10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The Sleep Medicine exam has 240 questions and runs 8 hours.
These 10 free Sleep Medicine questions are organized by exam domain, so you can see how each part of the Certification in Sleep Medicine blueprint is tested. Reveal the answer and explanation under each question.
During established N2 sleep, a six-second EEG arousal occurs near the end of a 30-second epoch. The entire following epoch contains low-amplitude mixed-frequency activity, predominantly 4-7 Hz, without a spindle or K complex. There is no posterior alpha rhythm, no rapid eye movement, and no reduction of chin tone from the preceding N2 level. How should the epoch following the arousal-containing epoch be scored?
Correct answer: B - N1 sleep
During a school vacation, a 17-year-old consistently sleeps well from 3:00 a.m. to 11:30 a.m. For the preceding school year, attempts to sleep from 10:00 p.m. to 6:30 a.m. produced prolonged sleep-onset difficulty and morning sleepiness. Circadian assessment places his core body temperature minimum at approximately 8:00 a.m. To advance rather than delay his circadian phase, when should the initial bright-light exposure occur?
Correct answer: D - 9:00 a.m.
For eight months, a teacher has needed more than an hour to fall asleep on most nights and has struggled with fatigue at work. She becomes drowsy while reading in the living room but feels suddenly alert when she gets into bed. She already keeps a consistent wake time, avoids naps, and allows eight hours for sleep. What instruction most directly addresses the mechanism perpetuating her insomnia?
Correct answer: A - Leave bed when unable to sleep and return when sleepy.
After taking zolpidem at the prescribed dose, a patient drives to a convenience store during the night. Her partner finds her confused, and she has no memory of the trip the following morning. She had allowed eight hours for sleep and had used no alcohol or other sedatives. She has withheld further doses and asks whether eszopiclone would be a safer substitute. Which recommendation should govern subsequent prescribing?
Correct answer: B - Avoid zolpidem, eszopiclone, and zaleplon after this reaction.
A woman with seven months of daily sleep attacks has brief episodes of bilateral jaw sagging and knee buckling when she laughs, with awareness preserved. Two weeks of actigraphy document a regular eight-hour sleep schedule, and she takes no sleep-altering medication. Polysomnography records 7.7 hours of sleep, an AHI of 1.1/hour, and REM sleep beginning 9 minutes after sleep onset. The next day's properly conducted MSLT has a mean sleep latency of 10.6 minutes and no sleep-onset REM periods. Under ICSD-3-TR, how should these findings be interpreted?
Correct answer: D - The nocturnal sleep-onset REM period and typical cataplexy establish narcolepsy type 1.
A 74-year-old repeatedly punches and kicks while dreaming that he is being attacked. Video-polysomnography documents the behaviors during REM sleep with REM without atonia, independent of respiratory arousals. His OSA is effectively treated, and bedroom injury-prevention measures are already in place, but episodes continue. He has mild cognitive impairment and has fallen twice when walking to the bathroom at night. Which initial medication trial best limits additional cognitive and balance risk?
Correct answer: C - Immediate-release melatonin
Pramipexole initially controlled a man's restless legs symptoms, which began around 10:00 p.m. After two years of treatment and several dose increases, symptoms now begin at 2:00 p.m., develop after shorter periods of sitting, and sometimes involve his arms. Walking still provides relief. Ferritin is 124 ng/mL, transferrin saturation is 28%, and renal function is normal. What treatment change best addresses this pattern?
Correct answer: C - Introduce pregabalin and gradually taper pramipexole.
A 52-year-old man is referred after a home sleep apnea test was reported as negative. His wife describes loud snoring and repeated breathing pauses, and he frequently awakens choking. The technically adequate recording lasted 7.8 hours and yielded a respiratory event index of 3.4/hour; he estimates that he slept for only 3 hours. His Epworth Sleepiness Scale score is 6. Which study should resolve the discrepancy between the history and the home test?
Correct answer: C - Attended overnight polysomnography
A seven-year-old with nightly snoring, enlarged tonsils, and worsening classroom behavior undergoes attended polysomnography. The obstructive AHI is 0.6/hour and the oxygen saturation nadir is 91%. However, end-tidal CO2 exceeds 50 mm Hg during 38% of sleep, accompanied by sustained inspiratory flow flattening and paradoxical thoracoabdominal motion. The CO2 waveform has a clear plateau, agrees with a simultaneous transcutaneous measurement, and is normal while awake. Which interpretation integrates these findings?
Correct answer: A - Obstructive sleep apnea expressed predominantly as obstructive hypoventilation
An MSLT referral includes a mean sleep latency of 6.2 minutes and three sleep-onset REM periods, labeled as narcolepsy type 2. The patient has no cataplexy. Two-week actigraphy confirms adequate, regular sleep, and the preceding polysomnogram shows 7.5 hours of sleep without sleep-disordered breathing. Medication reconciliation reveals that a venlafaxine taper ended three days before testing. What is the appropriate disposition of the narcolepsy diagnosis?
Correct answer: D - Defer confirmation and reassess after a safe medication plan and sufficient washout.
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