or hypopneas on PAP w/o a backup
rate
✔✔What characterizes sleep related hypoventilation disorders - ✔✔An abnormal
increase in arterial PCO2 during sleep
